Introduction:Spinal anesthesia is a widely used technique providing faster onset with effective and uniformly distributed sensory and motor block. Due to decreased cardiovascular and central nervous system toxicity, levobupivacaine is a good alternative for spinal anesthesia. Dexmedetomidine when used intrathecally is associated with prolonged motor and sensory block, hemodynamic stability, and less requirement of rescue analgesia in 24 h.Materials and Methods:A prospective, randomized study was carried out which included 60 adult patients between the age group of 20 and 65 years of physical status American Society of Anesthesiologists Classes I and II who underwent infraumbilical surgeries. Group L patients received 3 ml (15 mg) of 0.5% isobaric levobupivacaine + 0.3 ml normal saline while Group LD patients received 3 ml (15 mg) of 0.5% isobaric levobupivacaine + 0.3 ml (3 μg) dexmedetomidine. The two groups were compared with respect to the onset and duration of sensory and motor block and hemodynamic stability.Results:The mean duration of sensory block in Group L was 199.50 ± 7.96 min while in Group LD was 340.20 ± 11.78 min. All the differences were statistically highly significant between the two groups (P < 0.001). Mean duration of motor block in Group L and LD was 150.83 ± 9.17 min and 190.20 ± 9.61 min, respectively. Both the differences were highly significant (P < 0.001).Conclusion:It is concluded that Group LD has early-onset and prolonged duration of sensory and motor block and longer duration of postoperative analgesia than Group L.
Background:Intraperitoneal instillation of local anesthetics in laparoscopic cholecystectomy (LC) has been used to reduce postoperative pain and to decrease the need for postoperative analgesics.Aims:This study aimed to compare intraperitoneal instillation of bupivacaine and ropivacaine for postoperative analgesia in patients undergoing LC.Settings and Design:This was a prospective, randomized, double-blind study.Materials and Methods:After obtaining ethical committee's clearance and informed consent, sixty patients, aged 18–65 years, of either gender, and American Society of Anesthesiologists physical status I to III scheduled for LC were included and categorized into two groups (n = 30). Group A patients received 20 mL of 0.5% bupivacaine intraperitoneally after cholecystectomy and Group B patients received 20 mL of 0.5% ropivacaine intraperitoneally after cholecystectomy.Statistical Analysis:The data were analyzed using paired t-test. The results were analyzed and compared to previous studies. SPSS software version 22 was used, released 2013 (IBM Corp., Armonk, NY, USA).Results:Pulse rate, systolic blood pressure, and diastolic blood pressure were comparatively lower in Group B than in Group A. The visual analog scale (VAS) score was significantly lower in Group B. Rescue analgesia was given when VAS was >6. Verbal rating scale score was significantly lower in Group B, showing longer duration of analgesia in this group. Rescue analgesic requirement was also less in Group B.Conclusion:The instillation of bupivacaine and ropivacaine intraperitoneally was an effective method of postoperative pain relief in LC. It provided good analgesia in immediate postoperative period with ropivacaine, providing longer duration of analgesia.
Introduction: There are always efforts to find better and safer local anaesthetics along with adjuvants for supraclavicular brachial plexus block. Levobupivacaine has strongly emerged as a safer alternative for regional anaesthesia than its racemic sibling bupivacaine. Alpha 2 agonists are combined with local anaesthetics to improve the quality of regional anaesthesia. Method: A prospective randomized study was carried out which included 60 adult patients between the ages of 18-65 years of ASA grade I and II who underwent upper limb orthopaedic surgeries. Group A received 30 ml of 0.5% levobupivacaine with 150µg of clonidine and Group B received admixture of 30 ml of 0.5% levobupivacaine with 100 µg of Dexmedetomidine. Onset, duration of sensory and motor blockade and duration of analgesia were observed. Results: Duration of postoperative analgesia in group A was 14.36±0.36 minutes and in group B was 16.90±2.29 minutes. Hence from the above observation, the duration of analgesia in group B is longer than group A which is statistically highly significant (p<0.001). Conclusion: Dexmedetomidine as an adjuvant 0.5% levobupivacaine is more effective in prolonging the duration of sensory and motor block and post operative analgesia compare to clonidine as an adjuvant to 0.5% levobupivacaine.
Background:Spinal anesthesia is an effective method of anesthesia with fewer side effects. The main limitations include the shorter duration of action and shorter postoperative analgesia when performed only with local anesthetics.Aim:The aim of this study is to compare adjuvants nalbuphine and ketamine to hyperbaric bupivacaine in spinal anesthesia with respect to the duration of analgesia, sensory and motor onset, hemodynamic status, and side effects.Settings and Design:This was a prospective, randomized, double-blind study.Materials and Methods:After ethical committee's clearance and informed consent, 90 patients of the American Society of Anesthesiologists physical status I and II were randomly allocated in three groups N, K, and B who received 3 ml hyperbaric bupivacaine with 0.8 mg nalbuphine, 3 ml hyperbaric bupivacaine with 25 mg ketamine (preservative free), and 3 ml hyperbaric bupivacaine with 0.5 ml normal saline, respectively.Statistical Analysis:Data were analyzed using paired t-test. Results were analyzed and compared to previous studies. SPSS-22 version of software was used, released 2013, IBM Corp., Armonk, NY, USA.Results:Mean duration of analgesia in Group N, K, and B was 290 ± 6.09, 220 ± 5.03, and 154 ± 6.04 min, respectively. Mean time of sensory onset in Group N, K, and B was 2.08 ± 0.34, 3.5 ± 0.25, and 4.5 ± 0.37 min, respectively. Time of motor onset was 7.60 ± 0.58, 7.79 ± 0.37, and 7.82 ± 0.53 min in Group N, K, and B, respectively.Conclusion:Nalbuphine is an effective adjuvant in spinal anesthesia with respect to sensory onset, duration of analgesia, and hemodynamic stability.
Introduction: Intrathecal administration of opioids and local anaesthetics provides good analgesia. Fentanyl potentiates the afferent surgical blockade and improves both intra and post operative analgesia. The synergism between intrathecal opioids and local anaesthetics achieves a reliable spinal anaesthesia with minimal hypotension. The optimal doses and dilutions of intrathecal combination of bupivacaine and fentanyl remain a subject of discussion. Therefore, we designed this study to compare the effects of different doses of hyperbaric bupivacaine 0.5% (10 mg, 12.5 mg, 15 mg) with fentanyl 25 microgram in subarachnoid block on quality of anaesthesia and recovery. Objectives: To observe sensory and motor blockcharacteristics and effects of different doses of bupivacaine on haemodynamic parameters. Method: A prospective randomized study was carried out on three groups of 20 each. Group A patients were given 0.5% hyperbaric bupivacaine 10 mg, fentanyl 25 µg and 0.9% normal saline 1.5 ml. Group B patients were given with 0.5% hyperbaric bupivacaine 12.5 mg, fentanyl 25 µg and 0.9% normal saline 1ml. Group C patients were given 0.5% hyperbaric bupivacaine 15 mg, fentanyl 25 µg and 0.9% normal saline 0.5 ml. Results: Duration of sensory block was prolonged in group C (139.50±16.05 minutes) than group A (129.00±18.32 minutes). On statistical comparison, group B and C (126.25±15.29 minutes and 132.75±10.70 minutes respectively) had significant prolonged duration of motor block than group A (114.00±18.11 minutes). Conclusion: Fentanyl 25µg with 0.5% hyperbaric bupivacaine 12.5 mg is superior in terms of characteristics of sensory and motor block and haemodynamic stability.
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