Transient Neurologic Symptoms after Spinal Anesthesia

Background Recent evidence suggests that transient neurologic symptoms (TNSs) frequently follow lidocaine spinal anesthesia but are infrequent with bupivacaine. However, identification of a short-acting local anesthetic to substitute for lidocaine for brief surgical procedures remains an important goal. Prilocaine is an amide local anesthetic with a duration of action similar to that of lidocaine. Accordingly, the present, prospective double-blind study compares prilocaine with lidocaine and bupivacaine with respect to duration of action and relative risk of TNSs. Methods Ninety patients classified as American Society of Anesthesiologists physical status I or II who were scheduled for short gynecologic procedures under spinal anesthesia were randomly allocated to receive 2.5 ml 2% lidocaine in 7.5% glucose, 2% prilocaine in 7.5% glucose, or 0.5% bupivacaine in 7.5% glucose. All solutions were provided in blinded vials by the hospital pharmacy. Details of spinal puncture, extension and regression of spinal block, and the times to reach discharge criteria were noted. In the evening of postoperative day 1, patients were evaluated for TNSs by a physician unaware of the drug administered and the details of the anesthetic procedure. Results Nine of 30 patients receiving lidocaine experienced TNSs, 1 of 30 patients receiving prilocaine (P = 0.03) had them, and none of 30 patients receiving bupivacaine had TNSs. Times to ambulate and to void were similar after lidocaine and prilocaine (150 vs. 165 min and 238 vs. 253 min, respectively) but prolonged after bupivacaine (200 and 299 min, respectively; P < 0.05). Conclusions Prilocaine may be preferable to lidocaine for short surgical procedures because it has a similar duration of action but a lower incidence of TNSs.

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Intubating Conditions with three different doses of Rocuronium in surgery of cancer patients

Nepalese Journal of Cancer ◽

10.3126/njc.v1i1.25629 ◽

2017 ◽

Vol 1 (1) ◽

pp. 28-35

Author(s):

Bhawana Wagle ◽

Yogesh Regmi

Keyword(s):

Tracheal Intubation ◽

Surgical Procedures ◽

Double Blind Study ◽

Double Blind ◽

Duration Of Action ◽

Intubating Conditions ◽

Elective Surgical Procedures ◽

Train Of Four ◽

Tactile Response ◽

Group B

Background: This is a prospective randomized, double blind study to determine the doses of rocuronium that would give 90% and 95% probabilities of successful tracheal intubation within 60s after administration. This study evaluated intubating conditions and duration of action of 0.4 mg, 0.8 mg and 1.2 mg of rocuronium, administered intravenously in patients undergoing elective surgical procedures. Goal in this study is to define doses level of rocuronium that would provide optimal relaxation for tracheal intubation in patients in whom succinylcholine was relatively contraindicated. Methods: Sixty patients both male and female, ASA I & II, age between 18–60 years, with BMI of less that 30 who were planned for elective surgical procedures were randomized into three groups. Group A received 0.4 mg (n=20), Group B received 0.8 mg (n=20) and Group C received 1.2 mg (n=20) of rocuronium. At 60 seconds after injection of the rocuronium, laryngoscopy was initiated, with the goal being endotracheal tube passed through the patient's vocal cords and the cuff inflated within the trachea in 20s. Intubating conditions was graded excellent, good or poor according to Cooper scoring system criteria. When the patient lost consciousness, train-of-four (TOF) stimulation (at 2 Hz and repeated every 12s) were recorded. Immediately after tracheal intubation and every 5 min thereafter the investigator counted the number of tactile TOF responses. The duration of action of rocuronium was defined as the time from the end of injection of rocuronium until reappearance of first tactile response to TOF stimulation. Results: There were twelve patients in the 0.4mg/kg rocuronium group, two in the 0.8mg/kg group, and one in the 1.2mg/kg rocuronium group with an unacceptable intubation grade caused by sustained coughing at intubation. The D90 and D95 doses were 0.83(0.59 -1.03) and 1.04 (0.76-1.36) mg/kg, respectively. Estimated time until first tactile train-of-four response after D50 and D95 doses were 43min and 52 min, respectively. Conclusion: After induction with pethedine and sodium thiopentone, rocuronium in a dose of 0.8mg/kg produces equivalent intubating conditions as that of 1.2mg/kg after 60 seconds of administration

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Transient Neurologic Symptoms after Spinal Anesthesia with Mepivacaine and Lidocaine

Anesthesiology ◽

10.1097/00000542-199803000-00010 ◽

1998 ◽

Vol 88 (3) ◽

pp. 619-623 ◽

Cited By ~ 88

Author(s):

Gregory A. Liguori ◽

Victor M. Zayas ◽

Mary F. Chisholm

Keyword(s):

Spinal Anesthesia ◽

Knee Arthroscopy ◽

Ambulatory Surgery ◽

Optimal Dose ◽

Sensory Level ◽

Duration Of Action ◽

Lidocaine Group ◽

Promising Alternative ◽

Neurologic Symptoms ◽

The Times

Background Spinal anesthesia with lidocaine is ideal for ambulatory surgery because of its short duration of action. However, transient neurologic symptoms (TNS) occur in 0-40% of patients. The incidence of TNS with mepivacaine, which has a similar duration of action, is unknown. Methods Sixty ambulatory patients undergoing knee arthroscopy received spinal anesthesia in a randomized, double-blinded manner, with either 45 mg 1.5% mepivacaine or 60 mg 2% lidocaine. An L3-L4 midline approach was used with a 27-gauge Whitacre needle and a 20-gauge introducer. The local anesthetic was injected over approximately 30 s with the aperture of the Whitacre needle in a cephalad direction. Two to 4 days after operation, each patient was questioned about the development of TNS. In addition, the two groups were compared for time to regression of sensory and motor blockade and time to discharge milestones. Results Three patients receiving lidocaine were lost to follow-up. None of the 30 patients in the mepivacaine group developed TNS, whereas 6 of 27 (22%) in the lidocaine group did (P = 0.008). Time to regression to the L5 sensory level and to complete resolution of motor block were similar in both groups. The times to discharge milestones were also comparable. Conclusions The incidence of TNS is greater with 2% lidocaine than with 1.5% mepivacaine for patients having unilateral knee arthroscopy under spinal anesthesia. Mepivacaine seems to be a promising alternative to lidocaine for outpatient surgical procedures because of its similar duration of action. Further studies are warranted to determine the optimal dose of intrathecal mepivacaine for ambulatory surgery and the incidence of TNS with other doses and concentrations of intrathecal mepivacaine.

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Prophylactic ondansetron eight milligrams versus four milligrams against post spinal anaesthesia shivering

International Surgery Journal ◽

10.18203/2349-2902.isj20211825 ◽

2021 ◽

Vol 8 (5) ◽

pp. 1545

Author(s):

Ajay Kumar ◽

Anuj Singh ◽

Shamabhu P. Sharma ◽

Amitava Dutta ◽

Amit Kumar Sharma

Keyword(s):

Spinal Anesthesia ◽

Spinal Anaesthesia ◽

Double Blind Study ◽

Double Blind ◽

Prophylactic Administration ◽

American Society ◽

Group B ◽

Control And Management ◽

American Society Of Anesthesiologists ◽

To Receive

Background: Shivering is one of the commonly encountered adverse affect after spinal anaesthesia. Shivering can be very discomforting to the patient and hampers operative maneuvering. Pharmacological therapies have been studied for control and management of shivering. One such drug is ondansetron, a 5-HT3 antagonist. Aim of current study is to evaluate the efficacy of prophylactic administration of ondansetron 8 mg vs. 4 mg for prevention of shivering.Methods: A prospective, randomized, and double blind study was conducted on 100 patients, from either gender, aged 20-60 years, of the American society of anesthesiologists grade I or II, scheduled for various surgeries under spinal anesthesia. The patients were randomly divided into two groups of 50 each to receive either ondansetron 8 mg (group E) or ondansetron 4 mg, (group F) as slow intravenous infusion prior to spinal anesthesia. The primary end point were intraoperative shivering and secondary outcomes included hypotension, adverse reaction, cardiac dysrhythmia’s.Results: A total of 10 patients in group E (20%) and 20 (40%) patients in group F experienced shivering (p=0.029). Incidence of nausea was similar in both groups, total of 8 (16%) patients in group E and 5 (10%) in group B had hypotension (p=0.27). 1 (2%) patient in group E experienced bradycardia.Conclusions: Prophylactic administration of ondansetron 8 mg has better efficacy in prevention of spinal anaesthesia induced shivering with minimal side effects as compared to 4 mg dosage.

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Use of a local anesthetic and opioid combination in spinal anesthesia in short urologic surgeries

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20190333 ◽

2019 ◽

Vol 7 (2) ◽

pp. 351

Author(s):

Abdullah özdemir ◽

Mehmet Salih Çolak

Keyword(s):

Spinal Anesthesia ◽

Local Anesthetic ◽

Saline Group ◽

Spinal Block ◽

Peripheral Oxygen Saturation ◽

Double Blind ◽

Catheter Group ◽

Pressure Time ◽

Urological Procedures ◽

Lateral Decubitus

Background: To investigate how low-dose levobupivacaine affects both surgical comfort and hemodynamics in patients undergoing short urologic procedures using spinal anesthesia.Methods: Our study was conducted prospectively and double-blind. The study group comprised 40 patients aged 18-65 years from the ASA I-III risk group who had undergone short urological interventions, randomly split into two groups. Informed consent and ethics committee approval were received. Using a media approach and placed in the lateral decubitus position, the patients were given spinal anesthesia using 22 G catheter. Group L was given 1.5ml of levobupivacaine (7.5mg) at 0.5% concentration +0.5ml of saline. Group LF was given 1.2ml levobupivacaine (6mg) at 0.5% concentration +25μg fentanyl (0.5ml) +0.3ml saline. Patient data including peripheral oxygen saturation; systolic, diastolic, mean arterial pressure; time to first postoperative need for analgesics, and spinal block characteristics were recorded at 3, 5, 10, 15, 30, 60, 120 and 360minutes after spinal anesthesia.Results: No significant differences were observed in the demographic and hemodynamic data between groups. Motor blocks were seen to wear off more in Group LF than in Group L at 120minutes. Group LF required first postoperative analgesics later than Group L; this difference was not significant.Conclusions: Sufficient anesthesia was achieved in both groups via spinal block using local anesthetic or local anesthetic plus opioid for relatively short urological procedures. The latter group recovered faster.

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Perbandingan Efektivitas Anestesi Spinal dengan Bupivacain 12,5 Mg dan Bupivacain 5 Mg yang ditambah Fentanyl 50 Mcg pada Seksio Sesarea

Jurnal Anestesi Obstetri Indonesia ◽

10.47507/obstetri.v4i1.55 ◽

2021 ◽

Vol 4 (1) ◽

pp. 11-7

Author(s):

Fritzky Indradata ◽

Heri Dwi Purnomo ◽

Muh. Husni Thamrin ◽

Sugeng Budi Santoso ◽

Ardana Tri Arianto ◽

...

Keyword(s):

Side Effects ◽

Cesarean Section ◽

Spinal Anesthesia ◽

Randomized Control Trial ◽

Hyperbaric Bupivacaine ◽

Chi Square ◽

Double Blind ◽

Duration Of Action ◽

Significant Difference ◽

Randomized Control

Latar Belakang: Anestesi spinal mempunyai efek samping berupa hipotensi dan mual muntah. Tujuan: penelitian ini adalah membandingkan efek anestesi spinal bupivacain dosis normal 12,5 mg dan bupivacain dosis rendah 5 mg dengan fentanyl 50 mg pada seksio sesarea terhadap perubahan hemodinamik, ketinggian blok, onset, durasi dan efek samping. Subjek dan Metode: Penelitian double blind randomized control trial pada 36 pasien yang memenuhi kriteria. Pasien dibagi menjadi dua kelompok, yang masing-masing terdiri 18 pasien, kelompok 1 dilakukan anestesi spinal dengan bupivacain hiperbarik 5 mg ditambah adjuvan fentanyl 50 mcg, sedangkan kelompok 2 diberikan bupivacain hiperbarik 12,5 mg. Penilaian meliputi saat mula kerja blokade sensorik, mula kerja blokade motorik, durasi, tekanan darah, laju nadi, dan saturasi oksigen, lama kerja dan efek samping. Data hasil penelitian diuji secara statistik dengan uji chi-square. Hasil: Terdapat perbedaan signifikan pada onset dan durasi blokade sensorik dan motorik, bupivacain 12,5 mg lebih baik dibandingkan bupivacain 5 mg + fentanyl 50 mcg (p<0.05). Tidak ada perbedaan signifikan pada perubahan tanda vital dan efek samping (p>0.05). Simpulan: Bupivacain 12,5 mg menghasilkan onset lebih cepat dan durasi lebih lama dibandingkan bupivacain 5 mg + fentanil 50 mcg pada anestesi spinal untuk seksio sesarea Comparison of The Effectiveness Spinal Anesthesia with Bupivacaine 12,5 Mg and Bupivacaine 5 Mg added Fentanyl 50 Mcg in Caesarean Section Abstract Background: Spinal anesthesia has side effects such as hypotension and nausea and vomiting. Objective: The aim of this study was to compare the effects of spinal anesthesia with normal doses of 12,5 mg of bupivacaine and 5 mg of low-dose bupivacaine with fentanyl 50 mg in the cesarean section on hemodynamic changes, block height, onset, duration, and side effects. Subjects and Methods: Double-blind randomized control trial in 36 patients who met the criteria. Patients were divided into two groups, each consisting of 18 patients, group 1 underwent spinal anesthesia with 5 mg of hyperbaric bupivacaine plus 50 mcg of fentanyl adjuvant, while group 2 was given 12,5 mg of hyperbaric bupivacaine. Assessments include the initiation of sensory block action, onset of motor block action, duration, blood pressure, pulse rate, and oxygen saturation, duration of action, and side effects. The research data were statistically tested with the chi-square test. Results: There were significant differences in the onset and duration of sensory and motor blockade, bupivacaine 12,5 mg was better than bupivacaine 5 mg + fentanyl 50 mcg (p <0.05). There was no significant difference in changes in vital signs and side effects (p> 0.05). Conclusion: Bupivacaine 12,5 mg resulted in a faster onset and longer duration than bupivacaine 5 mg + fentanyl 50 mcg in spinal anesthesia for cesarean section.

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Comparison of Effect of Intrathecal Fentanyl-bupivacaine and Tramadol-bupivacaine Combination on Postoperative Analgesia in Lower Abdominal Surgeries

Research & Innovation in Anesthesia ◽

10.5005/jp-journals-10049-0010 ◽

2016 ◽

Vol 1 (2) ◽

pp. 35-40 ◽

Cited By ~ 2

Author(s):

Naina P Dalvi ◽

Narendra Patil

Keyword(s):

Blood Pressure ◽

Postoperative Analgesia ◽

Total Duration ◽

Double Blind Study ◽

Motor Blockade ◽

Hyperbaric Bupivacaine ◽

Double Blind ◽

Sensory Blockade ◽

Prolonged Duration ◽

American Society

ABSTRACT Introduction This single-center, prospective, randomized, double-blind study compares the effect of intrathecal fentanylbupivacaine and tramadol-bupivacaine on the onset and duration of sensory and motor blockade, as well as postoperative analgesia in lower abdominal surgeries. Materials and methods Patients of either sex, aged 18 to 60 years, American Society of Anesthesiologists (ASA) grade I/II undergoing lower abdominal surgeries like appendicectomy, inguinal hernia repair surgery, and hydrocele surgery were administered either 2.5 mL of 0.5% bupivacaine + 0.5 mL (25 μg) of fentanyl citrate (group F) or 2.5 mL of 0.5% bupivacaine + 0.5 mL (25 mg) of tramadol (group T) intrathecally. Monitoring of the vital parameters, onset and duration of sensory and motor block, duration of postoperative analgesia, visual analog scale (VAS) score, sedation score, and any adverse drug reactions was done at predetermined intervals. Results Sixty patients were randomized to the group F (n = 30) and group T (n = 30). The duration of sensory blockade was significantly prolonged in group F (314.66 ± 49.25 minutes) as compared to group T (261.66 ± 27.92 minutes). Similarly, duration of motor blockade was longer in group F (263.66 ± 40.97 minutes) compared to group T (214.66 ± 26.61 minutes). The total duration of analgesia was significantly prolonged (p < 0.001) in group F (412 ± 97.888 minutes) compared to group T (301 ± 38.75 minutes). Hemodynamic parameters, such as pulse, systolic blood pressure, diastolic blood pressure and oxygen saturation were comparable in both the groups. Visual analog scores were significantly lower in the group F patients as compared to the group T patients. The group F patients had got significantly higher sedation scores as compared to Group T patients. Discussion Fentanyl 25 μg, when added to 2.5 mL of 0.5% hyperbaric bupivacaine, confers prolonged duration of sensory and motor blockade than 25 mg tramadol added to 2.5 mL of 0.5% hyperbaric bupivacaine. The bupivacaine-fentanyl combination prolonged duration of sensory and motor blockade, improved analgesia, as manifested by lower pain scores, and prolonged duration of postoperative analgesia. How to cite this article Dalvi NP, Patil N. Comparison of Effect of Intrathecal Fentanyl-bupivacaine and Tramadol-bupivacaine Combination on Postoperative Analgesia in Lower Abdominal Surgeries. Res Inno in Anesth 2016;1(2):35-40.

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The Effect of Intrathecal Dexmedetomidine as an Adjuvant to Spinal Anesthesia: Double Blind Study

Indian Journal of Anaesthesia and Analgesia ◽

10.21088/ijaa.2349.8471.3216.2 ◽

2016 ◽

Vol 3 (2) ◽

pp. 77-82

Author(s):

Shah Bipin K. ◽

◽

Chaudhary Asmita ◽

Chhanwal Heena ◽

Chadha Indu A. ◽

...

Keyword(s):

Spinal Anesthesia ◽

Blind Study ◽

Double Blind Study ◽

Double Blind

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DOES NEEDLE TIP DESIGN AFFECT UNILATERAL DISTRIBUTION OF SPINAL BLOCK? A DOUBLE-BLIND STUDY

Anesthesiology ◽

10.1097/00000542-199809150-00043 ◽

1998 ◽

Vol 89 (Supplement) ◽

pp. 868A

Author(s):

A Casati ◽

G Fanelli ◽

A Leoni ◽

G L Cappelleri ◽

E Casaletti ◽

...

Keyword(s):

Blind Study ◽

Spinal Block ◽

Double Blind Study ◽

Double Blind

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Effects of Two Target-controlled Concentrations (1 and 3 ng/ml) of Remifentanil on MACBARof Sevoflurane

Anesthesiology ◽

10.1097/00000542-200402000-00012 ◽

2004 ◽

Vol 100 (2) ◽

pp. 255-259 ◽

Cited By ~ 39

Author(s):

Andrea Albertin ◽

Andrea Casati ◽

Piercarlo Bergonzi ◽

Greta Fano ◽

Giorgio Torri

Keyword(s):

Nitrous Oxide ◽

Skin Incision ◽

Double Blind Study ◽

Double Blind ◽

Surgical Incision ◽

Arterial Blood ◽

Sequential Allocation ◽

Sympathetic Responses ◽

American Society ◽

End Tidal

Background The aim of this prospective, randomized, double-blind study was to determine the effects of two different target-controlled concentrations of remifentanil (1 and 3 ng/ml) on the sevoflurane requirement for blunting sympathetic responses after surgical incision (MACBAR). Methods Seventy-four patients aged 20-50 yr, with American Society of Anesthesiologists physical status I, were anesthetized with propofol, cisatracurium, and sevoflurane with a mixture of 60% nitrous oxide in oxygen. Then, patients were randomly allocated to receive no remifentanil infusion (n = 27) or a target-controlled plasma concentration of 1 ng/ml (n = 27) or 3 ng/ml remifentanil (n = 20). Sympathetic responses to surgical incision (presence or absence of an increase in either heart rate or mean arterial blood pressure of 15% or more above the mean of the values measured during the 2 min before skin incision) were determined after a 20-min period of stable end-tidal sevoflurane and target-controlled remifentanil concentrations. Predetermined end-tidal sevoflurane concentrations and the MACBAR for each group were determined using an up-and-down sequential-allocation technique. Results The MACBAR of sevoflurane was higher in the group receiving no remifentanil (2.8% [95% confidence interval: 2.5-3.0%]) as compared with patients of the groups receiving 1 ng/ml (1.1% [0.9-1.3%]; P = 0.012) and 3 ng/ml remifentanil (0.2% [0.1-0.3%]; P = 0.006). When considering a minimum anesthetic concentration (MAC) value in this age population and the contribution of 60% nitrous oxide (0.55 MAC), the combined MACBAR values, expressed as multiples of the MAC, were 1.95 MAC, 1.1 MAC, and 0.68 MAC, in the three groups, respectively. Conclusion A target-controlled concentration of 1 ng/ml remifentanil results in a 60% decrease in the MACBAR of sevoflurane combined with 60% nitrous oxide. Increasing the target concentration of remifentanil to 3 ng/ml produces a further 30% decrease in the MACBAR values of sevoflurane.

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