Intrathecal Ropivacaine and Clonidine for Ambulatory Knee Arthroscopy

2001 ◽  
Vol 94 (4) ◽  
pp. 574-578 ◽  
Author(s):  
Marc De Kock ◽  
Philippe Gautier ◽  
Luc Fanard ◽  
Jean Luc Hody ◽  
Patricia Lavand’homme
Keyword(s):  
Small Dose ◽  
Knee Arthroscopy ◽  
Systemic Effects ◽  
Motor Blockade ◽  
Arterial Blood ◽  
Group 2 ◽  
American Society ◽  
Double Blinded ◽  
Intrathecal Clonidine

Background The aim of this study was to evaluate the association of a small dose of intrathecal ropivacaine with small doses of intrathecal clonidine for ambulatory surgery. Methods One hundred twenty patients, classified as American Society of Anesthesiologists physical status I and scheduled for knee arthroscopy, were studied. Patients were randomly assigned to receive 4 ml of one of the following double-blinded isobaric intrathecal solutions: 8 mg of ropivacaine (group 1; n =30); 8 mg ropivacaine plus 15 microg clonidine (group 2; n =30); 8 mg ropivacaine plus 45 microg clonidine (group 3; n =30); and 8 mg ropivacaine plus 75 microg clonidine (group 4; n =30). The level and duration of sensory anesthesia were recorded, along with the intensity and duration of motor block. Patient and surgeon were interviewed to evaluate the quality of anesthesia. Results Intrathecal ropivacaine (8 mg alone) produced short sensory anesthesia and motor blockade (132 +/- 38 min and 110 +/- 35 min; mean +/- SD). However, the quality of anesthesia was significantly lower than in any other group (P < 0.05). Ropivacaine (8 mg) plus 75 microg clonidine produced significantly longer sensory and motor anesthesia (195 +/- 40 min and 164 +/- 38 min; P < 0.05). However, this was associated with systemic effects, such as sedation and reduction of arterial blood pressure. Ropivacaine (8 mg) plus 15 microg clonidine did not prolong sensory or motor blockade, afforded high quality anesthesia, and was not associated with detectable systemic effects. Conclusion Small-dose intrathecal clonidine (15 microg) plus 8 mg intrathecal ropivacaine produces adequate and short-lasting anesthesia for knee arthroscopy.

scholarly journals Comparative study of fentanyl versus tramadol as adjuvant with low dose local anaesthetic ropivacaine (0.1%) for epidural labour analgesia

2020 ◽  
Vol 8 (9) ◽  
pp. 3309
Author(s):  
Aman Choudhary ◽  
Sakshi Maheshwari ◽  
Naveen Paliwal ◽  
Shobha Ujwal ◽  
Geeta Singariya
Keyword(s):  
Side Effects ◽  
Low Dose ◽  
International Association ◽  
Labour Analgesia ◽  
Arterial Blood ◽  
Physical Status Classification ◽  
Significant Difference ◽  
Ethical Committee Approval ◽  
American Society ◽  
Double Blinded

Background: Toxonomy committee of International Association defined pain as an unpleasant emotional and sensory experience associated with potential tissue damage. The present study was conducted to evaluate the effect of a combination of low dose ropivacaine with fentanyl and tramadol in epidural labour analgesia.Methods: This prospective randomized double blinded clinical study was conducted in 100 patients in labour after ethical committee approval. Inclusion criteria was patients who had ASA I and ASA II (American society of anesthesiologists physical status classification system), age above 18 years, height more than 150 cm, weight less than 110 kg, either primigravidae or gravid 2. Patients were allocated into two groups Group F (ropivacaine with fentanyl) and group T (ropivacaine with tramadol) by computer generated randomisation technique.Results: In the present study, mean age in group F (ropivacaine with fentanyl) was 22.54±2.5, mean age in group T (ropivacaine with tramadol) was 22.86±2.17, and weight in group F was 56.68±2.75 and group T was 56.58±2.58. Duration of labour in group F was 3.39±1.01 hrs and in group T was 3.42±0.70 hrs. There was no significant difference between the two groups at any time points for mean VAS score. There was no significant difference in the mean heart rate and arterial blood pressure among both the groups statistically (P>0.05). More side effects were seen in group F.Conclusions: Both fentanyl and tramadol in combination with ropivacaine provide similar analgesia with minimal motor block. Both have no adverse effects on cardiotocographic parameters. However side effects were relatively more common in fentanyl group. Thus tramadol is a safer alternative to fentanyl as an adjunct to epidural labour analgesia.

scholarly journals Effects of intramuscular alfaxalone-midazolam combination in pigs

2019 ◽  
Vol 88 (2) ◽  
pp. 187-192 ◽  
Author(s):  
Cecilia Vullo ◽  
Marina Meligrana ◽  
Adolfo Maria Tambella ◽  
Angela Palumbo Piccionello ◽  
Fabrizio Dini ◽  
...  
Keyword(s):  
Repeated Measure ◽  
Intramuscular Administration ◽  
Arterial Oxygen ◽  
Neck Muscle ◽  
Pain On Injection ◽  
Arterial Blood ◽  
Measure Analysis ◽  
American Society ◽  
Lateral Recumbency

The aim of this experimental study was to evaluate the sedative and cardiorespiratory effects of alfaxalone and midazolam after intramuscular administration in pigs. Fourteen pigs, weighing 18 to 22 kg, aged between 55 and 70 days, American Society of Anaesthesiologists classification 2, affected by congenital reducible umbilical hernia, were included in the study. Alfaxalone (5 mg/kg) and midazolam (0.5 mg/kg) mixed in the same syringe were administered into the neck muscle. Pain on injection, quality of sedation and time to achieve lateral recumbency were recorded. Heart rate (HR), respiratory frequency (fR), and rectal temperature (RT) were recorded at 0 (baseline: before drug administration), 10, 15, and 20 min after the injection. Oxygen saturation of haemoglobin (SpO2), arterial blood pH, arterial oxygen (PaO2) and carbon dioxide (PaCO2) tensions and bicarbonate concentration (HCO3-) were recorded at 10, 15, and 20 min after injection. Continuous data were analysed using a repeated-measure analysis of variance (ANOVA) and a P-value < 0.05 was considered significant. Ten animals out of fourteen showed no pain on injection, whereas the remaining four exhibited mild pain. The time from the end of injection to lateral recumbency was 266 ± 40 s. The quality of sedation ranged between good to very good. No significant changes in the variables monitored were observed between the time points. In conclusion, the intramuscular administration of alfaxalone and midazolam in pigs at the doses used induced reliable and fast sedation, without pain on injection and moderate respiratory effects.

scholarly journals Metoprolol Significantly Improves Visual Clarity and Hemodynamic Parameters during Functional Endoscopic Sinus Surgery

2019 ◽  
Vol 4 (2) ◽  
pp. 1-8
Author(s):  
Ahmed A. Sadek ◽  
Mokhtar Mostafa ◽  
Tarek Abdel-Monem
Keyword(s):  
Blood Loss ◽  
Endoscopic Sinus Surgery ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Controlled Study ◽  
Double Blind ◽  
Arterial Blood ◽  
Surgical Field ◽  
Group 2

Background and Objectives: The success of functional endoscopic sinus surgery (FESS) depends on the visual clarity of the surgical field, which is understudied. Controlled hypotension has many advantages for FESS including reduction in blood loss and improved quality of the surgical field. This study determined whether the use of β-blockers as a premedication could improve the operative field in FESS. Methods: Sixty patients aged from 18 to 50 years, undergoing septoplasty and FESS were included in this prospective, randomized, double-blind, placebo-controlled study. Patients were randomly assigned to receive either metoprolol (100 mg, group 1) or a placebo (a vitamin tablet, group 2) 60 min before surgery. Results: The average blood loss and surgery duration were not significantly higher in the placebo group. The surgical field was graded using the Fromme-Boezaart scale, and it was significantly clearer (p < 0.001) in metoprolol group. The mean arterial blood pressure was significantly lower in the metoprolol group after 30 min of induction until the end of surgery (p < 0.001). The heart rate was also significantly lower (p < 0.001) in those who received metoprolol from before induction of anesthesia up to the end of surgery. Conclusion: Metoprolol significantly improves visual clarity and hemodynamics during FESS. We would recommend the use of metoprolol in FESS and septoplasty.

scholarly journals EPIDURAL ANAESTHESIA

2010 ◽  
Vol 17 (02) ◽  
pp. 318-324
Author(s):  
AZMAT RIAZ ◽  
HAMID SAEED MALIK ◽  
BILAL YASIN
Keyword(s):  
Patient Satisfaction ◽  
Epidural Anaesthesia ◽  
Knee Arthroscopy ◽  
Single Shot ◽  
Care Hospital ◽  
Day Case ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Objectives: To compare the benefits and adverse effects of three different drug combinations when used for single-shot epidural anaesthesia for day-case arthroscopy. Design of Study: Prospective, random, double-blind study. Setting: A 250 bedded secondary care hospital. Period: From October 2005 to Feb 2007. Material and Methods: We studied 75 adult male patients, aged between 23 to 63 years, weight <100 kg, ASA physical status I or II undergoing elective knee arthroscopy as day-case procedure. Patients were randomly divided into three groups ( 25 patients in each group) and single-shot epidural anaesthesia was performed using a total of 20 ml epidural lignocaine 2% (Group 1) bupivacaine 0.5% (Group 2) or a mixture containing lignocaine 2% and bupivacaine 0.5%, 10 ml each (Group 3). Results: Time to achieve maximum height (in minutes) was similar in group-1 and group-3 (10±4 and 11±2), but it was significantly longer in group-2 (20±3). Block time was comparable in group-2 and 3 (130±25 and 118±37) but it was significantly shorter in group-1 (60±20). Post-operative discharge time was longest in the group-2, and comparable in group-1 and 3.The incidence of complications like bradycardia, hypotension, nausea and vomiting were more in group-2 and less in group-1 and group-3. Inadequate anaesthesia was more in group-1 and least in other two groups.Four patients of group-1 needed rescue analgesia and two from same group needed general anaesthesia as compared to none in group-2 and group-3. In 4-point patient satisfaction scale, maximum patients from Group-3 rated it perfect while most patients from group-1 were not satisfied with the quality of anaesthesia. Conclusions: The results of our study show that a 50-50 mixture of lignocaine and bupivacaine withfentanyl 50 μg when used for single-shot epidural anaesthesia for day case knee arthroscopy, provides better quality of analgesia, with fewer incidences of side effects and more patient satisfaction as compared to lignocaine or bupivacaine alone.

scholarly journals Intrathecal clonidine added to small-dose bupivacaine prolongs

2013 ◽  
Vol 6 (1) ◽  
pp. 25
Author(s):  
Agreta Gecaj-Gashi ◽  
Hasime Terziqi ◽  
Tune Pervorfi ◽  
Arben Kryeziu
Keyword(s):  
Spinal Anesthesia ◽  
Postoperative Analgesia ◽  
Motor Block ◽  
Sensory Block ◽  
Analgesia Requirement ◽  
American Society ◽  
Group B ◽  
Double Blinded ◽  
Intrathecal Clonidine ◽  
American Society Of Anesthesiologists

Introduction: The aim of this prospective, double-blinded studywas to investigate the effects of clonidine in co-administrationwith bupivacaine during spinal anesthesia, regarding the onset and regression of motor and sensory block, postoperative analgesia and possible side effects.Methods: We randomly selected 66 male patients (age 35 to 70), from the American Society of Anesthesiologists (ASA) class I-II; these patients were scheduled for transurethral surgical procedures. These patients were randomly allocated into two groups of 33 patients each: group B (bupivacaine) only received 0.5% isobaric bupivacaine 7.5 mg intrathecally and group BC (bupivacaine + clonidine) received bupivacaine 7.5 mg and clonidine 25 μg intrathecally. We performed the spinal anesthesia at a level of L3-L4 with a 25-gauge needle. We assessed the sensory block with a pinprick,the motor block using the Bromage scale, analgesia with thevisual analog scale and sedation with the modified Wilson scale.We also recorded the hemodynamic and respiratory parameters.Results: The groups were demographically similar. The mean time of achievement of moto block (Bromage 3) and sensory block at level T9 was significantly shorter in the BC group compared with B group (p = 0.002, p = 0.000, respeectively). The motor block regression time was not significantly different between the two groups (p = 0.237). The postoperative analgesia requirement was significantly longer in group BC compared with group B (p = 0.000). No neurological deficit, sedation or other significant adverse effects were recorded.Conclusion: The intrathecal application of clonidine in combination with bupivacaine improves the duration and quality of spinal anesthesia; it also provides longer duration of postoperative analgesia, without significant side effects.

scholarly journals Effects of Nalbuphine and Fentanyl as Adjuvants to (0.5 %) Isobaric Levobupivacaine in Subarachnoid Block for Elective Transurethral Endoscopic Surgeries

2021 ◽  
Vol 10 (38) ◽  
pp. 3380-3386
Author(s):  
Dinesh G ◽  
Shilpa G.B ◽  
Greeshma N. Murdeshwar
Keyword(s):  
Adverse Effects ◽  
Spinal Anaesthesia ◽  
Motor Blockade ◽  
Male Adult ◽  
Hemodynamic Variables ◽  
Positional Variation ◽  
Blinded Study ◽  
Neurotoxic Effects ◽  
American Society ◽  
Double Blinded

BACKGROUND Isobaric levobupivacaine has minimal effect on positional variation of sensory and motor blockade given intrathecally. Also, it has lesser cardiotoxic and neurotoxic effects. Present study was done to compare efficacy, analgesia haemodynamic effects and any adverse effects after spinal anaesthesia with isobaric levobupivacaine with nalbuphine and fentanyl as adjuvants in transurethral endoscopic surgeries. METHODS 60 male adult patients of American Society of Anaesthesiologists (ASA class I-III) of age group 40 - 80 years were randomized into 2 groups (n = 30) in this prospective, double blinded study. 10 mg of 0.5 % levobupivacaine with 25 µg fentanyl in group LF and 10 mg of 0.5 % levobupivacaine with 0.8 mg nalbuphine in group LN. Parameters assessed were sensory and motor blockade characteristics and hemodynamic variables in both the groups. Adverse effects were recorded if any. RESULTS Onset of sensory and motor blockade were significantly faster in group LF compared to group LN. In both the groups, time for two segment regression was comparable. Statistically significant prolonged analgesic duration was noticed in group with nalbuphine than fentanyl as adjuvant to isobaric levobupivacaine. Difference in haemodynamic variation was not significant in both the groups. CONCLUSIONS Intrathecal nalbuphine 0.8 mg as an adjuvant with isobaric levobupivacaine 0.5 % 10 mg is as efficacious as fentanyl 25µg in transurethral endoscopic surgeries in elderly population with better hemodynamic stability. KEY WORDS Levobupivacaine; Fentanyl; Nalbuphine; Spinal anaesthesia.

scholarly journals Comparison of the use of levobupivacaine with dexamethasone versus plain levobupivacaine in patients undergoing forearm surgeries under an infraclavicular block - a double-blinded randomized controlled trial

2020 ◽  
Vol 11 (1) ◽  
pp. 39-43
Author(s):  
Anandbabu Medidi ◽  
Serina Ruth Salins
Keyword(s):  
Controlled Trial ◽  
Motor Blockade ◽  
Rescue Analgesia ◽  
Pain Scores ◽  
Group A ◽  
Infraclavicular Block ◽  
Group B ◽  
Double Blinded ◽  
Larger Sample

Regional anesthesia can provide greater patient satisfaction. An infraclavicular approach to block the brachial plexus aided with ultrasound is proven to be safe. Lesser toxic, levobupivacaine, advocates its use, with the addition of dexamethasone, to prolong the action. After approval from the ethics committee, the consenting patients, for orthopedic forearm surgeries, were recruited, randomized into two groups of 20 patients. Group-A, received 30mls of 0.5% levobupivacaine with dexamethasone 4mgs(1ml) and Group-B,30mls of 0.5% levobupivacaine and 1ml normal saline.18-70 Year olds, ASA I-III, weight greater than or equal to 50 kg, were included and non-consenting, coagulopathic, local infection, pregnant women, general anesthesia requirement, less than 50kg, allergy to local anesthetic, were excluded. Both groups received the infraclavicular block. The onset and duration of sensory and motor blockade were noted. Comparisons made at 3 and 20 minutes. Required data was acquired. Visual Analogue Scale(VAS)used to assess pain. The onset of sensory and motor blockade was assessed and graded separately on radial, median and ulnar nerves, with significant findings of about 70-80% in Group-A at 4-5 minutes,80-87% complete at 20 minutes.87.5% Patients in both groups achieved adequate surgical anesthesia. There was a significant improvement in sensory grading of the median nerve and ulnar nerve between at 3 minutes and 20 minutes and also in motor grading improvement at 20 minutes duration in the Group-A than Group-B. Postoperatively, the VAS score showed scores hovering around 1-4, over 24 hours, with no difference, in scores, duration, and use of rescue analgesia in both arms. There were no statistical differences in the onset and duration of sensory and motor blockade in both groups, with some difference in the quality of analgesia between the nerves studied in group-A. Although a larger sample size might have brought out some difference in pain scores, with the addition of dexamethasone, its clinical implication is doubtful.

Intrathecal Ropivacaine for Ambulatory Surgery 

1999 ◽  
Vol 91 (5) ◽  
pp. 1239-1239 ◽  
Author(s):  
Ph. E. Gautier ◽  
M. De Kock ◽  
A. Van Steenberge ◽  
N. Poth ◽  
B. Lahaye-Goffart ◽  
...  
Keyword(s):  
Motor Block ◽  
Ambulatory Surgery ◽  
Group 4 ◽  
Group 3 ◽  
Group 5 ◽  
Group 2 ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
To Receive

Background The rationale of this study was to evaluate intrathecal ropivacaine for ambulatory surgery. Methods One hundred fifty patients with American Society of Anesthesiologists physical status 1 scheduled for knee arthroscopy were studied. Patients were randomly assigned to receive 4 ml of one of five isobaric intrathecal solutions: Patients in group 1 (n = 30) received 8 mg of bupivacaine; patients in group 2 (n = 30) received 8 mg ropivacaine; patients in group 3 (n = 30) received 10 mg ropivacaine; patients in group 4 (n = 30) received 12 mg ropivacaine; and patients in group 5 (n = 30) received 14 mg ropivacaine. The level and duration of sensory anesthesia were recorded along with the intensity and duration of motor block. Patients were interviewed to identify transient neurologic symptoms. Results Intrathecal ropivacaine 10 mg produced shorter sensory anesthesia and motor blockade than bupivacaine 8mg (152 +/- 44 min and 135 +/- 41 min vs. 181 +/- 44 min and 169 +/- 52 min, mean +/- SD; P &lt; 0.05). However, the quality of intraoperative analgesia was significantly lower in the 10-mg ropivacaine group (P &lt; 0.05). Ropivacaine 12 mg produced sensory and motor block almost comparable to bupivacaine 8 mg. Ropivacaine 14 mg produced sensory and motor block comparable to ropivacaine 12 mg but significantly increased the time to void. No sign of transient radicular irritation were noted. Conclusion Intrathecal ropivacaine 12 mg is approximately equivalent to bupivacaine 8 mg. At this dose, ropivacaine offers no significant advantage compared with bupivacaine.

Analysis of the quality of early diagnostics of cardiovascular diseases in students of educational institutions of Khabarovsk (according to the data of preventive examinations)

2020 ◽  
pp. 13-16
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Diseases ◽  
Sinus Tachycardia ◽  
Blood Pressure Level ◽  
Educational Institutions ◽  
Conduction Disturbances ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

To identify the prevalence of early pathology of cardiovascular diseases, a survey of 400 200 girls) in the age group 15 and 17 years old was conducted as a part of routine medical of the level of blood pressure (BP) was carried out, with the calculation of the average level pressure on the basis of three separate measurements estimated by percentile tables for a registration of a standard resting ECG in 12 leads. According to the results of the survey, into 3 groups: with an increase in blood pressure above 95 ‰ (group 1 – 16 people), which recorded in males (p<0,05); Group 2 (67 people) – adolescents with a normal blood pressure level and group 3 of adolescents with a decrease in blood pressure below 5 ‰ changes in the form of rhythm and conduction disturbances were noted in almost every a predominance of sinus tachycardia in the first group. In the third group of adolescents, form of ectopic rhythm and pacemaker migration were significantly more frequently only 78 % of adolescents were referred for consultation and in-depth examination by a pediatric cardiologist.

Treatment Peculiarity of the Chronic Trophic Ulcers with Different Pathogenic Mechanism

2020 ◽  
Vol 62 (1) ◽  
pp. 12-16
Author(s):  
Oksana K. Melekhovets ◽  
Tetyana O. Kharchenko ◽  
Victor F. Orlovskiy ◽  
Iuirii V. Melekhovets ◽  
Alevtina S. Radko ◽  
...  
Keyword(s):  
Photodynamic Therapy ◽  
Healing Process ◽  
Modern Medicine ◽  
Lower Limbs ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Second Stage ◽  
Group 2

Introduction: Trophic ulcers of the lower extremities are an unresolved problem of modern medicine. The treatment of this pathology requires new methods that optimize care regimens and improve patients’ quality of life. Aim: The study to improve efficacy of treatment of the patients with trophic ulcers of the lower limbs with consideration to pathogenesis. M aterials and Methods: The study included 32 patients with chronic venous disease C6 (1st group) and 31 with diabetes mellitus type 2, moderate severity, compensation stage with diabetic foot syndrome II stage according to Wagner’s classification (2nd group). In addition to basic therapy in both groups photodynamic therapy was added at the first stage of the study, and at the second stage plasma rich in growth factors was prescribed. Results: At baseline evaluating of the chronic venous disease demonstrates that a total score in patient of the 1st group was 20,9 points on a modified VCSS scale; after two weeks – 15,71 points (improvement by 24.83%), and 6 weeks after–9,72 points (improvement by 53.49%). In patients with DM (2nd group) at the baseline a total score average was 13,91 points according to S(AD)SAD-1 scale; after 2 weeks – 12,29 (improvement by 11,65%), after 6 weeks – 6,39 points (improvement by 54,06%). Conclusions: The inclusion of photodynamic therapy and plasmatherapy in complex therapy in both groups led to a significant improvement of the healing process and helps to reduce the depth and area of the wound surface. However, the wound healing in patients in group 2 was slower.

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