The Epidural “Top-up”

2002 ◽  
Vol 96 (6) ◽  
pp. 1310-1314 ◽  
Author(s):  
Michal Leeda ◽  
Rudolf Stienstra ◽  
M. Sesmu Arbous ◽  
Maarten J. M. Verschure ◽  
Albert Dahan ◽  
...  
Keyword(s):  
Maximum Level ◽  
Female Gender ◽  
Sensory Block ◽  
Saline Group ◽  
Volume Effect ◽  
Loading Dose ◽  
Sensory Blockade ◽  
Dural Sac ◽  
Group 2 ◽  
Number Of Segments

Background Extension of sensory blockade after an epidural top-up in combined spinal epidural (CSE) anesthesia is partly attributed to compression of the dural sac by the injected volume. This study investigated whether a volume effect plays a significant role when administering an epidural top-up after an initial epidural loading dose and assessed the predictive value of different factors with respect to the increase in sensory blockade. Methods After an epidural loading dose of 75 mg ropivacaine, 0.75%, 30 patients were randomly assigned to one of three groups. After the maximum level of sensory blockade (MLSB) had been established, patients received either an epidural top-up with 10 ml ropivacaine, 0.75% (group 1, n = 10) or saline (group 2, n = 10), or no epidural top-up (group 3, n = 10). Subsequently, sensory blockade was assessed at 5-min intervals for a further 30 min by a blinded observer. Results The MLSB increased significantly in the patients receiving an epidural top-up with ropivacaine but not in the patients receiving normal saline. Sensory block extension was inversely related to the number of segments blocked at the time of the epidural top-up, and female gender was associated with a smaller increase in MLSB. Conclusions When using epidural ropivacaine, the extension of sensory blockade after administering an epidural top-up is caused by a local anesthetic effect and not by a volume effect. Under the conditions of this study, predictors of the increase in sensory blockade are the presence of ropivacaine in the top-up injectate, the number of segments blocked at the time of epidural top-up, and gender.

A COMPARATIVE STUDY OF DEXMEDETOMIDINE AND FENTANYL AS AN ADJUVANT TO EPIDURAL BUPIVACAINE IN LOWER LIMB SURGERIES

2021 ◽  
pp. 59-61
Author(s):  
Anant Prakash ◽  
Rahul Kumar ◽  
Chandeshwar Choudhary ◽  
Debarshi Jana
Keyword(s):  
Lower Limb ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Maximum Level ◽  
Saline Group ◽  
Sensory Level ◽  
Motor Blockade ◽  
Sensory Blockade ◽  
Bupivacaine Hydrochloride ◽  
Epidural Bupivacaine

Background: Epidural anesthesia is the most commonly used technique for inducing surgical anesthesia and postoperative analgesia in patients undergoing lower limb surgeries. Fentanyl as an adjuvant to epidural local anesthetic has been used for a long time. Dexmedetomidine is a potent and highly selective á-2-adrenoceptor agonist with analgesic potency. Aim: The aim of the present study was to compare the effect of dexmedetomidine and fentanyl as an adjuvant to epidural bupivacaine in lower limb surgeries. Materials And Methods: Sixty patients belonging to the American Society of Anesthesiologists' Grade I or II who were undergoing lower limb surgery were randomly divided into two groups. Group BD: received epidural study solution of 38 ml of 0.25% bupivacaine hydrochloride + 1 ml of 100 ìg dexmedetomidine + 1 ml of normal saline. Group BF: received epidural study solution of 38 ml of 0.25% bupivacaine hydrochloride + 2 ml of 100 ìg fentanyl. Onset and maximum level of sensory blockade, time to attain maximum sensory level, time to complete motor blockade, time for two-segment regression, duration of analgesia and motor block, heart rate, and blood pressure were observed. Pain and sedation were assessed by numerical rating scale and Ramsay Sedation Scale, respectively. Data were recorded and statistically analyzed. Results: The onset of sensory blockade and time to attain maximum sensory level in Group BD were earlier than that of Group BF (P < 0.001). Duration of analgesia and motor blockade in Group BD were signicantly more than that of Group BF (P < 0.001). Postoperative visual analog scale was reduced statistically signicantly in Group BD (P < 0.001). Conclusion: Dexmedetomidine as an adjuvant to epidural bupivacaine is a better alternative to fentanyl with higher analgesic property

scholarly journals COMPARISON OF LEVOBUPIVACAIN AND ROPIVAKAIN IN COMBINED ANESTHESIA IN ONCOGNECOLOGICAL INTERVENTIONS

2018 ◽  
Vol 12 (2) ◽  
pp. 118-124
Author(s):  
Kirill A. Tsygankov ◽  
R. E Lakhin ◽  
A. V Schegolev ◽  
A. D Khalikov ◽  
V. V Mordovin ◽  
...  
Keyword(s):  
Epidural Anesthesia ◽  
Postoperative Period ◽  
Critical Incident ◽  
Critical Incidents ◽  
Pain Syndrome ◽  
Maximum Level ◽  
Sensory Block ◽  
Sensory Response ◽  
Group 2 ◽  
Group 1

The aim of the study was to evaluate the nature of the development of the sensory block and the frequency of occurrence of critical incidents during anesthesia, in the immediate postoperative period using levobupivacaine and ropivacaine in patients with an oncogynecological profile. Materials and methods. The study included 48 women who were randomized into two groups of 24 patients each, depending on the anesthetic used: group 1 - ropivacaine, group 2 - levobupivacaine. The latent period of the sensory block, the motor block, the maximum level of development of the sensory block after 15 minutes, critical incidents at the stages of anesthesia, the level of the pain syndrome after extubation and coughing were analyzed in the groups. Results. The sensory response to the cold sample, after the administration of local anesthetics in the groups, differed: in the first group, 300 (241.25, 314.75) s, in the second group 54.5 (45.75, 60.25) s. The maximum level of the sensory block in the groups was different. During the induction and maintenance of anesthesia, the most common critical incident was hypotension. Reduction of systolic blood pressure for the induction of anesthesia in group 1 was detected in 6 (25%) cases, in group 2 in 7 (29%). After extubation, the pain syndrome in the first group was 1.7 (1; 6), in the second group 1.7 (1; 4). With a cough, the assessment of the pain syndrome had the same intensity of pain, both in the first and in the second group 2 (1; 3). Conclusions. Levobupivacaine with epidural anesthesia accelerates the development of the sensory block. The maximum level of the sensory block does not differ with the use of levobupivacaine and ropivacaine. Hypotension in the stages of anesthesia is a frequent critical incident in epidural anesthesia. The severity of the pain syndrome during extubation and in the immediate postoperative period does not depend on the selected anesthetic.

scholarly journals Comparison of Two Doses of Chloroprocaine for Spinal Anaesthesia in Brachytherapy Procedures: A Randomised Clinical Study

2020 ◽  
Author(s):  
Shashidhar Gowdra Sugandarajappa ◽  
N Sneha ◽  
Namrata Ranganath
Keyword(s):  
Spinal Anaesthesia ◽  
Maximum Level ◽  
Sensory Block ◽  
Local Anaesthetics ◽  
Good Choice ◽  
Duration Of Action ◽  
Sensory Blockade ◽  
Subarachnoid Block ◽  
Group A ◽  
Group B

Introduction: Subarachnoid block is a widely used anaesthetic technique for lower abdominal and lower limb surgeries. Commonly used local anaesthetics are with longer duration of action and delayed recovery. Chloroprocaine is good choice for day care procedures because of its reliable action, faster resolution of block and earlier discharge time. Aim: To compare the minimum effective dose of chloroprocaine for spinal anaesthesia in brachytherapy. Materials and Methods: A total of 140 carcinoma cervix patients of ASA class I and II of age group 18 to 60 years were randomly divided into two groups of 70 each. They were posted for elective brachytherapy procedure under subarachnoid block. Group A patients received 2 mL of chloroprocaine (20 mg) and Group B patients received 3 mL of chloroprocaine (30 mg). Parameters like onset of sensory and motor blocks, maximum level of sensory block, time for two segment regression, duration of block and haemodynamic parameters were studied for the duration of procedure. Data were analysed using SAS 9.2, SPSS 15.0 software version. Descriptive and inferential statistical analysis was carried out. Results on continuous measurements are presented as mean±SD (min-max) and results on categorical measurements are presented in number (%). Significance was assessed at 5% level of significance. Results: Patients in both the groups were comparable with respect to the demographic characteristics. There were statistically significant differences in time for onset of motor blockade, duration of motor and sensory blockade, time for two segment regression which were shorter in chloroprocaine 20 mg (group A) compared to chloroprocaine 30 mg (group B). Haemodynamic variations and incidence of side-effects were similar in both groups. Conclusion: Subarachnoid 2-chloroprocaine (30 mg) provides adequate duration and density of spinal anaesthesia for brachytherapy procedures as compared with 20 mg 2-chloroprocaine.

scholarly journals A study on dexmedetomidine combinations during surgery

2019 ◽  
Vol 4 (2) ◽  
pp. 24-27
Author(s):  
Akhila CR ◽  
Sravan Kumar P ◽  
Vinaya B ◽  
Dinesh Babu J
Keyword(s):  
Motor Block ◽  
Meta Analysis ◽  
Sensory Block ◽  
Sedation Score ◽  
Medical Procedure ◽  
Motor Blockade ◽  
Adrenergic Agonists ◽  
Sensory Blockade ◽  
Group 2 ◽  
Dead Tissue

The meta analysis of 23 preliminaries covering 3395 patients reasoned that the consumption of α-2 adrenergic agonists moderated myocardial and mortality localized necrosis subsequent vascular medical procedure and that during cardiovascular medical procedure, a decrease in ischemia changed into found that would also have results on myocardial mortality and dead tissue. An infusion of dexmedetomidine at zero.4 μg.Kg-1 per hour at some point of cardiac surgery and reduced to zero.2 mg.Kg-1 in keeping with our within the ICU seems to lessen the time to exhumation and reduction the length of live in the ICU. The patients in institution 1 acquired zero.75% Ropivacaine + 1 mcg/kg Clonidine with a total extent of 20 ml and Group 2 received zero.75% Ropivacaine + 1 mcg/kg Dexmeditomidine with a complete quantity of 20 ml. Parameters determined had been time of onset of sensory block and motor block, duration of motor blockade, and sensory blockade, period of analgesia, sedation score and facet consequences. This study indicates that addition of dexmeditomidine to ropivacaine, while in comparison to Clonidine to Ropivacine, confirmed statistically considerable distinction in the onset of sensory and motor blockade among Ropivacaine with clonidine and Ropivacaine with dexmedetomidine.Duration of motor block is likewise prolonged with ropivacaine and dexmedetomidine institution as associated to Ropivacaine and clonidine. Side consequences of shivering and nausea were visible lesser with ropivacaine and dexmeditomidine.

Evaluating the Proposed Mechanism by Which Atorvastatin Can Protect Renal Tissue against Contrast Media: An Animal study

2019 ◽  
pp. 75-84
Keyword(s):  
Contrast Media ◽  
Kidney Injury ◽  
Saline Group ◽  
Pleiotropic Effect ◽  
Renal Tissue ◽  
Male Rats ◽  
Dependent Manner ◽  
Group 2 ◽  
Dose Dependent ◽  
Media Group

Contrast- induced nephropathy (CIN) is an elevation of serum creatinine of ≥ 0.5 mg/dL from baseline after two to three days of exposure to contrast substance if there is no other cause for acute kidney injury. Atorvastatin may protect normal kidney physiology from contrast- induced kidney injury by effects unrelated to hypolipidemia termed pleiotropic effect by decline of endothelin production, angiotensin system down regulation, and under expression of endothelial adhesion molecules. This study was conducted to assess the strategy by which atorvastatin can achieve protective effect for kidneys after exposure to contrast media in an animal model. A 40 male rats were distributed randomly into 4 groups; ten rats for each: group (1): given normal saline; group (2): CIN group given iopromide as contrast media; group (3): given atorvastatin (20mg/kg) and iopromide; and group (4): given atorvastatin (40mg/kg) and iopromide. Blood collected by cardiac puncture for detection of serum glutathione, malondialdehyde, matrix metalloproteinase-9, and interleukin-18. The results have shown a significant increase in inflammatory and oxidative stress markers in contrast media group, and significant reduction in these markers in atorvastatin treated groups, in a dose-dependent manner. As conclusion, atorvastatin mechanism for protection against CIN in a dose-dependent manner can mediate by anti-inflammatory and antioxidant effects.

scholarly journals Kidney ischemia and reperfunsion syndrome: effect of lidocaine and local postconditioning

2016 ◽  
Vol 43 (5) ◽  
pp. 348-353 ◽  
Author(s):  
IGOR NAGAI YAMAKI ◽  
RUY VICTOR SIMÕES PONTES ◽  
FELIPE LOBATO DA SILVA COSTA ◽  
VITOR NAGAI YAMAKI ◽  
RENAN KLEBER COSTA TEIXEIRA ◽  
...  
Keyword(s):  
Ischemia Reperfusion ◽  
Serum Levels ◽  
Saline Group ◽  
Renal Ischemia ◽  
Ischemic Postconditioning ◽  
Control Group ◽  
Ischemia And Reperfusion ◽  
Lidocaine Group ◽  
Group 5 ◽  
Group 2

ABSTRACT Objective: to evaluate the effects of blocking the regulation of vascular tone on the ischemia and reperfusion syndrome in rats through the use of lidocaine in the postconditioning technique. Methods: we randomized 35 rats into seven groups of five animals: Group 1- Control; Group 2- Ischemia and Reperfusion; Group 3- Ischemia, Reperfusion and Saline; Group 4- Ischemic Postconditioning; Group 5- Ischemic Postconditioning and Saline; Group 6- Lidocaine; Group 7- Ischemic Postconditioning and Lidocaine. Except for the control group, all the others were submitted to renal ischemia for 30 minutes. In postconditioning groups, we performed ischemia and reperfusion cycles of five minutes each, applied right after the main ischemia. In saline and lidocaine groups, we instilled the substances at a rate of two drops per minute. To compare the groups, we measured serum levels of urea and creatinine and also held renal histopathology. Results: The postconditioning and postconditioning + lidocaine groups showed a decrease in urea and creatinine values. The lidocaine group showed only a reduction in creatinine values. In histopathology, only the groups submitted to ischemic postconditioning had decreased degree of tubular necrosis. Conclusion: Lidocaine did not block the effects of postconditioning on renal ischemia reperfusion syndrome, and conferred better glomerular protection when applied in conjunction with ischemic postconditioning.

scholarly journals A prospective randomised double blind study of the comparison of two opioids- fentanyl and buprenorphine – as adjuvant to spinal bupivacaine in caesarean sections

2017 ◽  
Vol 4 (1) ◽  
pp. 45
Author(s):  
Kamal Sonya ◽  
Davies C. V.
Keyword(s):  
Side Effects ◽  
Intrathecal Morphine ◽  
Maximum Level ◽  
Sensory Block ◽  
Local Anaesthetics ◽  
Blind Study ◽  
Maximum Height ◽  
Double Blind Study ◽  
Double Blind ◽  
Fentanyl Group

<p class="abstract"><strong>Background:</strong> Opioids are first introduced as additives to spinal anaesthesia in 1979, with intrathecal morphine as forerunner. Neuraxial opioids when added to local anaesthetics prolong the duration of sensory block, improve quality of block and no unwanted sympathetic blockade leading to hypotension. This prospective randomized double blind study was undertaken to evaluate the duration of analgesia, sensory and motor blocking properties and side effects of two opioids – Fentanyl and Buprenorphine, when used as adjuvant to spinal Bupivacaine in caesarean section.</p><p class="abstract"><strong>Methods:</strong> Sixty patients between the age group 18-35 years belonging to ASA I and II posted for elective LSCS were randomly divided into two groups. Each group consisting of 30 patients , received either 1.8 ml 0.5% Bupivacaine with 25 mcg Fentanyl (group F) or 1.8 ml 0.5% Bupivacaine with 75 mcg buprenorphine (Group B). The onset, maximum level and duration of sensory and motor blockade and hemodynamic parameters were monitored.</p><p class="abstract"><strong>Results:</strong> Maximum height of sensory block was achieved faster in fentanyl group (i.e. 4.09±1.12 minutes compared to 4.56±1.21 minutes in buprenorphine group). Duration of analgesia was significantly prolonged in buprenorphine group. It was 317±54 minutes and 214±35 minutes respectively for buprenorphine and fentanyl groups.</p><p class="abstract"><strong>Conclusions:</strong> The study thus concluded that although fentanyl produce faster sensory block, duration of analgesia is longer with buprenorphine, and both the drugs do not cause significant side effects.</p>

scholarly journals Study of Some Parameters to Evaluate Immunization against Leishmaniasis in Golden hamsters

2011 ◽  
Vol 5 (2) ◽  
pp. 5-11
Author(s):  
Fawzia A. Al-Shanawi ◽  
Harith S. Al-Warid
Keyword(s):  
Phosphate Buffer ◽  
Saline Group ◽  
Challenge Infection ◽  
Leishmania Tropica ◽  
Parasite Culture ◽  
Golden Hamsters ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Incubation period, smears, impression and parasite culture for each liver, spleen, foot and blood were observed along five times follow up (15,30, 45, 60, 75, 90) days after challenge infection with virulent Leishmania tropica isolate in four groups of golden hamsters, inoculated with (one, two, three) doses of different antigens as following: Group (1) inoculated with autoclaved killed Leishmania tropica, Group (2) inoculated with BCG vaccine alone while Group (3) Inoculated with mixed vaccines (autoclaved killed Leishmania + BCG) and (4) control animals inoculated with phosphate buffer saline. Group 3, was considered as the best vaccine in this study because animal inoculated with this vaccine showed the following results compared with other antigens: - No lesion appeared along 90 days of following up.- Negative foot impression and culture up to 15 and 30 days of infection respectively, - Negative spleen and liver impression up to 30 days of infection when comparing with other groups.

Toxicity of bean cooking media containing EDTA in mice

2020 ◽  
Vol 36 (6) ◽  
pp. 436-445
Author(s):  
Sabry Ali El-Naggar ◽  
Karim Samy El-Said ◽  
Mona Elwan ◽  
Maysa Mobasher ◽  
Fotouh Mansour ◽  
...  
Keyword(s):  
Ethylenediaminetetraacetic Acid ◽  
White Blood Cells ◽  
Saline Group ◽  
Negative Control ◽  
Blood Levels ◽  
Group 4 ◽  
Liver And Kidney ◽  
Group 5 ◽  
Group 2 ◽  
Kidney Functions

The possible renal and hepatic toxicities of ethylenediaminetetraacetic acid (EDTA) in bean cooking media were studied using 100 male albino mice. Two sublethal doses of EDTA were used to explore their toxic effects; 20 mg/kg and 200 mg/kg, which corresponded to 1/100th and 1/10th of LD50, respectively. Accordingly, the toxicity study was performed using 50 mice, divided into five groups ( n = 10/group) as follows: group 1 (Gp1) served as a negative control and was orally administered normal saline; group 2 (Gp2) was administered the bean cooking medium; group 3 (Gp3) was administered EDTA (200 mg/kg); group 4 (Gp4) was administered bean cooking medium containing 20 mg/kg of EDTA; and group 5 (Gp5) was administered bean cooking medium containing 200 mg/kg of EDTA. The results showed no significant changes in liver and kidney functions in Gp2 while Gp3, Gp4, and Gp5 exhibited significant increases in adverse liver and kidney function markers. Hematocrit values were significantly decreased in Gp3 and Gp5, while the total white blood cells counts were significantly decreased in Gp3 and significantly increased in Gp5. The number of platelets was decreased in Gp3, Gp4, and Gp5. The blood levels of sodium (Na+), iron (Fe2+), and calcium (Ca2+) were decreased in Gp3, Gp4, and Gp5 due to the chelating effects of EDTA. The hepatic and renal architectures were disorganized in Gp3, Gp4, and Gp5 with some hemorrhagic manifestations in livers and kidneys of mice. These results demonstrate that EDTA in bean cooking is harmful in mice under the conditions of this study, and the potentially harmful effects in humans supports restricting its use.

scholarly journals A comparative clinical study of intrathecal hyperbaric bupivacaine with and without fentanyl for hysterectomy

2020 ◽  
Vol 11 (2) ◽  
pp. 59-63
Author(s):  
Hari Poudel ◽  
Surinder Nath Bawa ◽  
Surendra Mohan Sharma
Keyword(s):  
Side Effects ◽  
Spinal Anesthesia ◽  
Sensory Block ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Maximum Height ◽  
Hyperbaric Bupivacaine ◽  
Sensory Blockade ◽  
Group I ◽  
Group Ii

Background: Spinal anaesthesia has been widely used for lower abdominal surgeries like hysterectomy.Hyperbaric bupivacaine is the most extensively used local anesthetic. Addition of fentanyl can allow the reduction in the dose of bupivacaine, increase the height and duration of sensory blockade, and reduces complications of spinal anesthesia. Aims and Objective: The aim of the study was to examine whether adding fentanyl to hyperbaric bupivacaine would increase the height of sensory blockade, accelerate the onset of sensory blockade and increase the duration of the sensory blockade. Material and Methods: This study was done in Manipal Teaching Hospital, Pokhara, Nepal that included hundred patients who underwent total abdominal hysterectomy. The patients were randomly allocated in two groups; Group I: received 0.5% hyperbaric bupivacaine 2.5 ml (12.5 mg) plus normal saline 0.5 ml. Group II: received 0.5% hyperbaric bupivacaine 2.5 ml (12.5 mg) plus 0.5 ml fentanyl (25 μg). Hemodynamic variables, onset of motor and sensory blockade, duration of sensory and motor blockade and any side effects were observed and recorded. Results: The highest and lowest sensory block in Group I was T-7 and T-9 whereas in Group II was T-5 and T-9 respectively. In group I, the mean onset till maximum height of sensory blockade was 7.04 min whereas in group II it was 5.96 min (P<0.00).There was no significant statistical difference in the incidence of side effects in both the groups. Conclusion: Intrathecal fentanyl with hyperbaric bupivacaine for spinal anesthesia significantly accelerated the onset of sensory blockade and increased its maximum height and duration.

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