scholarly journals Spinal Anaesthesia with Hyperbaric Prilocaine in Day-Case Perianal Surgery: Randomised Controlled Trial

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Ozden Gorgoz Kaban ◽  
Dilek Yazicioglu ◽  
Taylan Akkaya ◽  
M. Murat Sayin ◽  
Duray Seker ◽  
...  
Keyword(s):  
Spinal Anaesthesia ◽  
Controlled Trial ◽  
Sensory Block ◽  
Local Anaesthetics ◽  
Day Case ◽  
Hyperbaric Bupivacaine ◽  
Versus Group ◽  
Group B ◽  
Randomised Controlled ◽  
Fentanyl Group

Background. The local anaesthetics used in day-case spinal anaesthesia should provide short recovery times. We aimed to compare hyperbaric prilocaine and bupivacaine in terms of sensory block resolution and time to home readiness in day-case spinal anaesthesia.Methods. Fifty patients undergoing perianal surgery were randomized into two groups. The bupivacaine-fentanyl group (Group B) received 7.5 mg, 0.5% hyperbaric bupivacaine + 20 μg fentanyl in total 1.9 mL. The prilocaine-fentanyl group (Group P) received 30 mg, 0.5% hyperbaric prilocaine + 20 μg fentanyl in the same volume.Results. Time to L1 block and maximum block was shorter in Group P than in Group B (Group P4.6±1.3 min versus Group B5.9±01.9 min,P=0.017, and Group P13.2±7.5 min versus Group B15.3±6.6 min,P=0.04). The time to L1 regression and S3 regression of the sensorial block was significantly shorter in Group P than in Group B (45.7±21.9 min versus59.7±20.9 min,P=0.024, and133.8±41.4 min versus200.4±64.8 min,P<0.001). The mean time to home readiness was shorter for Group P than for Group B (155±100.2 min versus207.2±62.7 min(P<0.001)).Conclusion. Day-case spinal anaesthesia with hyperbaric prilocaine + fentanyl is superior to hyperbaric bupivacaine in terms of earlier sensory block resolution and home readiness and the surgical conditions are comparable for perianal surgery.

scholarly journals Comparison of Intrathecal Fentanyl and Butorphanol as an Adjuvant to Intrathecal Bupivacaine 0.5% in Infraumbilical Surgeries- A Randomised Double Blind Study

2020 ◽  
Author(s):  
Sandip Roy Basunia ◽  
Prosenjit Mukherjee ◽  
Md Bakir Hossain Munshi
Keyword(s):  
Spinal Anaesthesia ◽  
Motor Block ◽  
Controlled Trial ◽  
Sensory Block ◽  
P Value ◽  
Double Blind Study ◽  
Hyperbaric Bupivacaine ◽  
Double Blind ◽  
Group A ◽  
Group B

Introduction: Neuraxial opioids are widely used as adjuvants to local anaesthetic as they improve quality and duration of block. Neuraxial opioids like Butorphanol and Fentanyl allow prolonged analgesia in the postoperative period and faster recovery from spinal anaesthesia. Aim: To compare the safety and efficacy of Butorphanol and Fentanyl combined with bupivacaine for spinal anaesthesia in infraumbilical surgeries. Materials and Methods: The present study was a randomised controlled trial in which 110, ASA I and II patients of either sex who underwent elective infraumbilical surgeries under spinal anaesthesia were selected. Patients were allocated randomly into two groups A (n=55) and B (n=55). Group A (F) received intrathecal 0.5% hyperbaric bupivacaine 12.5 mg (3 mL) with fentanyl 25 microgram (0.5 mL) to make it total 3.5 mL. Group B (B) received intrathecal 0.5% hyperbaric bupivacaine 12.5 mg (3 mL) with butorphanol 250 microgram (0.25 mL) and Normal Saline (NS) 0.25 mL to make it total 3.5 mL. Heart Rate (HR), Systolic and Diastolic Blood Pressure (SBP, DBP), two segment regression time of sensory block, motor block were assessed at preset intervals. Chi-square test or Fischer’s-exact test were used and a p-value ≤0.05 was considered as statistically significant. Results: Mean of two segment sensory regression time of Group A was 41.94±1.73 minutes and Group B was 50.56±4.43 minutes (p<0.0001). Time to onset of motor block in Group A was 5.28±.32 minutes and Group B was 5.27±.32 minutes (p=0.96). Mean duration of motor block in Group A was 81.23±4.87 minutes and Group B was 109.83±2.61 minutes (p<0.0001). Time to rescue analgesic was 289.27±7.37 minutes in Group A and 378.41±10.25 minutes in Group B (p<0.0001). HR, SBP and DBP were comparable among the groups. Conclusion: Intrathecal bupivacaine-butorphanol mixture was clinically better as it provided longer duration of analgesia with lesser incidences of pruritus and nausea/vomiting compared to intrathecal fentanyl-bupivacaine mixture.

scholarly journals Comparison of Fentanyl and Dexmedetomidine as Intrathecal Adjuvants to Spinal Anaesthesia for Abdominal Hysterectomy

2018 ◽  
Vol 56 (213) ◽  
pp. 848-855 ◽  
Author(s):  
Binod Gautam ◽  
Sushila Tabdar ◽  
Ujma Shrestha
Keyword(s):  
Spinal Anaesthesia ◽  
Visceral Pain ◽  
Sensory Block ◽  
Abdominal Hysterectomy ◽  
Hyperbaric Bupivacaine ◽  
Double Blind ◽  
Number Of Patients ◽  
First Choice ◽  
Group A ◽  
Group B

Introduction: Spinal anaesthesia, although advantageous for conducting abdominal hysterectomy, is not the first choice amongst surgeons for fear of intra-operative visceral pain. Intrathecal adjuvants may improve quality of spinal anaesthesia. This study aims to compare efficacy of intrathecal Fentanyl and Dexmedetomidine to reduce visceral pain during abdominal hysterectomy performed under spinal anaesthesia. Methods: Sixty women undergoing abdominal hysterectomy for benign indications were randomly assigned to two equal groups in a double-blind fashion. Fentanyl 25 micrograms in group A or Dexmedetomidine 10 micrograms in group B was co-administered with hyperbaric Bupivacaine 15 milligrams for spinal anesthesia. Surgery through Pfannenstiel incision proceeded once sensory block reached eighth thoracic dermatome. The intra-operative visceral pain was assessed using a five-point scale: none, mild, intermediate, severe, and failed spinal anaesthesia. Duration of analgesia and peri-operative events were studied for 24 hours. Chi-square test, Mann-Whitney U-test and Student’s t-test were used for analysis. Level of significance used was P<0.05. Results: Fifty eight participants completed the study. Demographic variables and sensory block were similar between groups. General anaesthesia was not required in both groups. Significantly greater number of patients in group A required medications for visceral pain with Relative Risk of 2.8 (1.16-6.7). Pruritus and shivering occurred significantly higher in group A. Hypotension was significantly higher in group B. Post-operatively, group B patients showed a significantly longer duration of analgesia. Conclusions: Dexmedetomidine is better than Fentanyl as an intrathecal adjuvant to spinal anaesthesia in minimizing visceral pain during abdominal hysterectomy and in prolonging post-operative analgesia.

scholarly journals Dexmedetomidine and Clonidine as an Adjuvant to Intrathecal Bupivacaine on Spinal Block Characteristic in Gynaecological Procedures - A Prospective Randomised Double-Blind Placebo Controlled Study

2021 ◽  
Vol 8 (19) ◽  
pp. 1363-1368
Author(s):  
Paidikondala L.R.N.N. ◽  
Kommula Gopala Krishna ◽  
Harika Surabattula ◽  
Nagalakshmi N.
Keyword(s):  
Adrenergic Receptor ◽  
Controlled Trial ◽  
Sensory Block ◽  
Local Anaesthetics ◽  
Controlled Study ◽  
Spinal Block ◽  
Hyperbaric Bupivacaine ◽  
Double Blind ◽  
Rescue Analgesia ◽  
Double Blind Placebo

BACKGROUND Clonidine and dexmedetomidine are two α-2 adrenergic receptor agonists which have been used as an adjuvant to intrathecal local anaesthetics. Both drugs act by different mechanisms and potentiate the effect of each other. The purpose of the study was to assess the efficacy and safety of adding clonidine and dexmedetomidine to intrathecal hyperbaric bupivacaine on spinal block characteristics in gynaecological procedures. METHODS This study was conducted as a prospective comparative, randomized, double blind, placebo-controlled trial. Based on exclusion and inclusion criteria, 90 patients were included in this study by using a computer generated randomization. Patients were randomly divided into three groups each as follows: Gr BD: 0.5 % hyperbaric bupivacaine (3.5 ml) + 3 μg preservative free dexmedetomidine (total volume of 4 ml), group BC: 0.5 % hyperbaric bupivacaine (3.5 ml) + 0.5 ml clonidine (30 μg) (total volume of 4 ml), group BN (control): 3.5 ml of 0.5 % hyperbaric bupivacaine + same volume normal saline. The spinal block characteristics, hemodynamic stability, and side effects were compared. RESULTS Time to reach sensory block to T10 was 2.52 ± 0.33 minutes in group BN, 1.95 ± 0.38 ms in gr BC and 1.53 ± 0.24 minutes in group BD. The span of sensory block was longer in group BD in comparison to group BC (453.76 ± 52.78 v 389.36 ± 37.4) and group BN (453.76 ± 52.78 vs. 173.33 ± 14.56). Time for rescue analgesia was 169.12 ± 21.14 minutes in group BN, 245.21 ± 32.42 minutes in group BC and 289 ± 24 minutes in group BD. CONCLUSIONS When α-2 adrenergic receptor agonist is used intrathecally with bupivacaine, early motor and sensory block can be achieved along with long span of analgesia. KEYWORDS Bupivacaine, Dexmedetomidine, Clonidine, Spinal Anaesthesia

scholarly journals Effects of Intrathecal Dexmedetomidine as an Adjuvant to Hyperbaric Bupivacaine for Spinal Anaesthesia in Adults Undergoing Elective Infra-umbilical Surgery

2017 ◽  
Vol 56 (208) ◽  
pp. 379-87 ◽  
Author(s):  
Binod Gautam ◽  
Sujata Niroula ◽  
Mona Sharma ◽  
Sushila Moktan Lama
Keyword(s):  
Spinal Anaesthesia ◽  
Local Anaesthetic ◽  
Visceral Pain ◽  
Sensory Block ◽  
P Value ◽  
Double Blind Study ◽  
Hyperbaric Bupivacaine ◽  
Double Blind ◽  
Group A ◽  
Group B

Introduction: Various adjuvants to local anaesthetic are used to improve quality and duration of spinal anaesthesia. Dexmedetomidine, a novel alpha-2 adrenergic agonist, has been proposed to augment local anaesthetic effects. This study aims to investigate effects of intrathecal Dexmedetomidine on duration of analgesia and duration of sensory block during spinal anaesthesia. Methods: In this randomized double-blind study 38 patients were allocated into each of two groups. Otherwise healthy patients (18 to 75 years) scheduled for inguinal hernia repair or vaginal hysterectomy were included. For spinal anaesthesia, Group A received 2.5 ml hyperbaric Bupivacaine 0.5%, whereas Group B received five micrograms intrathecal Dexmedetomidine in addition. Characteristics of sensory and motor blocks, duration of analgesia, analgesic requirements, and side effects were studied for 24 hours. Student’s t-test for quantitative variables and Chi- squared test for qualitative variables were used for statistical analysis. Results: Duration of analgesia was prolonged in Group B (326 min ±91) as compared to 217 min ±98 in Group A (P value <0.05). Sensory and motor block durations were significantly prolonged in Group B. Time taken to reach significant peak sensory block level was earlier in Group B. Significant reductions in incidence of visceral pain, shivering and analgesic requirements were observed in Dexmedetomidine group, without increased need of medications for altered hemodynamic parameters. Conclusions: Dexmedetomidineas an intrathecal adjuvant to hyperbaric Bupivacaine in spinal anaesthesia prolongs duration of analgesia and sensory block with minimal adverse effects. Keywords: Bupivacaine; Dexmedetomidine; intrathecal adjuvant; spinal anaesthesia.

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 Intrathecal Magnesium Sulfate as Analgesic and Anaesthetic Adjunct to Bupivacaine in Patients Undergoing Lower Extremity Orthopaedic Surgery

2018 ◽  
Vol 4 (2) ◽  
pp. 74-80 ◽  
Author(s):  
Prakash Maden Limbu ◽  
Sindhu Khatiwada ◽  
Birendra Prasad Sah ◽  
Satyendra Narayan Singh ◽  
Krishna Pokharel ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Lower Extremity ◽  
Magnesium Sulfate ◽  
Spinal Anaesthesia ◽  
Orthopaedic Surgery ◽  
Motor Block ◽  
Sensory Block ◽  
P Value ◽  
Hyperbaric Bupivacaine ◽  
Group B

Background: Subarachnoid block is a popular mode of anesthesia for lower limb surgeries. Studies of Magnesium Sulfate (MgS04 ) as an adjuvant to intrathecal local anaesthetic are limited. The objective was to find out the analgesic and anaesthetic effect of intrathecal MgS04 added to bupivacaine for spinal anaesthesia in patients undergoing lower extremity orthopaedic surgery.Methods: Sixty ASA I or II adult patients undergoing lower extremity orthopaedic surgery were randomly allocated in a double blinded fashion into two groups of thirty each. Group A received 3.0 ml of 0.5% hyperbaric bupivacaine with 0.15 ml of 50% MgSO4. Group B received 3.0 ml of 0.5% hyperbaric bupivacaine with 0.15 ml of NS. Onset of sensory and motor block as well as time to attain highest level of sensory block were recorded. Duration of sensory and motor block along with duration of spinal anaesthesia were also assessed. Any adverse effects were noted and treated.Results: Duration of sensory and motor block along with duration of spinal anaesthesia were prolonged in patients of MgSO4 but were not statistically significant with p-value of 0.33, 0.23 and 0.68 respectively. Onset of anaesthesia, requirement of rescue analgesics, haemodynamic parameters and adverse effects were comparable between two groups.Conclusion: In patients undergoing lower extremity orthopaedic surgery the addition of 75mg of MgSO4 to intrathecal bupivacaine did not prolong the duration of sensory block, spinal anaesthesia nor decreased postoperative analgesic consumption without any additional side effects. Journal of Society of Anesthesiologists of NepalVol. 4, No. 2, 2017, Page: 74-80

scholarly journals Comparative Study of Hyperbaric Bupivacaine Plus Ketamine Vs Bupivacaine Plus Fentanyl for Spinal Anaesthesia during Caeserean Section

2015 ◽  
Vol 11 (4) ◽  
pp. 287-291
Author(s):  
SK Shrestha ◽  
B Bhattarai ◽  
R Shah
Keyword(s):  
Caesarean Section ◽  
Spinal Anaesthesia ◽  
Sensory Block ◽  
Motor Blockade ◽  
Spinal Analgesia ◽  
Hyperbaric Bupivacaine ◽  
Group A ◽  
Group B ◽  
Dermatomal Level ◽  
Preservative Free

Background Spinal anesthesia is widely used for caesarean section due to its rapid onset, low failure rate, complete analgesia. Addition of intrathecal ketamine and opioids to local anaesthetics seems to improve the quality of block and prolong the duration of analgesia.Objectives The purpose of this study was to compare the effect of intrathecal ketamine mixed with hyperbaric bupivacaine to intrathecal fentanyl mixed with hyperbaric bupivacaine.Methods One hundred parturients ASA Grade I scheduled for elective or semiurgent caesarean section under spinal anaesthesia were randomly divided into two groups. Group A received 2ml (10 mg) hyperbaric bupivacaine 0.5% plus 25 mg preservative free ketamine. Group B received 2ml (10mg) hyperbaric bupivacaine 0.5% plus 25?g fentanyl. The patients were observed intraoperatively for the onset of sensory block, degree of motor block and total duration of analgesia.Results The time to achieve Bromage scale 3 motor blockade was shorter in Group A than in Group B.(p= 0.445) whereas time to achieve highest dermatomal level of sensory block was shorter in Group A than in Group B (p= 0.143). The duration of spinal analgesia was longer in Group B than in Group A (p= 0.730). The frequency of side effect such as sedation score was higher in Group A compared to Group B (p= 0.048). The incidence of pruritus was significantly higher in Group B compared to Group A (p = 0.000).Conclusion Addition of preservative free ketamine lead to faster onset of sensory and motor blockade, although it did not prolong the duration of spinal analgesia compared to addition of fentanyl in parturients undergoing caesarean section with spinal anaesthesia.Kathmandu Univ Med J 2013; 11(4): 287-291

scholarly journals 050419-OA- Spinal-Beena

2019 ◽  
pp. 162-167
Author(s):  
Tariq H Khan
Keyword(s):  
Spinal Anaesthesia ◽  
Motor Block ◽  
Sensory Block ◽  
Primary Objective ◽  
Spinal Block ◽  
Hemodynamic Parameters ◽  
Hyperbaric Bupivacaine ◽  
Voiding Function ◽  
Group A ◽  
Group B

Background: Spinal anaesthesia is a reliable and safe technique for infra-umbilical surgeries. Preservative-free 2-chloroprocaine has re-emerged for use in spinal anaesthesia. We compared onset and duration of sensory block with intrathecal use of 1% 2-Chloroprocaine (30 mg) or 0.5% Hyperbaric Bupivacaine (15 mg) as primary objective. Secondary objectives being onset and duration of motor block, duration of analgesia, time to return of voiding function, hemodynamic parameters and side effects. Materials and Methods: 90 patients of age group 18-60 years, either sex, belonging to ASA physical status I/II undergoing infra-umbilical surgeries were randomly divided into two groups, 1% 2-chloroprocaine Group A (n=45) and 0.5% hyperbaric bupivacaine Group B (n=45). Each group received intrathecally either 30 mg of 2-Chloroprocaine or 15 mg of hyperbaric bupivacaine 15 mg. For statistical analysis unpaired-t-test and chi-square test were used.  Results: Earlier onset and shorter duration of sensory block were observed in Group A as compared to Group B respectively (p < 0.001). Similarly, onset was earlier and duration of motor block, duration of analgesia and time to return of voiding function were shorter in Group A as compared to Group B respectively (p < 0.001). Hemodynamic parameters (HR, MAP) were comparable in both groups. Conclusion: Intrathecal 1% 2-Chloroprocaine 30 mg provides spinal anaesthesia of adequate duration for infra-umbilical surgeries with the advantage of earlier onset and faster regression of spinal block resulting in earlier voiding with stable hemodynamics as compared to 0.5% hyperbaric bupivacaine 15 mg. Keywords: Infra-umbilical surgeries, 2- chloroprocaine, Bupivacaine, Spinal Anaesthesia, Sensory Block, Motor Block.

scholarly journals Comparative study of intrathecal fentanyl with bupivacaine and fentanyl midazolam with bupivacaine in spinal anaesthesia

2021 ◽  
Vol 8 (2) ◽  
pp. 302-309
Author(s):  
Vishruti R Shah ◽  
Shweta Mehta ◽  
Danish A Khan
Keyword(s):  
Spinal Anaesthesia ◽  
Local Anaesthetic ◽  
Perioperative Complications ◽  
Sensory Block ◽  
Hyperbaric Bupivacaine ◽  
Rescue Analgesia ◽  
Significant Difference ◽  
Block Time ◽  
Group B

Spinal anaesthesia is preferred for lower abdominal and lower limb surgeries. Bupivacaine is the most popular local anaesthetic for subarachnoid blockade because of less neurotoxicity. Intrathecal bupivacaine alone may be insufficient to provide prolonged post-operative analgesia, even with high sensory block. So, various adjuvants are used like ketamine, midazolam, clonidine, opioids, neostigmine etc. to prolong the effect of local anaesthetic.To compare the effect of intrathecal fentanyl and fentanyl-midazolam combination with hyperbaric bupivacaine for quality of anaesthesia and post-operative analgesia.Study was conducted on 60 patients aged 20-60 years and were randomly divided into two groups of 30 patients each. Group A received 0.5% bupivacaine heavy 3 ml (15mg) + fentanyl 0.5 ml (25µg) and Group B 0.5% bupivacaine heavy 2.8 ml (14mg) +fentanyl 0.5 ml (25 µg) + midazolam 0.2 ml (1mg). Total volume is 3.5 ml in both groups. They were assessed for quality of block, post-operative analgesia and perioperative complications.Data were compared using t- test(unpaired). The level of significance used was p&#60;0.05. There was a significant difference in onset and duration of sensory and motor block, time to administer first rescue analgesia in group B. Addition of midazolam (1mg) to fentanyl with bupivacaine intrathecally gives better onset & duration of sensory & motor blockade and longer duration of post-operative analgesia.

Sign in / Sign up

Export Citation Format

Share Document