scholarly journals Does the Use of Nitroglycerin Patch Improve Local Anaesthetic Effects in Bier’s Block? A Double-Blind Placebo Controlled Study

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Ahmed Said Elgebaly
Keyword(s):  
Analgesic Effect ◽  
Recovery Time ◽  
Motor Block ◽  
Onset Time ◽  
Sensory Block ◽  
Controlled Study ◽  
Patients Satisfaction ◽  
Recovery Times ◽  
Vas Scores ◽  
Motor Effects

Aim. The aim of the study was to assess the nitroglycerin patch as a new additive to Bier’s block and its impact on the effects and dose of lidocaine. Methods. Forty patients of each sex belonging to ASA I or II underwent elective tendon repair surgeries of the forearm and hand. The patients were divided into two equal groups as follows: Group C received only lidocaine (1.5 mg/kg, 0.25%) and Group N received lidocaine (1.5 mg/kg, 0.25%) + 5 mg transcutaneous nitroglycerin patch. Onset and recovery times for sensory and motor block, visual analogue scale (VAS) scores for bandage pain, postoperative VAS score, analgesic requirements, patients’ satisfaction, and surgeons’ opinion were recorded. Results. Sensory block onset time was shorter in Group N (3.80 ± 1.0) than that in Group C (5.72 ± 1.46), and motor block onset time was shorter in Group N (10.72 ± 1.93) than that in Group C (13.56 ± 1.26). Sensory block recovery time was prolonged in Group N (10.56 ± 1.12) than Group C (6.88 ± 1.45), recovery time of motor block was prolonged in Group N (13.04 ± 1.57) than Group C (11.96 ± 1.72). Bandage pain had lower VAS scores in Group N. Postoperative VAS scores showed significant differences between both groups at the following points of measurement: 30 minutes, 1 hour, and 4 hours after bandage deflation. Postoperative analgesic effect was the longest in Group N (187.20 ± 60.79 min) than Group C (51.60 ± 25.28 min). Patients’ satisfaction and surgeons’ opinion were better in Group N than Group C. Conclusion. Supplementation of Bier’s block with transcutaneous nitroglycerin patch reduces the lidocaine dose, the sensory and motor block onset times, VAS scores, and analgesic consumption intra- and postoperatively. Length of the block recovery times for the sensory and motor effects, duration of postoperative analgesic effect, and the first time to analgesic requirement improved the quality of Bier’s block with better patients’ satisfaction and surgeons’ opinion and had no adverse effects.

The Study of Effectiveness of Ropivacaine in Axillary Brachial Plexus Block for Forearm Surgery

2020 ◽  
Vol 22 (4) ◽  
pp. 248-253
Author(s):  
Sulav Acharya ◽  
GR Bajracharya ◽  
S Gauchan ◽  
N Dhakal
Keyword(s):  
Side Effects ◽  
Brachial Plexus ◽  
Analgesic Effect ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
Onset Time ◽  
Sensory Block ◽  
Axillary Brachial Plexus Block ◽  
The Mean ◽  
Plexus Block

Brachial plexus block is a suitable alternative to general anaesthesia for patient undergoing upper extremity surgery. Ropivacaine the S-enantiomer emerged as a possible replacement of Bupivacaine without undesirable toxic effects.Therefore this study was conducted to assess the block characteristics and side effects of 0.75% ropivacaine in axillary brachial plexus block for forearm surgeries. This interventional study was carried out in 30 patients of ASA physical status I or II, aged 18 to 60 yrs undergoing elective surgery u nder axillary brachial plexus block with 20 ml of 0.75 % Ropivacaine using ultrasound and nerve stimulator. The mean onset time of sensory block was 4.53 ± 1.18 minutes and duration of sensory block was 491.00 ± 57.45 minutes. The mean onset time of motor block was 9.17 ± 1.39 minutes and duration of motor block was 452.50 ± 52.34 minutes. The mean time for rescue analgesia or total analgesic effect was 569.47 ± 88.46 minutes. No patients developed any side effects. The result of this study concluded that Ropivacaine is a safe drug providing longer duration of sensory analgesic effect and early recovery of motor function with good operating conditions for forearm surgeries under brachial blexus block.

scholarly journals Comparison of Postoperative Analgesic Effect of Dexamethasone and Fentanyl Added to Lidocaine through Axillary Block in Forearm Fracture

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Siamak Yaghoobi ◽  
Mahyar Seddighi ◽  
Zohreh Yazdi ◽  
Razieh Ghafouri ◽  
Marzieh Beigom Khezri
Keyword(s):  
Analgesic Effect ◽  
Motor Block ◽  
Forearm Fracture ◽  
Onset Time ◽  
Analgesic Efficacy ◽  
Controlled Study ◽  
Axillary Block ◽  
Regional Analgesia ◽  
Double Blind ◽  
Hemodynamic Variables

Aim. Regional analgesia has been introduced as better analgesic technique compared to using systemic analgesic agents, and it may decrease the adverse effects of them and increase the degree of satisfaction. Several additives have been suggested to enhance analgesic effect of local anesthetic agents such as opioids and steroids. We designed this randomized double-blind controlled study to compare the analgesic efficacy of the dexamethasone and fentanyl added to lidocaine using axillary block in patients undergoing operation of forearm fracture. Materials and Methods. Seventy-eight patients 20–60 years old were recruited in a prospective, double-blinded, randomized way. Axillary block was performed in the three groups by using 40 mL lidocaine and 2 mL distilled water (L group), 40 mL lidocaine and 2 mL dexamethasone (LD group), and 40 mL lidocaine and 2 mL fentanyl (LF group). The onset time of sensory and motor block, duration of sensory and motor block, the total analgesic dose administered during 6 hours after the surgery, and hemodynamic variables were recorded. Results. The duration of sensory and motor block was significantly longer in LD group compared to other groups (P<0.001). Similarly, the total analgesic consumption in LD group was smaller compared to other groups (P<0.001). Comparison of hemodynamic consequences of axillary block and surgery failed to reveal any statistically significant differences between all groups. Conclusion. Addition of dexamethasone to lidocaine significantly prolonged the duration of analgesia compared with fentanyl/lidocaine mixture or lidocaine alone using axillary block in patients undergoing forearm fracture surgery. This trial is registered with IRCT2012120711687N1.

scholarly journals Peri- and Postanalgesic Properties of Lidokain, Lornoxicam, and Nitroglycerine Combination at Intravenous Regional Anesthesia

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Biricik Melis Cakmak ◽  
Gokhan Cakmak ◽  
Elif Akpek ◽  
Gulnaz Arslan ◽  
Mehmet Sukru Sahin
Keyword(s):  
Regional Anesthesia ◽  
Recovery Time ◽  
Motor Block ◽  
Sensory Block ◽  
Study Groups ◽  
The Other ◽  
Lidocaine Group ◽  
Tourniquet Pain ◽  
Intravenous Regional Anesthesia ◽  
Vas Scores

Background.This study was conducted to compare and evaluate the effect of adding lornoxicam or nitroglycerine as adjuncts to lidocaine in intravenous regional anesthesia (IVRA).Methods.60 patients were randomly separated into three groups, lidocaine group (group L), lidocaine + lornoxicam group (group LL), and lidocaine + lornoxicam + transdermal nitroglycerine group (group LL-N). Hemodynamic parameters, sensory and motor blocks onset, and recovery times were recorded. Analgesic consumption for tourniquet pain and postoperative period were recorded.Results.Sensory block onset times and motor block onset times were shorter in the LL-N and LL groups compared with L group. Sensory block recovery time and motor block recovery time were prolonged in the LL and LL-N groups compared with group L. The amount of fentanyl required for tourniquet pain was less in group LL and group LL-N when compared with group L. VAS scores of tourniquet pain were higher in group L compared with the other study groups. Postoperative VAS scores were higher for the first 4 hours in group L compared with the other study groups.Conclusion.The adjuvant drugs (lornoxicam or TNG) when added to lidocaine in IVRA were effective in improving the overall quality of anesthesia, reducing tourniquet pain, increasing tourniquet tolerance, and improving the postoperative analgesia.

A COMPARATIVE STUDY OF 0.5 % BUPIVACAINE WITH FENTANYL VERSUS 0.75% ROPIVACAINE WITH FENTANYL IN EPIDURALANESTHESIA FOR ABDOMINAL HYSTERECTOMY

2021 ◽  
pp. 71-73
Author(s):  
Pravin Vijayan ◽  
Debarshi Jana
Keyword(s):  
Motor Block ◽  
Sensory Block ◽  
Local Anaesthetics ◽  
Abdominal Hysterectomy ◽  
Controlled Study ◽  
Rescue Analgesia ◽  
Study Results ◽  
Duration Of Surgery ◽  
Group B ◽  
Time To Onset

INTRODUCTION Abdominal hysterectomy (AH) is a quite common gynaecological surgical procedure and electively done under central neuraxial blockade. AH is performed for malignant as well as benign indications such as uterine leiomyoma, persistent vaginal bleeding, or pelvic organ prolapse. AIMS AND OBJECTIVES Compare the onset of motor and sensory block. Find out the duration of the sensory and motor blockade. Observe intraoperative hemodynamic changes and assess post-operative analgesia requirements in 24 hour. Duration of analgesia assessed by requirement of rst rescue analgesic. Observe any untoward incident during intraoperative and post-operative period and managed accordingly MATERIALS AND METHODS Study Area: Department of Anesthesiology & critical care, DARBHANGAMEDICALCOLLEGE AND HOSPITAL. Study Population: Adult patients (30- 65 years) undergoing elective abdominal hysterectomy with regional anaesthesia were included for this study. Study Period:January 2019 to March 2020 Sample Design: Subjects were divided into two groups (n=35) equal in numbers and they sampled as per computerized randomization chart. These patients were divided into two groups, group B (with epidural 0.5% bupivacaine and 100g fentanyl) and group R (with epidural 0.75% ropivavaine and 100g fentanyl). Study Design: Prospective, open, randomized, controlled study. RESULTS: In Our study showed that 3.38kg/m2 and 24.86 3.60 kg/m2in group B and R respectively. The duration of surgery was 100.86 9.35minutes and 98.86 8.32 minutes and the duration of stay, was4.86 0.81days and 4.60 0.914 days in group B and group R respectively. Now with comparison of both groups, time to onset of sensory block (uptoT6) has signicant variation. But the other parameters namely, time to onset of motor block, two segment regression or duration of sensory block, rescue analgesia timing and complete motor recovery time were comparable and not signicant statistically in both groups. SUMMARY & CONCLUSIONS To conclude that in the present study using 0.5% bupivacaine with fentanyl and 0.75% ropivacaine with fentanyl epidurally, ropivacaine produced an earlier onset but similar duration of sensory block. The onset, quality and duration of motor block werecomparable in both the groups. It is important that new local anaesthetics with lower cardiotoxic property are adopted to ensure that regional techniques using large amounts of local anaesthetics remain safe with minimal complications. The recovery prole of ropivacaine may be useful where prompt mobilization is require

scholarly journals Comparison of 0.5% Ropivacaine and 0.5% Bupivacaine in Lumbar Epidural Anaesthesia for Lower Limb Orthopaedic Surgery

1997 ◽  
Vol 25 (3) ◽  
pp. 262-266 ◽  
Author(s):  
D. P. McGlade ◽  
M. V. Kalpokas ◽  
P. H. Mooney ◽  
M. R. Buckland ◽  
S. K. Vallipuram ◽  
...  
Keyword(s):  
Lower Limb ◽  
Orthopaedic Surgery ◽  
Motor Block ◽  
Onset Time ◽  
Sensory Block ◽  
Pressure Profile ◽  
Technical Failure ◽  
Time Duration ◽  
Double Blind ◽  
Multi Centre Study

The purpose of this study was to compare the epidural use of 0.5% ropivacaine and 0.5% bupivacaine in patients undergoing lower limb orthopaedic surgery. In a double-blind, randomized, multi-centre study involving 67 patients, thirty-two patients received 20 ml of 0.5% ropivacaine and 35 patients received 20 ml of 0.5% bupivacaine at the L2,3 or L3,4 interspace. Parameters measured were the onset time, duration and spread of sensory block, the onset time, duration and degree of motor block, the quality of anaesthesia and the heart rate and blood pressure profile during block onset. Four patients (3 ropivacaine, 1 bupivacaine) were excluded from the study due to technical failure of the block. The onset and duration of analgesia at the T10 dermatome (median, interquartile range) was 10 (5-15) minutes and 3.5 (2.7-4.3) hours respectively for ropivacaine, and was 10 (6-15) minutes and 3.4 (2.5-3.8) hours respectively for bupivacaine. Maximum block height (median, range) was T6 (T2-T12) for ropivacaine and T6 (C7-T10) for bupivacaine. Nine patients receiving ropivacaine and eight patients receiving bupivacaine developed no apparent motor block. The incidence of complete motor block (Bromage grade 3) was low in both groups, being 4/27 for ropivacaine and 6/34 for bupivacaine. In the ropivacaine group, motor and sensory block were judged to be satisfactory in 78% of patients. In the bupivacaine group, motor and sensory block were judged to be satisfactory in 71% and 62% of patients respectively. Cardiovascular changes were similar in both groups. No statistical differences were found between the two groups regarding any of the study parameters.

scholarly journals Comparison of Racemic Bupivacaine and Levobupivacaine; combined with low dose Fentanyl, through Intrathecal Route for Transurethral Resection of Prostate

2018 ◽  
Vol 4 (3) ◽  
pp. 10-13
Author(s):  
Debalpana Chandra ◽  
Subir Kumar Brahma
Keyword(s):  
Transurethral Resection ◽  
Motor Block ◽  
Onset Time ◽  
Sensory Block ◽  
Racemic Mixture ◽  
Transurethral Resection Of Prostate ◽  
Complete Regression ◽  
Central Nervous System Toxicity ◽  
Suitable Alternative ◽  
Significant Difference

Background and Objectives:  Bupivacaine is available as a racemic mixture of dextro and levobupivacaine. Many studies show that dextrobupivacaine has greater cardiovascular and central nervous system toxicity than levobupivacaine. The objectives of the present study were to compare the effects of racemic Bupivacaine + Fentanyl and Levobupivacaine + Fentanyl on the complete regression of motor block, onset time to reach T10 level sensory block, duration of T10 level sensory block, onset time of motor block, duration of sensory block.Materials and Method: The study was conducted in 100 patients undergoing transurethral resection of prostate operation, who received either 1.75 ml Bupivacaine (0.5%) + 25 µg Fentanyl (Gr A) or 1.75 ml Levobupivacaine (0.5%) + 25 µg Fentanyl (Gr B) intrathecally.Results: Time to complete regression of motor block, onset time toT10 level sensory block were significantly prolonged in Gr A compared to Gr B. The onset time of motor block was significantly shorter in Gr A compared to Gr B. There was no statistically significant difference between the two groups in respect to the duration of T10 level sensory block, duration of sensory block.Conclusion: Intrathecal Levobupivacaine + Fentanyl used in the present study can be considered as a suitable alternative to Bupivacaine + Fentanyl for spinal anaesthesia in elective TURP surgery.

scholarly journals A Comparison on Brachial Plexus Block Using Local Anaesthetic Agents With and Without Midazolam

2013 ◽  
Vol 3 (1) ◽  
pp. 11-13 ◽  
Author(s):  
Shailendra Nath Gautam ◽  
SK Bhatta ◽  
NR Sharma
Keyword(s):  
Brachial Plexus ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
Onset Time ◽  
Sensory Block ◽  
Local Anaesthetics ◽  
Gaba A ◽  
Medical College ◽  
Anaesthetic Agents ◽  
Plexus Block

Brachial plexus block provide surgical anesthesia and analgesia of upper extremity. Any adjuvant to brachial plexus block have less systemic side effect as well as reduce the total dose local anaesthetics. The midazolam acts on GABA-A receptors in peripheral nerve. The sensory and motor block was significantly faster in our study who received midazolam. This could be local anesthetic properties of midazolam and synergistic action with local anaesthetics. Total 100 patients between ages 10-77 years of either sex of ASA I-III, underwent upper arm surgery were given supraclavicular brachial block with and without midazolam. The onset and duration of sensory block in Gr I (XB) and Gr II (XBM) were significantly different. The onset time for sensory block was significantly prolong and duration of block significantly less compared to Gr II (P<0.05). The onset time for motor block was significantly less and duration significantly higher in Gr II (XBM) as compared to Gr I (XB). Midazolam 50ugm/kg in brachial plexus block speed sensory and motor block with post operative analgesia. Journal of Chitwan Medical College 2013; 3(1): 11-13 DOI: http://dx.doi.org/10.3126/jcmc.v3i1.8458

A COMPARATIVE STUDY OF TWO DIFFERENT DOSES OF DEXMEDETOMIDINE AS ADJUNCT TO LIDOCAINE IN INTRAVENOUS REGIONAL ANESTHESIA

2021 ◽  
Vol 74 (9) ◽  
pp. 2259-2264
Author(s):  
Diana Salam Sami ◽  
Ali Hadi Muslih
Keyword(s):  
Regional Anesthesia ◽  
Motor Block ◽  
Onset Time ◽  
Sensory Block ◽  
P Value ◽  
Intravenous Regional Anesthesia ◽  
Group 3 ◽  
Group 2 ◽  
Different Doses ◽  
Group 1

The aim: To compare the different doses of dexmedetomidine as adjuvant to lidocaine in intravenous regional anesthesia. Materials and methods: Ninety patients participated in this study in Al-Yarmook teaching hospital in period between January 1st 2016 – July 1st 2016, divided randomly in to 3 groups. Group 1: received lidocaine diluted with normal saline; Group 2 – lidocaine with dexmedetomidine 0.5 μg/kg; Group3 -lidocaine with dexmedetomidine 1 μg/kg. Statistical analysis was done by IBM SPSS program version 20 and Microsoft excel version 2010 , the means were compared by ANOVA methods and Dunnett t3, significancebetween groups were recorded if p value less than 0.05. Results: Dexmedetomidine was effective in decreasing the sensory block onset time and motor block onset time and prolongation of the motor and sensory recovery with no significant hemodynamic changes than is often shown by the lidocaine alone, it also prolongs the time interval for analgesic requirement after the operation. For the group 3 it was faster than in group 2 and faster than in group 1 significantly (p value < 0.001) to form a sensory block onset and motor block onset; and it took significantly more time to recover the sensation than in group 1 (p value <0.001) and 2 (p value <0.002) , and more time for motor recovery than in group 1 (p value < 0.001). Group 3 had the longest time to call for the analgesia after operation than group 2 and 3 (p value < 0.001); and group 2 also had longer time for the same process than group 1 (p value < 0.001). Conclusions: A variety of adjuvants have been used in IVRA to decrease tourniquet pain, improve block quality, and prolong analgesia after cuff deflation. Opioids are relatively ineffective and cause nausea, vomiting, and dizziness after tourniquet deflation, but several NSAIDs have been shown to be beneficial, dexmedetomidine improves block quality and postoperative analgesia.

Comparative study of (0.5%) levobupivacaine and (0.75%) ropivacaine in supraclavicular brachial plexus block by lateral approach

2017 ◽  
Vol 5 (6) ◽  
pp. 2426
Author(s):  
Jitesh Kumar ◽  
. Sweta ◽  
Kumari Kanak Lata ◽  
B. K. Prasad ◽  
V. K. Gupta
Keyword(s):  
Brachial Plexus ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
Sensory Block ◽  
Lateral Approach ◽  
Controlled Study ◽  
Upper Limb Surgery ◽  
Significant Difference ◽  
Supraclavicular Brachial Plexus Block ◽  
Plexus Block

Background: As compared to general anaesthesia, brachial plexus block for upper limb surgery gives fewer side effects and better postoperative analgesia. The objective of this study was to evaluate the effects of 0.5% levobupivacaine and compare it with 0.75% ropivacaine.Methods: For this prospective randomized, controlled study, 60 patients of both sexes of ASA grade 1 and 2 were enrolled and divided into two groups and supraclavicular brachial plexus block was performed by lateral approach using 30 ml of 0.5% levobupivacaine and 0.75% ropivacaine. The onset of sensory and motor block, duration of sensory and motor block and analgesia and possible adverse events were recorded.Results: No statistically significant difference was observed in the onset of sensory block in both groups. Onset of motor block was significantly faster in levobupivacaine group (P<0.05). Duration of sensory block, motor block and analgesia was significantly longer in levobupivacaine group (P<0.05).Conclusions: 0.5% levobupivacaine is better alternative to 0.75% ropivacaine in brachial plexus block in term of early onset of sensory block and long duration of analgesia.

A multicenter, randomized comparison between 2, 5, and 8 mg of perineural dexamethasone for ultrasound-guided infraclavicular block

2019 ◽  
Vol 44 (1) ◽  
pp. 46-51 ◽  
Author(s):  
Daniela Bravo ◽  
Julian Aliste ◽  
Sebastián Layera ◽  
Diego Fernández ◽  
Prangmalee Leurcharusmee ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Motor Block ◽  
Onset Time ◽  
Sensory Block ◽  
Procedural Pain ◽  
Ultrasound Guided ◽  
Performance Time ◽  
Blinded Observer ◽  
Infraclavicular Block ◽  
Equivalence Margin

Background and objectivesThis multicenter, randomized trial compared 2, 5, and 8 mg of perineural dexamethasone for ultrasound-guided infraclavicular brachial plexus block. Our research hypothesis was that all three doses of dexamethasone would result in equivalent durations of motor block (equivalence margin=3.0 hours).MethodsThree hundred and sixty patients undergoing upper limb surgery with ultrasound-guided infraclavicular block were randomly allocated to receive 2, 5, or 8 mg of preservative-free perineural dexamethasone. The local anesthetic agent (35 mL of lidocaine 1%-bupivacaine 0.25% with epinephrine 5 µg/mL) was identical in all subjects. Patients and operators were blinded to the dose of dexamethasone. During the performance of the block, the performance time, number of needle passes, procedural pain, and complications (vascular puncture, paresthesia) were recorded. Subsequently a blinded observer assessed the success rate (defined as a minimal sensorimotor composite score of 14 out of 16 points at 30 min), onset time as well as the incidence of surgical anesthesia (defined as the ability to complete surgery without local infiltration, supplemental blocks, intravenous opioids, or general anesthesia). Postoperatively, the blinded observer contacted patients with successful blocks to inquire about the duration of motor block, sensory block, and postoperative analgesia. The main outcome variable was the duration of motor block.ResultsNo intergroup differences were observed in terms of technical execution (performance time/number of needle passes/procedural pain complications), onset time, success rate, and surgical anesthesia. Furthermore, all three doses of dexamethasone provided similar durations of motor block (14.9–16.1 hours) and sensory block. Although 5 mg provided a longer analgesic duration than 2 mg, the difference (2.7 hours) fell within our pre-established equivalence margin (3.0 hours).Conclusions2, 5, and 8 mg of dexamethasone provide clinically equivalent sensorimotor and analgesic durations for ultrasound-guided infraclavicular block. Further trials are required to compare low (ie, 2 mg) and ultra-low (eg, 0.5–1 mg) doses of perineural dexamethasone for brachial plexus blocks.Trial registration numberTCTR20150624001.

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