scholarly journals Effect of Lateral Posture on Epidural Blockade for Surgery

1983 ◽  
Vol 11 (2) ◽  
pp. 97-102 ◽  
Author(s):  
L. T. Seow ◽  
F. J. Lips ◽  
M. J. Cousins
Keyword(s):  
Lateral Position ◽  
Double Blind Study ◽  
Motor Blockade ◽  
Volume Data ◽  
Time Intervals ◽  
Double Blind ◽  
Sensory Blockade ◽  
Epidural Blockade ◽  
Initial Onset ◽  
Lateral Posture

In a prospective double-blind study, single-dose lumbar epidural blockade was administered to 60 healthy patients undergoing lower abdominal surgery, the patients lying in the lateral position only during the time of injection of the local anaesthetic. Solutions used were bupivacaine HCl 0.5%, lignocaine HCl 2% and lignocaine-bupivacaine mixtures in the ratios of 1:3, 1:1 and 3:1 by volume. Data were pooled and analysed for the effects of posture on epidural blockade. Using skin temperature as a criterion of sympathetic blockade, onset of blockade was more rapid and there was more prolonged blockade on the dependent side. Initial onset of sensory blockade was faster on the dependent side by I minute and 3.1 minutes for partial and complete blockade, respectively. Mean duration of sensory blockade was longer in the dependent dermatomes for partial (14, SD 7, minutes, T6-L4) and complete blockade (20, SD 6, minutes, T8-L3) respectively. Initial onset of complete motor blockade was 5 minutes more rapid on the dependent side, with mean myotome score consistently greater at all time intervals on the dependent side. Our study therefore suggests that a more efficacious sensory and motor blockade could be achieved by lying the patient on the operative side during the administration of the epidural and injection of the local anaesthestic solution close to the operative dermatomes.

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

2016 ◽  
Vol 1 (2) ◽  
pp. 35-40 ◽  
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.

scholarly journals Comparision of dexmedetomidine and clonidine with hyperbaric bupivacain in spinal anaesthesia

2021 ◽  
Vol 8 (12) ◽  
pp. 3563
Author(s):  
Anshul Agrawal ◽  
Sunita Jain ◽  
Ashish Goyal
Keyword(s):  
Spinal Anaesthesia ◽  
Onset Time ◽  
Peak Level ◽  
Sensory Block ◽  
Double Blind Study ◽  
Motor Blockade ◽  
Hyperbaric Bupivacaine ◽  
Double Blind ◽  
Sensory Blockade ◽  
Lower Limb Surgery

Background: Alpha-2 adrenergic agonists used as adjuvant to spinal anaesthesia produce substantial sensory and motor blockade of bupivacaine. This study was planned to compare the sensory and motor blockade characteristics of intrathecal combinations of adjuvants dexmedetomidine and clonidine with hyperbaric bupivacaine in the cases who underwent lower limb surgery under spinal anaesthesia.Methods: This was prospective, randomized, double blind study. 90 patients of age group between 18-60 years, ASA grade I and II were allotted into 3 equal groups. Group B received 15 mg bupivacaine plain, group BD and BC received dexmedetomidine (5mcg) and clonidine (50mcg) as adjuvants to bupivacaine respectively.Results: The duration of 2 dermatome regression time, sensory blockade and motor blockade were longest in dexmedetomidine group (129.37±4.87; 386±58.43; 353±48.87) in compared to clonidine (109.77±5.95; 296.53±57.19; 269.7±51.2) and bupivacaine group (81.03±6.83; 211.1± 30.47;181.03±20.8). Both drugs do not affect the peak level of sensory blockade, sensory block onset and motor block onset time. Dexmedetomidine and clonidine do not cause sedation in intraoperative and postoperative period.Conclusions: We conclude that addition of dexmedetomidine and clonidine in spinal anesthesia with hyperbaric bupivacaine increase the duration of ‘2 dermatome regression’ time, sensory and motor blockade and both are more with dexmedetomidine than with clonidine.

Sensory and Motor Blockade During Epidural Analgesia With 1%, 0.75%, and 0.5% Ropivacaine???A Double-Blind Study

1991 ◽  
Vol 72 (4) ◽  
pp. 509???515 ◽  
Author(s):  
Dusanka Zaric ◽  
Kjell Axelsson ◽  
Per-Anders Nydahl ◽  
Lennart Philipsson ◽  
P??l Larsson ◽  
...  
Keyword(s):  
Epidural Analgesia ◽  
Blind Study ◽  
Double Blind Study ◽  
Motor Blockade ◽  
Double Blind

scholarly journals Comparison of Postoperative Analgesic Effect of Intrathecal Clonidine and Fentanyl Added to Bupivacaine in Patients Undergoing Cesarean Section: A Prospective Randomized Double-Blind Study

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Marzieh Beigom Khezri ◽  
Meisam Rezaei ◽  
Morteza Delkhosh Reihany ◽  
Ezzatalsadat Haji Seid Javadi
Keyword(s):  
Cesarean Section ◽  
Onset Time ◽  
Analgesic Efficacy ◽  
Double Blind Study ◽  
Motor Blockade ◽  
Time Duration ◽  
Analgesic Requirement ◽  
Double Blind ◽  
Link Type ◽  
Intrathecal Clonidine

Objectives. To compare the analgesic efficacy of intrathecal clonidine and fentanyl added to bupivacaine after cesarean section. Methods. Ninety patients scheduled for cesarean section under spinal anesthesia were randomly allocated to one of the three following groups to receive bupivacaine 10 mg combined with 75 µg clonidine (group C), bupivacaine 10 mg combined with 0.5 mL fentanyl (group F), and bupivacaine 10 mg combined with 0.5 mL distilled water (group P), intrathecally. The time to first analgesic request, analgesic requirement in the first 24 hours after surgery, sensory and motor blockade onset time, duration of sensory and motor blockade, the incidence of hypotension, ephedrine requirements, bradycardia, and hypoxemia were recorded. Results. The duration of anesthesia in clonidine group (275.10±96.09) was longer compared to the placebo (211.73±74.80) and fentanyl (192.33±30.36) groups. This difference between group C versus F (P=0.006) and P groups (P<0.001) was significant. Similarly, the mean time to first analgesic request was also longer in group C (519.44±86.25) than in groups F (277.88±94.25) and P (235.43±22.35 min). This difference between group C versus F (P<0.001) and P groups (P<0.001) was significant. Conclusion. Intrathecal clonidine 75 µg with bupivacaine prolonged the time to first analgesic request compared to fentanyl; however, the total analgesic consumption within the first 24 h postoperative was similar in fentanyl and clonidine groups following cesarean section. This trial is registered with ACTRN12611000909921 and ClinicalTrials.gov NCT01425658.

scholarly journals Comparison of dexmedetomidine and buprenorphine as an adjuvant to bupivacaine during spinal anaesthesia for tibial interlocking nailing surgeries

2017 ◽  
Vol 4 (6) ◽  
pp. 1653
Author(s):  
Amitha S. ◽  
Pradeep R.
Keyword(s):  
Spinal Anesthesia ◽  
Spinal Anaesthesia ◽  
Motor Blockade ◽  
Hyperbaric Bupivacaine ◽  
Chi Square ◽  
Double Blind ◽  
Sensory Blockade ◽  
Exact Test ◽  
Interlocking Nailing ◽  
Group 3

Background: Buprenorphine is being used as an adjuvant to local anaesthetic for spinal anaesthesia since long. Dexmedetomidine is a new drug which has got alpha 2 agonistic property, and is being tried for spinal anesthesia along with bupivacaine in recent times. Settings and Design: This study was conducted in a prospective, randomized, controlled and double-blind manner. The study included ninety American Society of Anaesthesiologists class I and II patients undergoing tibial interlocking nailing surgeries under spinal anaesthesia.Methods: The patients were randomly divided into three groups (n=30 each) by closed envelope technique. Patients in group 1 received 15 mg of 0.5% hyperbaric bupivacaine, group 2 received 15 mg of 0.5% hyperbaric bupivacaine with 30μg of buprenorphine, and group 3 received 15 mg of 0.5% hyperbaric bupivacaine with 5μg dexmedetomidine for spinal anesthesia. The duration of motor and sensory blockade and any adverse events were recorded. Data were analysed using Chi-square test or Fisher’s exact test for categorical data and analysis of variance for continuous data. A value of P<0.05 was considered as statistically significant.Results: In our study the subjects in group 3 (dexmedetomidine) group had significantly longer period of motor blockade (240±20min) and sensory blockade (180±22.2min) compared to other groups, which is statistically significant (P=0.0001 and P= 0.006 respectively). The time to first request of analgesic in the post-operative period was also longer (240±30.2min) in dexmedetomidine group when compared with other groups (P=0.0001). There were no untoward complications (hypotension, sedation) in any groups.Conclusions: We concluded that dexmedetomidine (5μg) with bupivacaine for spinal anesthesia gives significantly longer duration of sensory and motor blockade, than buprenorphine (30μg) with bupivacaine for spinal anaesthesia.

scholarly journals Isobaric levobupivacaine a better and safer substitute for spinal anaesthesia in patients undergoing prolonged lower abdominal and lower limb surgeries

2018 ◽  
Vol 6 (9) ◽  
pp. 3111
Author(s):  
Wasimul Hoda ◽  
Abhishek Kumar ◽  
Priodarshi Roychoudhury
Keyword(s):  
Spinal Anesthesia ◽  
Spinal Anaesthesia ◽  
Lower Limb ◽  
Motor Block ◽  
Sensory Block ◽  
Double Blind Study ◽  
Double Blind ◽  
Sensory Blockade ◽  
Group A ◽  
Group B

Background: Bupivacaine being the drug of choice for spinal anaesthesia is associated with serious cardiac toxicity. Levobupivacaine and ropivacaine, both being the two S enantiomers of bupivacaine can be a safer alternatives with better cardiovascular safety. Hence, the clinical efficacy of both were assessed and compared in patients undergoing spinal anesthesia.Methods: A prospective randomized controlled double blind study was done in 68 adult posted for elective lower abdominal and lower limb surgeries under spinal anesthesia. They were randomized into 2 groups. About 3ml isobaric levobupivacaine 0.5% (15mg) was given in group A and 3ml isobaric ropivacaine 0.5% (15mg) was given in group B. Onset, duration of sensory and motor blocks, time for maximum sensory and motor block, time for 2 segment sensory regression and haemodynamic parameters were recorded and analyzed.Results: All patients achieved a sensory block of T10 dermatome. Onset of sensory blockade at T10 was similar in both groups, group A (5.71±1.31min) and group B (5.94±1.72min). Time from injection to two dermatomal regression was 129.68±15.54min in group A and 111.38±22.35min in group B. Onset of Bromage score of 1 in group A was 4.68±1.27min and in group B was 6.44±1.64min. The mean duration of motor and complete motor block was prolonged in group A patients (197.74±18.51min, 168.82±17.90 min) as compared to group B (131.88±20.41min, 106.71±10.85min).Conclusions: Isobaric levobupivacaine was found to be a better and safer substitute for spinal anesthesia in patients undergoing prolonged lower abdominal and lower limb surgeries.

scholarly journals Comparison between intrathecal nalbuphine and butorphanol as adjuvants to isobaric ropivacaine in elective lower limb orthopedic surgeries: A prospective, randomized, double blind study

2020 ◽  
Author(s):  
Akash Nirmal ◽  
Yashpal Singh ◽  
Sharad Kumar Mathur ◽  
Satish Patel
Keyword(s):  
Postoperative Analgesia ◽  
Lower Limb ◽  
Primary Outcome Measure ◽  
Blind Study ◽  
Double Blind Study ◽  
Motor Blockade ◽  
Chi Square ◽  
Double Blind ◽  
Lower Limb Surgery ◽  
To Receive

Background: Intrathecal ropivacaine is now routinely used for lower limb surgery. Adjuvants e.g. fentanyl, dexmedetomidine or morphine etc. are commonly used to prolong the intraoperative anesthesia or postoperative analgesia. The available literature lacks information on use of butorphanol and nalbuphine as adjuvants with 0.75% isobaric ropivacaine. We aimed to compare nalbuphine and butorphanol as adjuvant with isobaric ropivacaine in lower limb orthopedic surgeries. Methodology: After institutional ethical committee approval and informed written consent, a total of 108 patients of ages between 18 to 65 y, of either sex, American Society of Anesthesiologists (ASA) grade ӏ & ӏӏ, scheduled for elective lower limb orthopedic surgeries, were enrolled and  randomly allocated into two groups: Group RN; to receive isobaric ropivacaine (0.75%, 7.5 mg/ml) 2.5 ml plus nalbuphine 500 µg (0.5 ml), and Group RB; to receive isobaric ropivacaine 2.5 ml plus butorphanol 100 µg (0.5 ml) intrathecally. Primary outcome measure was the duration of sensory‑motor blockade from the time of intrathecal drug administration. Statistical analysis was performed by using t-test and chi-square test as applicable. A p < 0.05 was considered as significant. Results: Duration of sensory (p < 0.001) and motor blockade (p = 0.02) was significantly prolonged in nalbuphine group than butorphanol group. Onset of blockade was earlier in nalbuphine group. Duration of motor block and sensory analgesia was prolonged in group RN (p < 0.001). Perioperative hemodynamic parameters and the observed side effects including bradycardia, hypotension, nausea and vomiting, sedation and shivering were comparable between the two groups (p = 0.77). Conclusion: Intrathecal nalbuphine produces prolonged motor blockade as well as postoperative analgesia than intrathecal butorphanol when used as adjuvants to isobaric 0.75% ropivacaine. Citation: Nirmal A, Singh Y, Mathur SK, Patel S. Comparison between intrathecal nalbuphine and butorphanol as adjuvants to isobaric ropivacaine in elective lower limb orthopedic surgeries: A prospective, randomized, double blind study. Anaesth pain & intensive care 2019;23(4)__ Received: 22 August 2019; Reviewed: 8, 9 October 2019; 6, 7 November 2019; Revised: 18 November 2019; Reviewed: 19 November 2019; Accepted: 20 November 2019

scholarly journals Bupivacaine-dexmedetomidine versus bupivacaine-nalbuphine in ultrasound-guided supraclavicular brachial plexus block: a prospective, randomized, double-blind study

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
H. S. Mohamed ◽  
G. S. Gad
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Block ◽  
Isotonic Saline ◽  
Double Blind Study ◽  
Motor Blockade ◽  
Double Blind ◽  
Upper Limb Surgery ◽  
Supraclavicular Brachial Plexus Block ◽  
Post Operative Nausea ◽  
Plexus Block

Abstract Background Brachial plexus block is frequently performed for ambulatory upper limb surgery as an alternative to general anesthesia. It can significantly reduce pain, reduce post-operative nausea, and vomiting and allowing for faster discharge from hospital. Performing this block under ultrasound guidance has higher index of safety and can monitor the distribution of local anesthetic (LA) in real time. The aim of this study is to compare the block characteristics among bupivacaine-dexmedetomidine (BD), bupivacaine–nalbuphine8 (BN), and bupivacaine-isotonic saline groups. Results The duration of both the sensory and motor blockade was statistically longer in both BD and BN groups with a longer duration of analgesia compared to the BS group. Also, the BD group showed statistically significant higher sedation scores at different times during the study compared with both the BN and BS groups. Conclusion Adding either dexmedetomidine or nalbuphine to isobaric bupivacaine in US-guided supraclavicular brachial plexus block prolongs both sensory and motor blockade. Dexmedetomidine produces significant sedation when added to bupivacaine.

scholarly journals COMPARISON OF INTRATHECAL HYPERBARIC ROPIVACAINE 0.5% WITH AND WITHOUT 75 MG MAGNESIUM SULFATE AS AN ADJUVANT FOR INFRA UMBILICAL SURGERIES: A DOUBLE-BLIND RANDOMIZED CLINICAL TRIAL

2021 ◽  
pp. 117-121
Author(s):  
SRINIDHI SRIKANTH ◽  
ANTONY JOHN CHARLES S ◽  
YASHA KAMAESHAR ◽  
GAYATRI MISHRA
Keyword(s):  
Clinical Trial ◽  
Adverse Effects ◽  
Magnesium Sulfate ◽  
Statistical Tests ◽  
Total Duration ◽  
Motor Blockade ◽  
Double Blind ◽  
Sensory Blockade ◽  
Free Interval ◽  
Post Operative Pain

Objective: Intrathecal magnesium as an adjuvant to hyperbaric ropivacaine could extend duration of sensory blockade and improve the quality of post-operative analgesia; thereby reducing opioid requirements and its adverse effects. Hence, we conducted this prospective, randomized, double-blind clinical trial to observe its effects for day care surgeries. Methods: After obtaining institutional ethical committee approval and registration of trial, patients’ informed consent was taken and eighty adult patients of either gender, ASA 1 and 2, posted for infra umbilical surgeries were divided into two groups: Group RM received 3 ml hyperbaric Ropivacaine with 0.75 ml magnesium sulfate (75 mg) and Group R received 3 ml hyperbaric Ropivacaine with 0.75 ml sterile water. Sensory and motor blockade parameters, hemodynamic variables, and adverse effects were monitored, analyzed using appropriate statistical tests. Results: Total duration of sensory blockade was significantly prolonged in Group RM compared to Group R (242.8 ± 9.9 versus 186.6 ± 8.4 min) (***p<0.001). Complete motor regression was observed significantly earlier in Group RM than in Group R (151.3 ± 7.8 versus 184.7 ± 5.6 min) (*p<0.05). Post-operative pain free interval was significantly prolonged in group RM compared to group R (725.2 ± 18.6 vs. 515.2 ± 17.8 min) (***p<0.001). Conclusion: We concluded that intrathecal magnesium as an adjuvant to hyperbaric Ropivacaine significantly prolonged both sensory blockade duration, post-operative pain-free interval without increasing motor blockade duration and the incidence of adverse effects.

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