Effect of the use of dexmedetomidine as a local anesthetic adjuvant to bupivacaine 0.125% in epidural labor analgesia: randomized controlled study

Abstract Background Multiple methods exist for the management of pain during normal labor. Epidural analgesia has been reported to be an effective method in that perspective. The current study was conducted to evaluate the efficacy of dexmedetomidine as an adjuvant to local anesthetics in epidural analgesia for pregnant females presented for normal delivery. Sixty pregnant females were included in this prospective randomized study, and they were divided into two equal groups: control group which received bupivacaine alone and dexmedetomidine group that received bupivacaine with dexmedetomidine. The primary outcome was the onset of analgesia, while the secondary outcomes included the duration of analgesia, hemodynamic changes, labor progress, neonatal outcomes, and maternal complications. Results Dexmedetomidine group was associated with earlier onset of analgesia (P ˂ 0.001), prolonged duration (P ˂ 0.001), and lower need for top-up doses (P ˂ 0.001) compared to control group. Also, sedation and maternal satisfaction were significantly better in the same group (P = 0.001, 0.025; respectively). Labor progress parameters and neonatal outcomes were comparable between the two groups. Dexmedetomidine group has lower heart rate and mean arterial blood pressure compared to the control group. Despite of dexmedetomidine group had higher incidence of hypotension and bradycardia, it was statistically insignificant when compared to control group. Conclusions Dexmedetomidine is a reliable and an effective adjuvant to the local anesthetics in epidural analgesia during normal delivery as it resulted in earlier onset and significant prolongation of the analgesic time with decrease in the top-up doses intake. Trial registration Pan African Clinical Trial Registry (PACTR201710002664704). Register on 3 October 2017.

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Ultrasound-Guided Cannulation of the Great Saphenous Vein in Neonates: A Randomized Study

American Journal of Perinatology ◽

10.1055/s-0041-1733958 ◽

2021 ◽

Author(s):

Zhenzhen Tu ◽

Yanzhe Tan ◽

Lifei Liu ◽

Jia Xie ◽

Ying Xu ◽

...

Keyword(s):

Great Saphenous Vein ◽

Randomized Study ◽

Controlled Study ◽

Control Group ◽

Success Rates ◽

Procedure Time ◽

Ultrasound Guided ◽

Randomized Controlled ◽

Key Points ◽

Procedural Time

Objective This prospective randomized controlled study aimed to compare the ultrasound-guided (USG) technique with the standard single-wall puncture technique for epicutaneo-caval catheter (ECC) placement in neonates. Study Design A total of 100 neonates were included in this study. All enrolled neonates were randomly divided into two groups (n = 50): the USG group and the control group. The control group underwent standard single-wall puncture for ECC placement procedures, and the USG group underwent USG ECC placement procedures. Results The first attempt success rates (62 vs. 38%; p = 0.016) and the total success rates (92 vs. 74%; p = 0.017) were higher in the USG group than in the control group. The procedure time was shorter in the USG group than in the control group: 351.43 (112.95) versus 739.78 seconds (369.13), p < 0.001. The incidence of adverse events was not significantly different between the two groups. Conclusion Compared with the standard single-wall puncture method, USG cannulation is superior for neonatal ECC placement, with a higher success rate, and decreases the total procedural time. Key Points

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Renal arteries denervation with second generation systems: a remedy for resistant hypertension?

European Heart Journal Supplements ◽

10.1093/eurheartj/suaa158 ◽

2020 ◽

Vol 22 (Supplement_L) ◽

pp. L160-L165

Author(s):

Francesco Versaci ◽

Sebastiano Sciarretta ◽

Massimiliano Scappaticci ◽

Simone Calcagno ◽

Riccardo di Pietro ◽

...

Keyword(s):

Radiofrequency Ablation ◽

Second Generation ◽

Randomized Study ◽

Renal Arteries ◽

Control Group ◽

Energy Delivery ◽

Arterial Blood ◽

Treatment Of Hypertension ◽

Effective Therapeutic Strategy

Abstract Initial studies on renal denervation (RDN) for the treatment of non-controlled arterial hypertension (HTN) through radiofrequency ablation of renal arteries demonstrated that RDN is an effective therapeutic strategy to reduce arterial blood pressure (BP). Nonetheless, the first randomized study, SYMPLICITY-HTN-3, failed to demonstrate a clear benefit for RND over the control group. Technologic evolution, with the introduction of new second generation multi-electrode devices, allowed deep energy delivery along the full circumference of the vessel. Two recent randomized studies involving patients assuming (SPYRAL HTN-ON MED) or not (SPYRAL HTN-OFF MED) antihypertensive pharmacologic treatment, demonstrated the efficacy and safety of RDN using second generation systems for radiofrequency ablation. Another recent randomized study demonstrated that RDN with ultrasounds (RADIANCE-HTN SOLO) of the main renal arteries led to a significant BP reduction compared to the control group. These studies have once again raised the interest of the scientific community towards attempting to define the appropriate role of RDN in the treatment of hypertension. Nonetheless, larger and longer clinical trials will be necessary to draw further conclusions.

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Efficacy of dexamethasone in reducing the incidence of postoperative sore throat: a double blind randomized study

Journal of Patan Academy of Health Sciences ◽

10.3126/jpahs.v5i1.24034 ◽

2018 ◽

Vol 5 (1) ◽

pp. 10-15 ◽

Cited By ~ 1

Author(s):

Sujita Manandhar ◽

Kishor Manandhar ◽

Sharad Khakrel

Keyword(s):

Endotracheal Tube ◽

Sore Throat ◽

Randomized Study ◽

Saline Group ◽

Controlled Study ◽

Control Group ◽

Lower Grade ◽

Postoperative Sore Throat ◽

Double Blind ◽

Dexamethasone Group

Introductions: Postoperative sore throat (POST) is a commonly seen adverse event after general anesthesia with endotracheal intubation. Dexamethasone, a potent corticosteroid with anti-inflammatory action is the most popular steroid studied in this regard with positive results. Methods: This randomized, prospective, double-blinded, placebo-controlled study was conducted on one hundred and ten adult patients of either sex, American Society of Anesthesiologists physical status I & II, undergoing elective surgeries requiring endotracheal tube intubation. After obtaining written informed consent, they were randomly divided into Control (A, n=55) and Dexamethasone (B, n=55) groups and received either an injection of Dexamethasone (Group B) 8 mg intravenously or an equivalent volume of Normal Saline (Group A) just before entering the operating theatre. All the patients received a similar anesthesia with endotracheal tube intubation and at the end of surgery, extubated and transferred to the post-anesthesia care unit. The incidence and severity of sore throat were assessed at 1, 6 and 24 hours post-extubation. Severity of sore throat were graded on a 4 point scale, p <0.05 was considered significant. Results: Incidence of POST in Dexamethasone group was found significantly low compared to the control group up to six hours (p<0.05) but was comparable at 24 hours post extubation. Severity of POST in the study group was of lower grade in compare to control group. Conclusions: Prophylactic intravenous Dexamethasone 8 mg administered to patients undergoing elective surgeries requiring endotracheal tube intubation significantly reduces the incidence and severity of POST up to six hours post-extubation.

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RANDOMISED CONTROLLED STUDY TO EVALUATE THE EFFECTS OF NITROGLYCERINE SUBLINGUAL SPRAY ON TRACHEAL EXTUBATION RESPONSE IN NORMOTENSIVE PATIENTS UNDERGOING SURGERIES UNDER GENERAL ANAESTHESIA

10.36106/ijsr/1600746 ◽

2020 ◽

pp. 1-6

Author(s):

Surendra Kumar Raikwar ◽

Anil Kori* ◽

Aditya Agarwal

Keyword(s):

Stress Response ◽

General Anaesthesia ◽

Tracheal Extubation ◽

Controlled Study ◽

Control Group ◽

Pain Anxiety ◽

Arterial Blood ◽

Variable Success ◽

Related Stress ◽

Randomised Controlled

Tracheal extubation is the translaryngeal removal of a tube from the trachea via the nose or mouth and associated with awakening, pain, anxiety, airway irritation which may cause a cough or difculties in breathing and may contribute to an increase in haemodynamic response (1) .Several modalities, both pharmacological and nonpharmacological have been tried to decrease this stress response with variable success. We undertook this study to assess the efcacy of NTG spray in decreasing extubation related stress response in normotensive patients undergoing elective surgeries under general anaesthesia. Material and methods : Sixty normotensive patients were included in study and randomly subdivided into two groups of 30 patients each – group N receiving NTG spray and Group C not receiving NTG spray prior to extubation. Hemodynamic stress response during extubation was noted in both the groups and compared. Result and conclusion : Extubation was associated with signicant rise in systolic, diastolic and mean arterial blood pressure and heart rate in both the groups, but this stress response was signicantly less in NTG Group as compared to control group.

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Pre-incisional epidural magnesium provides pre-emptive and postoperative analgesia in lower abdominal surgeries: a comparative study

Journal of Society of Anesthesiologists of Nepal ◽

10.3126/jsan.v1i1.13585 ◽

2015 ◽

Vol 1 (1) ◽

pp. 22-28 ◽

Cited By ~ 1

Author(s):

Ninadini Shrestha ◽

Renu Gurung ◽

Moda Nath Marhatta

Keyword(s):

Epidural Analgesia ◽

Postoperative Analgesia ◽

Magnesium Sulphate ◽

Opioid Analgesic ◽

Controlled Study ◽

Anesthetic Technique ◽

Control Group ◽

Double Blind Study ◽

Double Blind ◽

Comparable Group

Background: Magnesium sulphate has been used successfully as a non opioid analgesic adjuvant for postoperative pain management. This prospective controlled study was designed to evaluate the pre-emptive analgesic efficacy of adding magnesium to epidural analgesia in patients undergoing lower abdominal surgeries.Methodology: In a randomized, double- blind study sixty patients undergoing lower abdominal surgery under general anesthesia were assigned to three groups. Pre-magnesium (Group PI), post-magnesium (Group PO) and control (Group C) group. Anesthetic technique was standardized. Patients in pre-magnesium group received bolus of magnesium 50 mg via epidural before induction of anaesthesia followed by boluses of 10 mg h-1 until end of surgery. Post-magnesium group patients received epidural saline during the same time periods plus bolus epidural magnesium 50 mg at the end of surgery. Patients in control group received epidural saline during all three periods. Patients in the magnesium groups received bolus epidural analgesia with Fentanyl 8mcg, Bupivacaine 0.1%, and Magnesium 8mg in a volume of 8 ml after operation, when patient complained of pain and VAS score was more than 4. Patients in the control group received epidural analgesia with Fentanyl 8 mcg and Bupivacaine 0.1% in a volume of 8ml. Blood Pressure, pulse rate, respiratory rate, time to the first request for analgesic, visual analogue scale at rest, 24 hour, opioids consumption and side effect profiles were studied for 24 hours postoperatively.Results: The demographic parameters were comparable. Group PI had significantly lower VAS scores at all times 0,2,4,6,10,14,18 and 24 hours than those in the Group PO or Group C(P<0.05). The groups were similar with respect to haemodynamic, respiratory variables and side effects.Conclusion: Epidural Magnesium sulphate provided preemptive analgesia, and an a analgesic-sparing effect that improved postoperative analgesia without increasing the incidence of side-effects.Journal of Society of Anesthesiologists 2014 1(1): 22-28

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Efficacy of Dexmedetomidine Infusion Without Loading Dose on Hemodynamic Variables and Recovery Time During Craniotomy: A Randomized Double-Blinded Controlled Study

Anesthesiology and Pain Medicine ◽

10.5812/aapm.113410 ◽

2021 ◽

Vol 11 (2) ◽

Author(s):

Ismail Mohammed Ibrahim ◽

Rania Hassan ◽

Raham Hasan Mostafa ◽

Mayada Ahmed Ibrahim

Keyword(s):

Recovery Time ◽

Controlled Study ◽

Control Group ◽

Loading Dose ◽

Hemodynamic Stability ◽

Arterial Blood ◽

Postoperative Intensive Care ◽

Double Blinded ◽

Group D ◽

Dexmedetomidine Infusion

Background: Maintaining hemodynamic stability during intracranial surgery is one of the most important tasks. There is no general agreement regarding which anesthetics are optimal for craniotomy. Propofol and short-acting opioids are usually used, but their use is not without side effects. Recently, dexmedetomidine has been considered a safe alternative in different surgeries. Objectives: We aimed to assess the efficacy of 0.5 µg/kg/h dexmedetomidine infusion without loading dose as an adjunct to general anesthesia for craniotomy. Methods: A prospective, randomized, double-blinded, parallel-group, placebo-controlled trial was conducted. Setting: Single university teaching hospital’s operating rooms and postoperative intensive care unit. Patients: A total of 50 patients scheduled for elective supratentorial craniotomy participated in this study. Interventions: Patients were randomly divided into either control group (Group C) and Dexmedetomidine group (Group D). Main outcome measure: Intraoperative hemodynamics measurements at specific timings. Results: We found that dexmedetomidine had significantly maintained mean arterial blood pressure and heart rate (P-value < 0.001); with lower intraoperative fentanyl and propofol consumption in group D (132 ± 35 µg and 14 ± 30 mg, respectively) when compared to group C (260 ± 38 µg and 534 ± 66 mg, respectively). Finally, a lesser sedation level was noticed in the dexmedetomidine group, together with a significantly lesser recovery time of 10.3 ± 4 min. Conclusions: Dexmedetomidine infusion without loading dose could be an efficacious and safe agent in achieving hemodynamic stability with intraoperative opioid-sparing effect and lesser recovery time.

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The Effect of Integrated Yoga on Labor Outcome: A Randomized Controlled Study

International Journal of Childbirth ◽

10.1891/2156-5287.3.3.165 ◽

2013 ◽

Vol 3 (3) ◽

pp. 165-177 ◽

Cited By ~ 4

Author(s):

Satyapriya Maharana ◽

Raghuram Nagarathna ◽

Venkatram Padmalatha ◽

Hongasandra Ramarao Nagendra ◽

Alex Hankey

Keyword(s):

Birth Weight ◽

Epidural Analgesia ◽

Normal Pregnancy ◽

Controlled Study ◽

Control Group ◽

Cesarean Sections ◽

Apgar Scores ◽

Beneficial Effects ◽

Yoga Group ◽

And Control

BACKGROUND:Antenatal yoga has been found to be useful and reported to have many beneficial effects. The objective of this study was to investigate the effect of yoga on labor outcome.METHODS:This randomized two-armed active control study recruited 96 women with normal pregnancy. The experimental group practiced integrated yoga and the control group practiced standard antenatal exercises (1 hr/day), from 18 to 20 weeks of gestation until term.RESULTS:The first stage of labor was 4.71 ± 0.59 and 6.19 ± 0.79 hr in yoga and control groups, respectively (p< .001, independent samplesttest); the second stage was 23.41 ± 7.68 min in yoga and 55.19 ± 10.87 min in control group (p< .001); the third stage took 9.07 ± 2.35 min in yoga and 12.96 ± 2.86 min in control group (p< .001). Fewer number of women in yoga group required epidural analgesia (p< .001). The cesarean sections (7/51 in yoga and 18/45 in control;p= .004) and complications of pregnancy (intrauterine growth restriction [IUGR], pregnancy-induced hypertension [PIH], and preterm labor) were fewer (p= .010) in yoga than in control group. Birth weight of babies (p< .001) was higher and Apgar scores (p< .001) were better in yoga as compared to the control group.CONCLUSION:Yoga during pregnancy decreases the duration of all stages of labor, complications of pregnancy, need for epidural analgesia, and cesarean sections; it also improves birth weight and Apgar scores of the infant.

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Effect of epidural analgesia in trial of labor after cesarean on maternal and neonatal outcomes in China: a multicenter, prospective cohort study

BMC Pregnancy and Childbirth ◽

10.1186/s12884-019-2648-1 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Jing Sun ◽

Xuetao Yan ◽

Aiwu Yuan ◽

Xiaolei Huang ◽

Yuci Xiao ◽

...

Keyword(s):

Logistic Regression ◽

Epidural Analgesia ◽

Success Rate ◽

Uterine Rupture ◽

Neonatal Outcomes ◽

Study Group ◽

Lactation Period ◽

Trial Of Labor ◽

Arterial Blood ◽

Multivariable Logistic Regression

Abstract Background The trial of labor after cesarean section (TOLAC) is a relatively new technique in mainland of China, and epidural analgesia is one of the risk factors for uterine rupture. This study aimed to evaluate the effect of epidural analgesia on primary labor outcome [success rate of vaginal birth after cesarean (VBAC)], parturient complications and neonatal outcomes after TOLAC in Chinese multiparas based on a strictly uniform TOLAC indication, management and epidural protocol. Methods A total of 423 multiparas undergoing TOLAC were enrolled in this study from January 2017 to February 2018. Multiparas were divided into two groups according to whether they received epidural analgesia (study group, N = 263) or not (control group, N = 160) during labor. Maternal delivery outcomes and neonatal characteristics were recorded and evaluated using univariate analysis, multivariable logistic regression and propensity score matching (PSM). Results The success rate of VBAC was remarkably higher (85.55% vs. 69.38%, p < 0.01) in study group. Epidural analgesia significantly shortened initiating lactation period and declined Visual Analogue Score (VAS). It also showed more superiority in neonatal umbilical arterial blood pH value. After matching by PSM, multivariable logistic regression revealed that the correction of confounding factors including epidural analgesia, cervical Bishop score at admission and spontaneous onset of labor were still shown as promotion probability in study group (OR = 4.480, 1.360, and 10.188, respectively; 95%CI = 2.025–10.660, 1.113–1.673, and 2.875–48.418, respectively; p < 0.001, p = 0.003, and p < 0.001, respectively). Conclusions Epidural analgesia could reduce labor pain, and no increased risk of postpartum bleeding or uterine rupture, as well as adverse effects in newborns were observed. The labor duration of multiparas was increased, but within acceptable range. In summary, epidural analgesia may be safe for both mother and neonate in the three studied hospitals. Trial registration Chineses Clinical Trial Register, ChiCTR-ONC-17010654. Registered February 16th, 2017.

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Effect of magnesium supplementation on emergence delirium and postoperative pain in children undergoing strabismus surgery: a prospective randomised controlled study

BMC Anesthesiology ◽

10.1186/s12871-020-01192-7 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Ji-Hyun Lee ◽

Seungeun Choi ◽

Minkyoo Lee ◽

Young-Eun Jang ◽

Eun-Hee Kim ◽

...

Keyword(s):

Postoperative Pain ◽

Randomized Study ◽

Strabismus Surgery ◽

Preoperative Anxiety ◽

Controlled Study ◽

Control Group ◽

Magnesium Supplementation ◽

Emergence Period ◽

Emergence Delirium ◽

Respiratory Events

Abstract Background The benefits of intraoperative magnesium supplementation have been reported. In this prospective, randomized study, the effects of magnesium supplementation during general anaesthesia on emergence delirium and postoperative pain in children were evaluated. Methods A total of 66 children aged 2 to 5 years who underwent strabismus surgery were assigned to the magnesium or to the control group. Preoperative anxiety was assessed using the modified Yale Preoperative Anxiety Scale. After anaesthesia induction, the magnesium group received an initial loading dose of 30 mg/kg magnesium sulphate over 10 min and, then, continuous infusion of 10 mg/kg per h until 10 min before the end of the surgery. The control group received an equal volume of normal saline via the same regimen. The Paediatric Anaesthesia Emergence Delirium (PAED) score, pain score, and respiratory events were assessed at the postanaesthetic care unit. Results Data obtained from 65 children were analyzed. The PAED and pain scores of the two groups did not differ significantly. There were 26 of 33 (78.8%) and 27 of 32 (84.4%) children with emergence delirium in the control and the magnesium groups, respectively (odds ratio 0.69, 95% CI 0.19–2.44; p = 0.561). The preoperative anxiety score was not significantly correlated with the PAED score. The incidence of respiratory events during the emergence period did not differ significantly between the two groups. Conclusions Magnesium supplementation during anaesthesia had no significant effects on the incidence of emergence delirium or postoperative pain in children undergoing strabismus surgery. Trial registration ClinicalTrials.gov (NCT03132701). Prospectively registered May 8, 2017.

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A prospective, open label, randomized study of efficacy of vitamin A as an add on therapy in the clinical outcome of tuberculosis patients

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20172083 ◽

2017 ◽

Vol 6 (6) ◽

pp. 1333

Author(s):

Sujatha G. ◽

Suguna Bai A. ◽

Preetha N.

Keyword(s):

Drug Therapy ◽

Vitamin A ◽

Pulmonary Tuberculosis ◽

Randomized Study ◽

Phase Iii ◽

Controlled Study ◽

Control Group ◽

Standard Drug ◽

Total Period ◽

Tuberculosis Patients

Background: Tuberculosis is the most prevalent infectious disease in the world. India accounts for nearly one fifth of global incidence of tuberculosis. If untreated the disease may be fatal within five years in 50-65 percent of cases. Many decades of research have shown that severe oxidative stress plays a significant role in tuberculosis patients. Moreover, the malnutrition which is commonly present in patient with tuberculosis can add to the impaired anti oxidant capacity. The present study was to investigate the effect of supplementation of vitamin A with standard treatment on the health status of newly diagnosed sputum positive pulmonary tuberculosis patients.Methods: Phase III, prospective, open, two arm parallel group, outpatient, randomized, active controlled study. Centre of the study was Tuberculosis clinic, Department of Internal medicine, Stanley Medical College Chennai.Duration of the study was for active drug therapy - 2 months, for follow up period - 4 months and for total period - 6 months.Results: In our study it was evident that there was a statistically significant improvement in the Karnofsky’s score, body mass index, mid upper arm circumference in the in the vitamin A supplementation group when compared to the control group at the end of 2 months and 6 months. And also, a statistically significant decrease in C.R.P. levels and E.S.R levels were also observed.Conclusions: This study shows that vitamin A as an add on therapy with regular anti-tuberculosis treatment improves the quality of life and decreases the disease activity in pulmonary tuberculosis patients to a greater extent than with routine standard drug therapy alone.

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