scholarly journals Evaluation of Dexmedetomidine Co-Administered with Neostigmine and Bupivacaine for Postoperative Epidural Analgesia in Lower Limb Orthopaedic Surgeries – A Study from Maharashtra, India

2021 ◽  
Vol 10 (32) ◽  
pp. 2634-2639
Author(s):  
Parag Yashawant Dongre ◽  
Aruna Vijay Chandak ◽  
Amol P. Singam
Keyword(s):  
Side Effects ◽  
Epidural Analgesia ◽  
Lower Limb ◽  
Rescue Analgesia ◽  
Post Surgery ◽  
Group I ◽  
Post Operative Pain ◽  
Key Words Epidural ◽  
Spinal Epidural

BACKGROUND Addition of adjuvants to the neuro axial blocked helps prolongate the duration and quality of analgesia and anaesthesia. The safety and efficacy of drugs dexmedetomidine and neostigmine have been less commonly studied. We wanted to compare post-operative analgesia, haemodynamics, and side effects if any in this study. METHODS Combined spinal - epidural anaesthesia was performed in 60 patients who underwent lower limb surgeries of less than 2 hrs. The patients were given the drug epidurally post-surgery. Group I, II and III were given 10 ml of 0.25 % bupivacaine alone, with 1 microgram per kg of neostigmine and with 0.5 milligram per kg of dexmedetomidine and 1 microgram per kg of neostigmine, respectively. 50 mg tramadol intravenous was kept as rescue analgesic. Parameters which predict haemodynamics, assessment of pain, period of analgesia, demand for rescue analgesia and the chances of side effects were noted over the next ten hrs. RESULTS To conclude, epidural analgesia is the most preferred analgesia these days in management of lower limb orthopaedic surgery’s post-operative pain. When bupivacaine was combined with neostigmine and dexmedetomidine as a neuraxial adjuvant, it prolonged the post-operative analgesia significantly without increasing the side effects of those drugs. The combination of two drugs proved better than the use of single drug alone. CONCLUSIONS Combination of neostigmine and dexmedetomidine when used as a neuraxial adjuvant, significantly prolonged the duration of post-operative analgesia by 274.13 4.539 in lower limb orthopaedic cases compared to neostigmine alone that was 176.23 ± 3.441. KEY WORDS Epidural, Neostigmine, Dexmedetomidine, Orthopaedic Surgeries, Post-Operative Analgesia

scholarly journals The place of dural puncture epidural as a modern method of pain relief in labor

2021 ◽  
Vol 17 (2) ◽  
pp. 112-115
Author(s):  
A.O. Zhezher ◽  
Ye.M. Sulimenko ◽  
O.A. Loskutov
Keyword(s):  
Side Effects ◽  
Epidural Analgesia ◽  
Dural Puncture ◽  
Epidural Block ◽  
Needle Size ◽  
Combined Spinal Epidural ◽  
Dural Puncture Epidural ◽  
Spinal Epidural ◽  
The Impact

Childbirth is a physiological process that is accompanied by severe pain. Physiological and psychological factors may be involved in the pathological process. Increasing the concentration of catecholamines may help reduce uteroplacental perfusion. Pain during childbirth can lead to hyperventilation of the mother, which in turn can affect the acid-base status of the fetus and the state of the newborn. Prolonged pain can lead to the development of severe psychological disorders with a violation of the connection between mother and newborn. Acute pain during childbirth can transform into chronic in the postpartum period. The most effective are neuroaxial methods of analgesia: epidural analgesia, combined spinal-epidural analgesia and their modifications. Classical epidural analgesia has minimal adverse and side effects, but may be associated with a high incidence of insufficient analgesia. The frequency of inadequate epidural block reaches 23 %. Combined spinal-epidural analgesia, in contrast to epidural analgesia, has a higher quality of sensory block, but it is associated with a higher frequency of side effects such as hypotension, severe motor block, fetal arrhythmia. Since 2005, dural puncture epidural has been introduced into the practice of obstetric anesthesiologists as a method to improve the quality of classical epidural analgesia with minimal side effects of combined spinal-epidural analgesia. Data from existing studies show that dural puncture epidural potentially improves the quality of analgesia (faster onset of analgesia, better sacral coverage, lower incidence of inadequate block) compared with epidural analgesia and causes less hypotension, disorders of fetal heart rate compared with combined spinal-epidural analgesia. But the spinal needle size is important in achieving these effects. Further researches may be aimed at determining the duration of labor, the option of delivery and the possible impact of dural puncture epidural on the vegetative regulation of labor and a broader study of the impact of this method on the fetus and newborn.

scholarly journals A Clinical Comparative Study between Epidurally Administered Ropivacaine 0.2 % and Ropivacaine 0.2 % with Clonidine for Post-Operative Analgesia in Lower Limb and Abdominal Surgeries

2020 ◽  
Vol 7 (50) ◽  
pp. 3010-3015
Author(s):  
Vishwanath V.M ◽  
Ravishankar R.B
Keyword(s):  
Blood Pressure ◽  
Side Effects ◽  
Epidural Analgesia ◽  
Postoperative Analgesia ◽  
Lower Limb ◽  
Analgesic Efficacy ◽  
Hemodynamic Parameters ◽  
Alpha Agonist ◽  
Effective Analgesia

BACKGROUND There are many modalities to give postoperative analgesia. Out of them epidural analgesia offers good reliable pain relief. Addition of alpha agonist enhances the onset of analgesia and duration of analgesia is prolonged. This study was done to compare the analgesic efficacy, and the hemodynamic parameters of ropivacaine compared with ropivacaine in combination with clonidine for post-operative epidural analgesia. METHODS 30 patients of age 18 - 70 years with ASA grade of I & II, undergoing elective lower limb and abdominal surgeries were randomly taken into each of the 2 groups. Group R received 0.2 % ropivacaine and group RC received 0.2 % ropivacaine + clonidine (1 mcg / Kg) epidurally.1,2 Patients were monitored for onset, duration, quality of analgesia, cardiorespiratory stability and side effects. RESULTS The onset of analgesia and quality of analgesia were better in the RC group compared to the R group. The duration of analgesia in group RC (9.43 + - 1.17 hours) was found to be significantly prolonged than group R (4.90 + - 1.03 hours) with p < 0.001. Blood pressure was more stable in group RC compared to group R. CONCLUSIONS In this study we found that ropivacaine with clonidine as epidural postoperative analgesia provided superior and more effective analgesia when compared to ropivacaine. The duration of analgesia was significantly longer in group ropivacaine with clonidine. KEYWORDS Ropivacaine, Clonidine, Post-operative Analgesia, Epidural

scholarly journals Comparative study of duration of analgesia with epidural bupivacaine and bupivacaine with tramadol in lower limb surgeries

2017 ◽  
Vol 5 (5) ◽  
pp. 2003
Author(s):  
Dipti Saxena ◽  
Sadhana Sanwatsarkar ◽  
Atul Dixit ◽  
Bipin Arya
Keyword(s):  
Side Effects ◽  
Lower Limb ◽  
Total Duration ◽  
Onset Of Action ◽  
Group I ◽  
Epidural Bupivacaine ◽  
Group B ◽  
High Level ◽  
A Prospective Study

Background: The administration of local anaesthetic and opioid mixture via epidural route is excellent for post-operative pain during lower limb surgeries. This combination provides better quality of analgesia, lower side effects and high level of patient satisfaction. Therefore, this study was taken up to evaluate the efficacy safety, tolerance and side effects for the combination of tramadol and bupivacaine in the management of post-operative pain.Methods: This was a prospective study where a total of 40 patients; 20 each in group I and II were selected. Patients who were admitted for lower limb surgeries   in age range of 18-50yrs and belonged to ASA grade I &II.  Group A was given epidural bupivacaine 0.5% and group B was given epidural bupivacaine 0.5% with tramadol 50mg. The parameters studied were onset of action, quality of anesthesia, degree of motor blockade, duration of analgesia, hemodynamic alterations, intraoperative and postoperative complications. Pain was evaluated with verbal score. Results were evaluated statistically.Results: The mean duration of analgesia was significantly longer in patients with tramadol. The quality of analgesia and pain scores were better in patients who were administered tramadol.  The number of drug doses required was significantly reduced by addition of tramadol.Conclusions: Tramadol is a safe and effective adjuvant to epidural bupivacaine for prolongation of total duration of analgesia in lower limb surgeries.

Effectiveness analysis of the new method of antireflux surgery in patients with hiatal hernia

2020 ◽  
Vol 26 (4) ◽  
pp. 50-55
Author(s):  
A.R. Stasyshyn ◽  
◽  
A.A. Hurayevskyy ◽  
Yu.Y. Holyk ◽  
◽  
...  
Keyword(s):  
Quality Of Life ◽  
Los Angeles ◽  
Hiatal Hernia ◽  
Antireflux Surgery ◽  
New Method ◽  
Life Questionnaire ◽  
Post Surgery ◽  
Group I ◽  
Significant Difference

Aim. To analyze the effectiveness of a new method of antireflux surgery in patients with hiatal hernia. Materials and Methods. The results of treatment of 157 patients with hiatal hernia from 2016 to 2020 are analyzed. The patients were divided into 3 groups: group I, N=59, underwent laparoscopic antireflux operation modified by the authors (Patent of Ukraine № 59772); group II (N=77), underwent laparoscopic Nissen fundoplication; and group III (N=21) - laparoscopic Toupet fundoplication. Results and Discussion. At 36 months post-surgery follow-up, there was a statistically significant difference in favor of group I on the average scores of the visual analog scale for reflux symptoms, dysphagia and extraesophageal symptoms; the average quality of life questionnaire scores; the average DeMeester index; distribution of the patients by satisfaction; distribution of the patients by degree of reflux esophagitis according to the Los Angeles classification; and distribution by gas-bloat syndrome. Conclusions. Clinical application of the developed new method of laparoscopic surgery for hiatal hernia reduces the number of relapses and complications after surgery, and improves the quality of life of patients. Key words: hiatal hernia, antireflux surgery, new methods of treatment

scholarly journals POST-OPERATIVE PAIN RELIEF FOR LOWER ABDOMINAL SURGERY

2005 ◽  
Vol 12 (03) ◽  
pp. 340-345
Author(s):  
ROBINA FIRDOUS
Keyword(s):  
Pain Management ◽  
Side Effects ◽  
Pain Relief ◽  
Abdominal Surgery ◽  
Opioid Receptors ◽  
Acute Pain ◽  
Alternate Route ◽  
Parenteral Route ◽  
Group I ◽  
Post Operative Pain

The severity of post-operative pain and the lack of efforts in relievingit have led to the involvement of Anaesthesiologists in the management of post-operative and acute pain. Parenteralopiates have been utilized for post-operative pain management. The identification of the opioid receptors on substantiagelatinosa has provided an alternate route i.e 1 the epidural route - for administering opiates. Objectives: To evaluateand compare the efficacy and side effects of parenteral Buprenorphine with those of Extradural Buprenorphine.Setting: Department of Anaesthesia, District Headquarter Hospital, Faisalabad. Period: The data was collected duringthe last three and a half years. Materials and Methods: Sixty adult patients of either sex and ages ranging from 35-45years, who underwent lower abdominal surgery, were randomly selected for the study. They were equally divided intotwo groups. Group I patients were administered Buprenorphine 0.3 mg through the epidural catheter in extraduralspace. Group II patients were given Buprenorphine 0.3 mg intramuscularly. Results: Buprenorphine through theepidural route gives better analgesia with fewer side effects as compared with the parenteral route.

scholarly journals Advantageous usage combined spinal, epidural and general anesthesia versus general anesthesia in abdominal surgery

2003 ◽  
Vol 131 (5-6) ◽  
pp. 232-237 ◽  
Author(s):  
Vesna Malenkovic ◽  
Sava Zoric ◽  
Tomislav Randjelovic
Keyword(s):  
Intensive Care ◽  
Side Effects ◽  
Abdominal Surgery ◽  
General Anesthesia ◽  
Controlled Study ◽  
General Anesthetics ◽  
Subjective Effect ◽  
Combined Spinal Epidural ◽  
Spinal Epidural

Type and technique of anesthesia have an important effect on per operative surgical course. The aim of the study was prospective analyses of advantages of combined spinal, epidural and general anesthesia (CSEGA) versus general anesthesia (GA) in abdominal surgery according to: 1. operative course (haemodynamic stability of patients, quality of analgesia, undesirables effects), 2. postoperative course (quality of analgesia, unfavorable effects, temporary abode of patients in intensive care). Using prospective randomized double blind controlled study, we evaluated two groups of patients whom the same type of abdominal surgical intervention was planed and the only difference was the type of technique of anesthesia. First group of patients (n=34), was treated with CSEGA and second group of patients (n=33), was treated only with standard (GA). Both groups had intraoperative and 24-hour-long postoperative continued monitoring of blood pressure central venous pressure, and dieresis. In the 24 hours postoperative period the following parameters were analyzed: vigilance conditions, motor block level, pain intensity in rest and movement, necessity for a complementary analgesia, side effects and final subjective effect of analgesia. There was important difference in waking up the patients after a general anesthesia in the first group this period was shorter. In the first 24 hours, patients from the first group didn't get any systemic analgesic, while the patients from the second group needed fractionary application of parenteral analgesics in the period of 4-6 hours. Patients from the first group were also physically faster and easier recovered and they had less respiratory complications and there was not any example of thromboembolysm and the intestine motility was faster re-established. First group of patients spent less time in intensive care (three days) than second group (six days). Final subjective effect of analgesia, according to verbal descriptive scale (VDS) of pain was satisfying with 75% of patients of the first group and 15% of patients of the second group. According to results investigation advantages of CSEDGA versus GA in abdominal surgery manifold: better hemodynamic stability and perfusion of operative region, decrease of single doses of opioid analgesics, local and general anesthetics followed by the decrease of their side effects, better intensity and longer duration of analgesia, improved total functional capability of patients.

scholarly journals Comparitive evaluation of different concentrations of alcohol in ultrasound guided coeliac plexus neurolysis for pain relief in upper abdominal malignancies

2021 ◽  
Vol 8 (4) ◽  
pp. 492-500
Author(s):  
Manish Kumar Singh ◽  
Pragya Verma ◽  
Sarita Singh ◽  
Gyan P Singh ◽  
Hemlata Verma
Keyword(s):  
Quality Of Life ◽  
Morphine Consumption ◽  
Rescue Analgesia ◽  
Vas Score ◽  
Group I ◽  
Significant Difference ◽  
The Mean ◽  
Group Ii ◽  
Upper Abdominal

Patients suffering from advanced upper abdominal malignancies have pain as predominant symptom affects their quality of life and survival. USG guided coeliac plexus neurolysis become benevolence in these patients on part of their pain management and quality of life improvement. To compare the efficacy of USG guided coeliac plexus neurolysis for pain relief in upper abdominal malignancies by using different concentration of alcohol (50% vs 75%).This Prospective, comparative, randomised double blinded study was conducted during Sep 2019 – Aug 2020 at our tertiary care centre. Total 60 cases were taken as per following inclusion and exclusion criteria and randomly divided into 2 groups i.e. 30 each group, we compare Visual Analogue Scale (VAS) score, quality of life (QOL) and need of rescue analgesia profile between the groups to know the efficacy of USG guided coeliac plexus block. In our study, we observed that the baseline mean VAS score in group I was 8.26±0.78 while in group II was 8.03±0.76. No significant difference was found in mean VAS score at this time between the groups (p=0.24). The baseline mean QOL score in group-I was 77.46±3.40 while for the cases of group II the mean QOL score was 77.36±3.33. No significant difference was found in mean QOL score at baseline between the groups (p=0.90). The baseline mean morphine consumption in group-I was 113.33±39.24 mg while for the cases of group-II the mean morphine consumption was 120.33±38.37mg. No significant difference was found in mean morphine consumption at this time between the groups (p=0.48).Both groups having 50% alcohol and 75% alcohol decreases the VAS score from baseline in patients having upper abdominal malignancies along with QOL and dosages of rescue analgesia whereas no significant difference in VAS score in patients of both groups.

scholarly journals Epidural butorphanol for post operative analgesia in lower limb surgeries: A comparative study with epidural tramadol

2017 ◽  
Vol 6 (3) ◽  
pp. 26-32
Author(s):  
G P Deo ◽  
S K Shrestha ◽  
I N Shrestha
Keyword(s):  
Patient Satisfaction ◽  
Side Effects ◽  
Lower Limb ◽  
Analgesic Efficacy ◽  
Epidural Injection ◽  
Double Blind ◽  
Duration Of Action ◽  
Number Of Patients ◽  
Group B

To compare the efficacy of epidural butorphanol and tramadol for post operative analgesia in lower limb surgeries. Randomized, controlled, double blind, prospective study conducted at Department of Anaesthesia and Critical Care, Chitwan Medical College from September 1st 2015 to August 31st 2016. 60 patients of ASA Grade I and II of either sex, aged between 18-65 years willing for epidural analgesia for post operative analgesia were included in the study. They were divided into two groups: Group B- Butorphanol group and Group T- Tramadol group. Subjects of Group B received 2mg of Butorphanol and 0.25% Bupivacaine making a total volume of 10 ml and that of Group T received 100mg of Tramadol and 0.25% Bupivacaine also making a total volume of 10 ml. Analgesic efficacy was assessed by Visual Analogue Scale (VAS). The onset and duration of analgesia along with side effects were also assessed. The quality of analgesia was studied using time to independent mobilization and overall patient satisfaction. Total number of patients was 60, of ASA Grade I and II, aged between 18-65 years. The mean age of patients in Group B was 42.6±11.7 years and 46.1±11.2 years in Group T. Time of onset of analgesia after epidural injection was 7.4±0.9 minutes in Group B and 12.7±1.5 minutes in Group T and the difference was found to be statistically significant. Duration of analgesia was 317.1±99.1 minutes and 438.8±136.6 minutes in Butorphanol and Tramadol groups respectively which was also statistically significant. Sedation was significantly higher in butorphanol group whereas nausea and vomiting was higher in tramadol group. Quality of analgesia in terms of patient satisfaction was better with epidural butorphanol. Both epidural tramadol and butorphanol were effective in relieving post operative pain however butorphanol had lesser side effects and greater patient satisfaction compared to tramadol but the duration of action was relatively short.

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