scholarly journals Clinical efficacy of clonidine versus nalbuphine as intrathecal adjuvants to 0.5% hyperbaric bupivacaine for subarachnoid block during gynaecological procedures: a double blind study

Author(s):  
Manoranjan Bansal ◽  
Shikha Agarwal ◽  
Kumkum Gupta ◽  
Prashant K. Gupta ◽  
Salony Agarwal ◽  
...  

Background: Regional anesthesia techniques for gynaecological procedures are on increasing trends due to their advantage of postoperative analgesia owing to intrathecal adjuvants. The present study was aimed to comparatively evaluate the clinical efficacy of clonidine with nalbuphine when co-administered intrathecally with 0.5% hyperbaric bupivacaine for gynaecological procedures.Methods: Regional anesthesia techniques for gynaecological procedures are on increasing trends due to their advantage of postoperative analgesia owing to intrathecal adjuvants. The present study was aimed to comparatively evaluate the clinical efficacy of clonidine with nalbuphine when co-administered intrathecally with 0.5% hyperbaric bupivacaine for gynaecological procedures.Results: The onset of sensory block was earlier in patients of Group BN (3.91±2.25 min vs 4.30±0.87 min, p=0.039). The onset of motor block was also earlier in patients of Group BN (p=0.042). The time to first rescue analgesia in patients receiving intrathecal clonidine was significantly delayed (283±14.18 min vs 231.50±26.18 min, p=0.001). Intraoperative hemodynamic changes were comparable and none of the patient suffered from respiratory depression, shivering, nausea or vomiting.Conclusions: Intrathecal clonidine as adjuvant to bupivacaine provided was clinically more effective than nalbuphine for prolonging the duration of analgesia for gynaecological procedures.

Author(s):  
Trishala Jain ◽  
Jaipal .

Background: Regional anesthesia techniques for gynecological procedures are on increasing trends due to their advantage of postoperative analgesia owing to intrathecal adjuvants. The present study was aimed to comparatively evaluate the clinical efficacy of clonidine with nalbuphine when co-administered intrathecally with 0.5% hyperbaric bupivacaine for Lower abdominal surgeries in Gynecology. Methods: With institutional ethics committee clearance No. 193MC/EC/2018, randomized, double blind study was conducted. After obtaining informed written consent total of 84 patients scheduled for lower abdominal surgeries were randomly allocated into two groups: Group A (n=42) - Inj.  3.5 ml Bupivacaine 0.5% + 0.2 ml Clonidine(30µg) intrathecally.  Group B (n=42) - Inj.3.5 ml Bupivacaine 0.5%+0.2 ml Nalbuphine(2mg) intrathecally. The characteristics of sensory and motor block, hemodynamic data, side effects were recorded. Results: The onset of sensory block was earlier in Group B than Group A (3.08±0.52 min vs 4.00±0.54 min, p<0.001 ). The onset of motor block was also earlier in Group B than Group A (7.78±0.80 min vs 8.80±0.95min, p<0.001). The time to first rescue analgesia in patients receiving intrathecal clonidine was significantly delayed than patients receiving intrathecal nalbuphine (284.95 ± 12.93 min vs 211.52 ± 15.92 min, p<0.001). Introperative hemodynamic changes were comparable and none of the patient suffered from respiratory depression except very little cases of shivering which are not significant. Conclusions: Intrathecal clonidine as adjuvant to bupivacaine provided was clinically more effective than nalbuphine for prolonging the duration of analgesia for gynecological procedures. Keywords: Bupivacaine, Clonidine, Lower abdominal surgeries in gynecology, Nalbuphine, Subarachnoid block.


2019 ◽  
Vol 6 (1) ◽  
pp. 17
Author(s):  
G. S. Sai Ram Prudhvi ◽  
N. S. S. Naga Shyam ◽  
Anand Acharya

<p class="abstract"><strong>Background:</strong> The synergistic action of local anesthetics and morphine is well known, morphine probably more superior for postoperative analgesia, when compared to other opioids. Preservative-free morphine is now available in India making intrathecal administration possible. The present randomized double blind study was designed to evaluate the effect of adding preservative free morphine to hyperbaric bupivacaine given intrathecally for abdominal hysterectomy.</p><p class="abstract"><strong>Methods:</strong> Following approval by the institutional review board and institutional research grant committee, eighty patients presenting for elective abdominal hysterectomy were included in this randomized, double blind study. All drugs used for spinal anesthesia were autoclaved as per the departmental protocol. 3.5 ml of hyperbaric bupivacaine 0.5% [heavy] was given in both groups along with preservative free morphine according to study group.</p><p class="abstract"><strong>Results:</strong> 27.5% (11/40) patients in group A, 17.5% (7/40) patients in group B received one dose of rescue analgesia (ketorolac 10 mg),during the 24 hours for pain relief  while 29 patients is group A (72.5%) and 82.5% (33/40) patients in group B received 2 doses of rescue analgesia. 10% patients in Group A (4/40) and 10% patients in Group B (4/40) had a sedation score of 1 (drowsy and arousable).</p><p class="abstract"><strong>Conclusions: </strong>The mean duration of analgesia in patients who received 250 μgms of intrathecal morphine was 18.725±1.38 hours while in patients who received 150 μgms it is 16.075±1.23 hours. We conclude that 250 µgms of preservative-free intrathecal morphine provides longer duration of analgesia when compared to 150 µgms morphine, with hardly any additional adverse effects.</p>


Author(s):  
Suchita A. Joshi ◽  
Venkatesh V. Khadke

Background: Intrathecal drugs when used as adjuvant to spinal anaesthesia produce substantial anti-nociception and potentiate analgesia of bupivacaine. This study was planned to evaluate the effects of intrathecal non opioid drugs-clonidine, midazolam, neostigmine and magnesium sulphate on duration of analgesia, characteristics of SA and hemodynamic stability when added to 0.5% hyperbaric bupivacaine for spinal anaesthesia.Methods: In this randomized, prospective, double blind study, 100 ASA physical status I and II adults patients posted for elective lower abdominal surgery were divided into 4 groups (n=25). Group BN received preservative free neostigmine 25µg, group BMG received Mgso4 50mg, group BC received clonidine 30µg and BM received midazolam 2mg with 15mg hyperbaric bupivacaine. Duration of postoperative analgesia, effect on onset and duration of sensory and motor block, incidence of side effects was noted. Continuous variables were compared using one way Analysis of Variance (ANOVA).Results: The duration of postoperative analgesia was significantly prolonged in BM group 391.64 (132.98) minutes, followed by BN group 308.76 (127.40), BC group 296.60 (52.77) and BMG group 252.2 (86.76). The numbers of analgesic doses in 24 hours were significantly less in BM group. One patient required additional analgesia in BM group as against 40%, 36% and 64% in BN, BC, BMG group respectively. The duration of sensory block was significantly prolonged in group BM followed by group BC and BN.Conclusions: Intrathecal midazolam provides superior analgesia without clinically relevant side effects. The onset of analgesia was rapid and duration prolonged with intrathecal midazolam followed by neostigmine and clonidine.


2016 ◽  
Vol 1 (2) ◽  
pp. 35-40 ◽  
Author(s):  
Naina P Dalvi ◽  
Narendra Patil

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.


Author(s):  
Sandip Roy Basunia ◽  
Prosenjit Mukherjee ◽  
Md Bakir Hossain Munshi

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.


Author(s):  
Mukesh Choudhary ◽  
Neeti Mahla

Background: Subarachnoid block is the preferred anesthesia for cesarean section, being simple to perform and economical with rapid onset. This study aims to compare the postoperative analgesia of intrathecal nalbuphine and fentanyl as adjuvants to bupivacaine in cesarean section. Methods: A prospective, randomized, double?blind, and comparative study was conducted on 120 patients of American Society of Anesthesiologists (ASA) physical status I and II. These patients were randomized into three groups with fifty patients in each group. Group A received 2 ml of 0.5% hyperbaric bupivacaine (10 mg) plus 0.4 ml nalbuphine (0.8 mg), Group B received 2 ml of 0.5% hyperbaric bupivacaine (10 mg) plus 0.4 ml fentanyl (20 ?g), and Group B received 2 ml of 0.5% hyperbaric bupivacaine (10 mg) plus 0.4 ml of normal saline. Results: The mean duration of sensory block was 107.32 ± 5.36 min in Group A, 111.23 ± 4.23 min in Group B, and 85.69 ± 2.31 min in Group C. The mean duration of motor block (time required for motor block to return to Bromage’s Grade 1 from the time of onset of motor block) was 152.02 ± 3.12 min in Group A, 151.69± 2.36 min in Group B, and 122.12 ± 2.32 min in Group C. Conclusion: We concluded that intrathecal nalbuphine prolongs postoperative analgesia maximally and may be used as an alternative to intrathecal fentanyl in cesarean section. Keywords: Nalbuphine, Bupivacaine, Fentanyl.


Author(s):  
Neha Sharma ◽  
Chetan Shukla

Background: Objective of the study was to identify the efficacy of midazolam as an adjuvant to intrathecal hyperbaric bupivacaine 0.5%, a prospective, randomized, double blind study was conducted to compare the onset, duration of sensory and motor block, postoperative analgesia, hemodynamic changes and complications.Methods: Sixty patients, ASA I/II, Age 18-60 year, scheduled for infraumbilical surgeries, were randomly allocated to group BNS(n=30) to receive intrathecally 2.5 ml of 0.5% hyperbaric bupivacaine with 0.4 ml normal saline; and group BM (n=30) to receive 2.5 ml of 0.5% hyperbaric bupivacaine +2 mg preservative free midazolam 0.4 ml (5mg/ml). We observed onset, duration and regression of sensory and motor block, degree of sedation and pain scores, hemodynamic changes and adverse effects. (PS) version 3.0.0.34 was used for power and sample size calculation. Statistical analysis was performed using Microsoft (MS) office excel software with the student’s t-test and chi-square test (P=0.05)Results: Highest level of sensory blockade (p<.05), motor block duration (179.67±14.94 vs 151.83±10.96 min), sensory block duration (222±16.5 vs 174±12.53 min) and time to first requirement of i.v. analgesia were significantly higher in group BM. Postoperative VAS score was significantly less in group BM. Both groups were comparable in demographic data and hemodynamic changes.Conclusions: Intrathecal 2 mg midazolam found as an attractive adjuvant to 0.5% hyperbaric bupivacaine in spinal anesthesia in infraumbilical surgeries by producing significantly longer duration of motor and sensory block, good quality of intraoperative and postoperative analgesia with less incidence of nausea vomiting as compared to bupivacaine alone. 


2021 ◽  
Vol 8 (19) ◽  
pp. 1363-1368
Author(s):  
Paidikondala L.R.N.N. ◽  
Kommula Gopala Krishna ◽  
Harika Surabattula ◽  
Nagalakshmi N.

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


2017 ◽  
Vol 56 (208) ◽  
pp. 379-87 ◽  
Author(s):  
Binod Gautam ◽  
Sujata Niroula ◽  
Mona Sharma ◽  
Sushila Moktan Lama

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.


JMS SKIMS ◽  
2019 ◽  
Vol 22 (1) ◽  
Author(s):  
Sheikh Irshad Ahmad ◽  
Gowhar Hameed ◽  
Tanveera Gani ◽  
Tantry Tariq Gani ◽  
Wasim Mohammad Bhat ◽  
...  

Background and Aims: This prospective, randomized, double blind study was undertaken to establish the effect of addition of dexamethasone as an adjunct to epidural ropivacaine in patients of carcinoma rectum undergoing lower anteriorresection. Materials and Methods: Sixty ASA (American Society of Anesthesiologists) class I and II patients undergoing lower anterior resection were enrolled to receive either 6mg or 8mg or 10mg of dexamethasone along with epidural ropivacaine to a total of 10ml test solution in each group for epidural analgesia. Hemodynamic parameters, postoperative analgesia, total requirement of rescue analgesia and adverse events were monitored. Results: Analgesia in the postoperative period was better in Group receiving 10mg of dexamethasone associated with less postoperative rescue analgesic consumption Conclusion: Hence, addition of dexamethasone 10mg to epidural ropivacaine can be advantageous with respect to better postoperative analgesia.


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