scholarly journals Comparison of levobupivacaine vs bupivacaine in thoracic spinal anaesthesia for laparoscopic cholecystectomies

2019 ◽  
Vol 7 (12) ◽  
pp. 4568
Author(s):  
Loveleen Kour ◽  
Madan Lal Katoch
Keyword(s):  
Spinal Anaesthesia ◽  
Epidural Anaesthesia ◽  
Motor Block ◽  
Sensory Block ◽  
Neurological Complications ◽  
Combined Spinal Epidural ◽  
Thoracic Spinal ◽  
Long Acting ◽  
Group B ◽  
Spinal Epidural

Background: Levobupivacaine is the pure S enantiomer of racemic bupivacaine. It is a long acting variant that is less toxic to the heart and central nervous system. It has gained relevance and popularity in the modern anaesthetic practice. Thoracic spinal anaesthesia has been shown to an effective   and safe anaesthetic approach for a varied spectrum of surgeries including laparoscopic cholecystectomies.  Incorporation   of epidural catheter adds flexibility and the provision of postoperative analgesia. To adopt thoracic combined spinal epidural anaesthesia for laparoscopic cholecystectomies was chosen in the study. This study aimed at comparing the efficacy of levobupivacaine and bupivacaine in thoracic combined spinal epidural anaesthesia for laparoscopic cholecystectomies.Methods: Total 60 ASA 1 and 2 patients scheduled for laparoscopic cholecystectomies were chosen for the purpose of this study extending from January 2019 to May 2019.  They were randomly divided into two groups - group L and group B. Both the groups received thoracic combined spinal anaesthesia using 2ml of 0.5% isobaric levobupivacaine and 25 µg (0.5ml) fentanyl in group L and 2ml of 0.5% isobaric bupivacaine and 25 µg (0.5ml) fentanyl in group B.  The duration of sensory and motor block, peak block height, maximum motor block achieved, haemodynamic variables and any postoperative neurological complications were evaluated.Results: Both the groups showed similar onset of sensory and motor block. The duration of motor block was similar in both the drug groups; however, levobupivacaine showed a significantly loner duration of sensory block.  There were no significant haemodynamic differences between the two groups and no postoperative neurological complications were seen in any patient.Conclusions: Levobupivacaine was found to be slightly better than bupivacaine in thoracic combined spinal epidural anaesthesia.

COMPARATIVE STUDY OF SEQUENTIAL COMBINED SPINAL EPIDURAL ANAESTHESIA VERSUS SPINAL ANAESTHESIA IN HIGH RISK GERIATRIC PATIENTS FOR MAJOR ORTHOPAEDIC SURGERY

2020 ◽  
Vol 4 (7) ◽  
Author(s):  
Sheetal .
Keyword(s):  
High Risk ◽  
Spinal Anaesthesia ◽  
Epidural Anaesthesia ◽  
Geriatric Patients ◽  
Hyperbaric Bupivacaine ◽  
Combined Spinal Epidural ◽  
Group A ◽  
Major Orthopaedic Surgery ◽  
Group B ◽  
Spinal Epidural

Sequential combined spinal epidural anaesthesia (Sequential CSEA) is probably the greatest advance in central neuraxial block in this decade for high risk geriatric patients because here the advantages of both spinal and epidural anaesthesia are summated avoiding the side effects. This study is designed to compare the clinical effects of sequential combined spinal epidural anaesthesia versus spinal anaesthesia in high risk geriatric patients undergoing major orthopaedic procedure. Sixty patients aged 65 to 80 years, ASA III were randomly allocated into two equal groups. Group A (n=30)  received sequential combined spinal epidural anaesthesia with 1 ml (5 mg) of 0.5% hyperbaric bupivacaine with 20  mg  fentanyl  through  spinal  route, and the expected incompleteness of spinal block was managed with small incremental dose  of  0.5%  isobaric bupivacaine  through epidural catheter, 1.5 to 2 ml for every unblocked segment to achieve T10 sensory level. Group B (n=30) received spinal anaesthesia with 2 ml (10 mg) of 0.5% hyperbaric bupivacaine and 20 mg of fentanyl. Both the groups showed rapid onset, excellent analgesia and good quality motor block. Group A showed a significantly less incidence of hypotension (p< 0.01) along with the provision of prolonging analgesia as compared to group B. So sequential combined spinal epidural anaesthesia is a safe, effective, reliable technique with stable haemodynamic along with provision of prolonging analgesia compared to spinal anaesthesia for high risk geriatric patients undergoing major orthopaedic surgery. Keywords: Sequential combined spinal epidural anaesthesia, Spinal anaesthesia, Fentanyl, Geriatric

scholarly journals A COMPARITIVE EVALUATION BETWEEN COMBINED SPINAL EPIDURAL BLOCK AND EPIDURAL BLOCK FOR LOWER ABDOMINAL SURGERIES

2021 ◽  
pp. 1-3
Author(s):  
Chandeshwar Choudhary ◽  
Praveen Kumar Singh ◽  
Debarshi Jana
Keyword(s):  
Epidural Anesthesia ◽  
Epidural Anaesthesia ◽  
Muscle Relaxation ◽  
Sensory Block ◽  
Epidural Block ◽  
Maximum Height ◽  
Randomised Study ◽  
Combined Spinal Epidural ◽  
Group B ◽  
Spinal Epidural

Introduction: Most of the lower abdominal surgeries are conducted under spinal or epidural anaesthesia. The purpose of this study is to evaluate combined spinal epidural anesthesia and epidural block in terms of efficacy, surgical analgesia and muscle relaxation in patients undergoing lower abdominal surgeries. Material and methods: This prospective randomised study was conducted at SKMCH, Muzaffarpur, Bihar where 60 patients of ASA I and II, aged 20-60 years of both sexes scheduled for elective lower abdominal surgeries were randomized into two groups. Group A – receiving epidural anaesthesia. 20ml of 0.5% plain bupivacaine was injected epidurally.1.5-2ml of 0.5% Bupivacaine was injected epidurally for every unblocked segment after the maximum height of block is reached so as to get the required T6 level. Group B – receiving combined spinal epidural anaesthesia. (2.5 ml) of 0.5% Bupivacaine (heavy) was deposited in the subarachnoid space.1.5-2ml of 0.5% bupivacaine was injected epidurally for every unblocked segment after 10 minutes to get required T6 height of block. Results: The changes in hemodynamic parameters observed between the two groups are statistically not significant. The time to achieve T6 sensory block was significantly shorter in CSE group when compared to epidural group. CSEA provided more degree of motor blockade and significantly good quality of analgesia compared to epidural anesthesia alone. The amount of bupivacaine required to produce the desired level of T6 blockade is 2.5 times less in CSEA compared to epidural anesthesia. Conclusion: Combined spinal epidural technique is effective, safe, with stable hemodynamics and superior to epidural anaesthesia in patients undergoing lower abdominal surgeries.

Combined Spinal Epidural Anaesthesia versus Spinal Anaesthesia with Clonidine for Hip Surgeries: A Randomized Comparative Study

2017 ◽  
Vol 4 (4 (Part-2)) ◽  
pp. 1208-1214
Author(s):  
Pushpa Agrawal ◽  
◽  
Surekha Shinde ◽  
Rohit Jakhalekar ◽  
Pravin Jadhav ◽  
...  
Keyword(s):  
Comparative Study ◽  
Spinal Anaesthesia ◽  
Epidural Anaesthesia ◽  
Combined Spinal Epidural ◽  
Spinal Epidural

scholarly journals Comparison of Intrathecal Fentanyl and Butorphanol as an Adjuvant to Intrathecal Bupivacaine 0.5% in Infraumbilical Surgeries- A Randomised Double Blind Study

2020 ◽  
Author(s):  
Sandip Roy Basunia ◽  
Prosenjit Mukherjee ◽  
Md Bakir Hossain Munshi
Keyword(s):  
Spinal Anaesthesia ◽  
Motor Block ◽  
Controlled Trial ◽  
Sensory Block ◽  
P Value ◽  
Double Blind Study ◽  
Hyperbaric Bupivacaine ◽  
Double Blind ◽  
Group A ◽  
Group B

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.

scholarly journals Effects of Combined Spinal Epidural Anaesthesia and Spinal Anaesthesia on Peri-Operative Pulmonary Status in Geriatric Patients in Lower Extremity Surgery

2020 ◽  
Vol 08 (10) ◽  
pp. 132-147
Author(s):  
Sharmin Ara Begum ◽  
A. K. M. Akhtaruzzaman ◽  
Dilip Kumar Bhowmick ◽  
Debabrata Banik ◽  
Md. Afzalur Rahman ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Spinal Anaesthesia ◽  
Epidural Anaesthesia ◽  
Geriatric Patients ◽  
Combined Spinal Epidural ◽  
Spinal Epidural ◽  
Pulmonary Status

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.

Ambulatory Combined Spinal-Epidural Analgesia for Labor: Influence of Epinephrine on Bupivacaine-Sufentanil Combination

1997 ◽  
Vol 22 (2) ◽  
pp. 143-149
Author(s):  
Philippe E. Gautier ◽  
François Debry ◽  
Luc Fanard ◽  
Albert Van Steenberge ◽  
Jean-Luc Hody
Keyword(s):  
Motor Block ◽  
Randomized Study ◽  
Sensory Block ◽  
Cervical Dilation ◽  
Double Blind ◽  
Late Side Effect ◽  
Combined Spinal Epidural ◽  
Block Level ◽  
Spinal Epidural ◽  
Late Side

Background and ObjectivesSubarachnoid sufentanil 5 μg during labor is known to have variable results. However, subarachnoid sufentanil 5 μg plus bupivacaine 1 mg provides good quality labor analgesia of 100 minutes' average duration. The objective of this study was to examine the effects of adding epinephrine 25 μg to this mixture.MethodsForty-two parturients with less than 5 cm cervical dilation participated in this double-blind, randomized study. A combined spinal-epidural technique was used for subarachnoid administration of sufentanil 5 μg and bupivacaine 1 mg with or without epinephrine 25 μg. Analgesia was assessed by visual analog scores. Time elapsed until first request for additional analgesia, blood pressure, heart rate, sensory levels, motor block, and incidence of pruritus, nausea, and sedation were noted.ResultsAddition of epinephrine prolonged the duration of analgesia from 103.8 ± 28.2 minutes to 142 ± 54.3 minutes and lowered the median cephalad level of sensory block from T3 to T6. The incidence of side effects was similar in both groups, as was the motor performance; 19 patients were able to ambulate in each group.ConclusionsThis minimal bupivacaine-sufentanil-epinephrine mixture allows high-quality analgesia of 142 ± 54.3 minutes' duration, with a low sensory block level and no motor block. However, hypotension can occur as a late side effect.

scholarly journals Intrathecal Magnesium Sulfate as Analgesic and Anaesthetic Adjunct to Bupivacaine in Patients Undergoing Lower Extremity Orthopaedic Surgery

2018 ◽  
Vol 4 (2) ◽  
pp. 74-80 ◽  
Author(s):  
Prakash Maden Limbu ◽  
Sindhu Khatiwada ◽  
Birendra Prasad Sah ◽  
Satyendra Narayan Singh ◽  
Krishna Pokharel ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Lower Extremity ◽  
Magnesium Sulfate ◽  
Spinal Anaesthesia ◽  
Orthopaedic Surgery ◽  
Motor Block ◽  
Sensory Block ◽  
P Value ◽  
Hyperbaric Bupivacaine ◽  
Group B

Background: Subarachnoid block is a popular mode of anesthesia for lower limb surgeries. Studies of Magnesium Sulfate (MgS04 ) as an adjuvant to intrathecal local anaesthetic are limited. The objective was to find out the analgesic and anaesthetic effect of intrathecal MgS04 added to bupivacaine for spinal anaesthesia in patients undergoing lower extremity orthopaedic surgery.Methods: Sixty ASA I or II adult patients undergoing lower extremity orthopaedic surgery were randomly allocated in a double blinded fashion into two groups of thirty each. Group A received 3.0 ml of 0.5% hyperbaric bupivacaine with 0.15 ml of 50% MgSO4. Group B received 3.0 ml of 0.5% hyperbaric bupivacaine with 0.15 ml of NS. Onset of sensory and motor block as well as time to attain highest level of sensory block were recorded. Duration of sensory and motor block along with duration of spinal anaesthesia were also assessed. Any adverse effects were noted and treated.Results: Duration of sensory and motor block along with duration of spinal anaesthesia were prolonged in patients of MgSO4 but were not statistically significant with p-value of 0.33, 0.23 and 0.68 respectively. Onset of anaesthesia, requirement of rescue analgesics, haemodynamic parameters and adverse effects were comparable between two groups.Conclusion: In patients undergoing lower extremity orthopaedic surgery the addition of 75mg of MgSO4 to intrathecal bupivacaine did not prolong the duration of sensory block, spinal anaesthesia nor decreased postoperative analgesic consumption without any additional side effects. Journal of Society of Anesthesiologists of NepalVol. 4, No. 2, 2017, Page: 74-80

scholarly journals Comparison of effect of isobaric bupivacaine vs hyperbaric bupivacaine on haemodynamic variables in thorcic combined spinal epidural anaesthesia for laparoscopic cholecystectomies

2018 ◽  
Vol 6 (10) ◽  
pp. 3413
Author(s):  
Loveleen Kour ◽  
Kuldip C. Gupta
Keyword(s):  
General Anaesthesia ◽  
Spinal Anaesthesia ◽  
Epidural Anaesthesia ◽  
Regional Anaesthesia ◽  
Hyperbaric Bupivacaine ◽  
Combined Spinal Epidural ◽  
Group I ◽  
Operative Complications ◽  
Lumbar Spinal ◽  
Spinal Epidural

Background: Regional anaesthesia has always been an attractive option for laparoscopic surgeries in patients who are not fit for general anaesthesia. Also, regional anaesthesia has certain advantages over general anaesthesia like lesser oropharyngeal morbidity, lesser blood loss and decreased chances of thrombosis. Lumbar spinal anaesthesia has been synonymous with the term regional anaesthesia for laparoscopic surgeries for quite some time now. In the light of recent works by Imbelloni and Zundert, thoracic spinal anaesthesia has been shown to be a promising alternative not only for healthy patients but for high risk patients as well. Baricity defines the density of the drug with respect to CSF density. This undoubtedly makes it is one of the most important factors that influence drug distribution in the subarachnoid space. Drugs of differing baricities have been studied previously in lumbar spinal anaesthesia. We aimed at studying the behaviour of isobaric and hyperbaric bupivacaine using a different approach which in this study was thoracic combined spinal epidural anaesthesia. Authors evaluated the haemodynamic changes as well as neurological and any other post operative complications that occurred in any of the patients.Methods: There were 60 ASA I and II patients undergoing elective laparoscopic cholecystectomy who were chosen for this study. They were randomly divided into two equal groups - group I and group H. Thoracic combined spinal epidural anaesthesia (CSE) was performed at T9-T10 / T10-T11 interspace. Patients in group I received 1.5ml of isobaric bupivacaine 0.5% (5mg/ml) + 25µg (0.5ml) of fentanyl and group H patients were given 1.5ml of hyperbaric bupivacaine 0.5% (5mg/ml) + 25µg (0.5ml) of fentanyl.Results: There was no significant difference among the haemodynamic variables between the two groups and no neurological complication was seen in any patient.Conclusions: Thoracic combined spinal epidural anaesthesia allows haemodynamic stability in laparoscopic cholecystectomies with minimal neurological and post operative complications irrespective of baricity of the drug used.

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