scholarly journals Comparative study of ropivacaine with ropivacaine-fentanyl and ropivacaine-fentanyl- magnesium sulfate in epidural anesthesia for lower limb surgeries

2018 ◽  
Vol 5 (4) ◽  
pp. 1300 ◽  
Author(s):  
Arushi Gupta ◽  
Tanmay Tiwari ◽  
Rajni Kapoor ◽  
Anita Malik ◽  
Haider Abbas ◽  
...  
Keyword(s):  
Magnesium Sulfate ◽  
Epidural Anesthesia ◽  
Normal Saline ◽  
Lower Limb ◽  
Quality Care ◽  
Complete Recovery ◽  
Motor Blockade ◽  
Double Blind ◽  
Sensory Blockade ◽  
Anesthetic Drugs

Background: Epidural anesthesia is currently one of the most used technique for patients undergoing lower limb surgery. Dose sparing action of one adjuvant for another in epidural anesthesia with local anesthetic drugs for providing quality care to the patient remains controversial. Aims of the present study was to compare and study the properties 0.75% Ropivacaine alone (R) with 0.75% Ropivacaine-Fentanyl (RF) and 0.75% Ropivacaine-Fentanyl-Magnesium sulfate (RFM) in epidural anesthesia for lower limb surgeries. Study design was prospective randomized double blind study.Methods: Patients between 18-60 years of age of ASA physical status class I and II undergoing lower limb surgeries were randomly allocated into 3 groups of 20 each. Total volume in epidural space given was 17ml in all 3 groups. Group R (n=20) received 15ml of 0.75% Ropivacaine with 2ml of normal saline, Group RF (n=20) received 15ml of 0.75% Ropivacaine with 50mg of fentanyl (1ml) and 1ml normal saline and Group RFM (n=20) received 15ml of 0.75% Ropivacaine with 50mg of fentanyl (1ml) and 100mg MgSO4 (1ml). Patients were then studied for hemodynamic profile, various block characteristics and side effects. Statistical analysis used was ANOVA, paired t-test, Chi-square and post hoc test were used. P <0.05 was considered significant.Results: All three groups had stable hemodynamic parameters with Group RFM showing better block characteristics (p <0.001) in terms of time for achieving onset of analgesia, time for achieving T10 sensory blockade, time for requirement of first epidural top up, time for achieving motor Blockade, time for complete recovery of motor blockade with no significant differences in the side effect profile.Conclusions: Epidural anesthesia for lower limb surgeries may have better block characteristic parameters if a combination of Ropivacaine-fentanyl-magnesium sulphate is used in comparison with ropivacaine-fentanyl or ropivacaine alone.

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.

scholarly journals A prospective randomised double-blind study of comparison of efficacy and safety of dexmedetomidine and clonidine as adjuvants to intrathecal isobaric ropivacaine 0.75% in lower limb surgeries

2019 ◽  
Vol 7 (3) ◽  
pp. 711
Author(s):  
Basavaraj Kallapur ◽  
Yashavanthi H. S. ◽  
Safiya I. Sheikh
Keyword(s):  
Normal Saline ◽  
Lower Limb ◽  
Sensory Block ◽  
P Value ◽  
Double Blind Study ◽  
Efficacy And Safety ◽  
Double Blind ◽  
Sensory Blockade ◽  
Intrathecal Clonidine ◽  
Motor Onset

Background: Studies comparing the efficacy of dexmedetomidine and clonidine as adjuvants to ropivacaine 0.75% in spinal anesthesia are few. The objective was to study the safety and efficacy of dexmedetomidine in comparison to clonidine as an adjuvant to ropivacaine in subarachnoid block.Methods: Patients were randomly allotted into 3 groups. Group R (n=30) patients received 3ml of 0.75% isobaric ropivacaine +0.5ml of 0.9% normal saline to a total volume of 3.5ml. Group RD (n=30) patients received 3ml of 0.75% isobaric ropivacaine +5μg of dexmedetomidine +0.9% normal saline to a total volume of 3.5ml. Group RC (n=30) patients received 3ml of 0.75% isobaric ropivacaine +30μg of clonidine +0.9% normal saline to a total volume of 3.5ml. The patients and the investigator were blinded for the study.Results: Time to reach T10 level of sensory block in group R was 7.6±1.3 min, group RC was 7.8±1.4 min and in group RD it was 7.9±1.4 min which was statistically not significant with p value 0.66. Time to reach motor onset to Bromage scale 4 was 9.8±1.4 min in group R, 10±1.4 min in group RC, 10.5±1.5 min in group RD which was statistically not significant with p value 0.24. Time to reach maximum sensory block in group R was 10.7±1.4 min, 10.6±1.1 min in group RC, 11±1.7 min in group RD which was statistically insignificant with p value 0.51.Conclusions: Intrathecal dexmedetomidine had superior anaesthetic effects with respect to duration of sensory blockade, motor blockade and duration of analgesia compared to intrathecal clonidine.

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 COMPARATIVE EVALUATION OF TRAMADOL AND FENTANYL FOR EPIDURAL ANALGESIA IN LOWER LIMB SURGERIES

2020 ◽  
Vol 8 (12) ◽  
pp. 811-816
Author(s):  
Hp Singhl ◽  
◽  
Naveen Jindal ◽  
Jaspreet Singh ◽  
◽  
...  
Keyword(s):  
Lower Limb ◽  
Comparative Evaluation ◽  
Epidural Block ◽  
Epidural Fentanyl ◽  
Epidural Administration ◽  
Double Blind ◽  
Sensory Blockade ◽  
Catheter Technique ◽  
Lower Limb Surgery ◽  
History Of

Background:Epiduralandspinalblocksaremajorregionaltechniques with along history of effectiveuseforavarietyofsurgicalprocedures and pain relief. Epidural block with the catheter technique gives a better control of the level of analgesia and can be used for providingpost-operativepainreliefbyopioidsorlocalanaestheticagents.The purposeofthepresentstudywastocomparethe safetyandefficacyofepiduraltramadolversusepiduralfentanylas adjuvantstobupivacaineforlowerlimbsurgeries. Materials and methods:100 patients werer an domisedin to two groups with50 patient sineach group: Group BB-epidural administration of 20mL 0.5% plain bupivacaine with [50 mg (1 mL) tramadol + 1 mL NS= 2 mL].Group BF- epidural administration of 20 mL 0.5% plain bupivacainewith100mcg(2mL)of fentanyl.Settings and Design- Randomised double-blind trial. Results:The mean onset of sensory blockade and time for maximum sensory blockade was observed to be significantly reduced with the addition of fentanyl to bupivacaine as compared to tramadol and bupivacaine. The results showed statistically significant increase in the duration of analgesia with the addition of fentanyl to bupivacaine as compared to tramadol and bupivacaine. Conclusion:We can conclude that tramadol and fentanyl were effective adjuvants to bupivacaine when used epidurally in patients undergoing lower limb surgery. Although, epidural fentanyl with bupivacaine produces significantly faster onset of sensory blockadecompared to epiduralhowever,epiduraltramadolwithbupivacaineproducessignificantlyprolonged durationofanalgesiacomparedtoepiduralfentanyl.

scholarly journals Comparing the Analgesic Efficacy of Intrathecal Bupivacaine Alone with Intrathecal Bupivacaine Midazolam or Magnesium Sulphate Combination in Patients Undergoing Elective Infraumbilical Surgery

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Josef Attia ◽  
Amany Abo Elhussien ◽  
Mostafa Zaki
Keyword(s):  
Side Effects ◽  
Magnesium Sulphate ◽  
Lower Limb ◽  
Analgesic Efficacy ◽  
Motor Blockade ◽  
Sensory Blockade ◽  
Lower Limb Surgery ◽  
Group A ◽  
Group B ◽  
Limited Duration

Background. Spinal anaesthesia, which is one of the techniques for infraumbilical surgeries, is most commonly criticized for limited duration of postoperative analgesia. Aim of the Work. The aim of this study was to decrease bupivacaine dose used in spinal anesthesia in patients undergoing orthopedic lower limb surgery and reduce its possible side effects. Patient and Methods. Sixty adult patients of both sexes, divided into three. Group C received 2.5 mL bupivacaine and 0.5 mL saline 0.9%. Group A received 2.5 mL bupivacaine and 0.5 mL midazolam. Group B received 2.5 mL bupivacaine and 0.5 mL magnesium sulphate. Results. As regards onset of both motor and sensory blockade, there are a significant decrease in group A and a significant increase in group B as compared to group C, with a significant decrease in duration of motor blockade and significant increase in duration of sensory blockade in both group A and group B, respectively, as compared to group C, with a significant decrease in the duration of sensory blockade in group B as compared to group C. Conclusions. These results suggested that intrathecal midazolam as an adjuvant for bupivacaine increases the duration of both sensory and motor blockade more than that of magnesium sulphate.

A COMPARATIVE STUDY OF DEXMEDETOMIDINE AND FENTANYL AS AN ADJUVANT TO EPIDURAL BUPIVACAINE IN LOWER LIMB SURGERIES

2021 ◽  
pp. 59-61
Author(s):  
Anant Prakash ◽  
Rahul Kumar ◽  
Chandeshwar Choudhary ◽  
Debarshi Jana
Keyword(s):  
Lower Limb ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Maximum Level ◽  
Saline Group ◽  
Sensory Level ◽  
Motor Blockade ◽  
Sensory Blockade ◽  
Bupivacaine Hydrochloride ◽  
Epidural Bupivacaine

Background: Epidural anesthesia is the most commonly used technique for inducing surgical anesthesia and postoperative analgesia in patients undergoing lower limb surgeries. Fentanyl as an adjuvant to epidural local anesthetic has been used for a long time. Dexmedetomidine is a potent and highly selective á-2-adrenoceptor agonist with analgesic potency. Aim: The aim of the present study was to compare the effect of dexmedetomidine and fentanyl as an adjuvant to epidural bupivacaine in lower limb surgeries. Materials And Methods: Sixty patients belonging to the American Society of Anesthesiologists' Grade I or II who were undergoing lower limb surgery were randomly divided into two groups. Group BD: received epidural study solution of 38 ml of 0.25% bupivacaine hydrochloride + 1 ml of 100 ìg dexmedetomidine + 1 ml of normal saline. Group BF: received epidural study solution of 38 ml of 0.25% bupivacaine hydrochloride + 2 ml of 100 ìg fentanyl. Onset and maximum level of sensory blockade, time to attain maximum sensory level, time to complete motor blockade, time for two-segment regression, duration of analgesia and motor block, heart rate, and blood pressure were observed. Pain and sedation were assessed by numerical rating scale and Ramsay Sedation Scale, respectively. Data were recorded and statistically analyzed. Results: The onset of sensory blockade and time to attain maximum sensory level in Group BD were earlier than that of Group BF (P < 0.001). Duration of analgesia and motor blockade in Group BD were signicantly more than that of Group BF (P < 0.001). Postoperative visual analog scale was reduced statistically signicantly in Group BD (P < 0.001). Conclusion: Dexmedetomidine as an adjuvant to epidural bupivacaine is a better alternative to fentanyl with higher analgesic property

INTRATHECALLY ADMINISTERED ADJUVANTS MIDAZOLAM AND CLONIDINE WITH BUPIVACAINE ON HEMODYNAMIC STABILITY- A PROSPECTIVE STUDY

2021 ◽  
pp. 12-14
Author(s):  
Ganga Nagalakshmi ◽  
Subha . J
Keyword(s):  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Respiratory Rate ◽  
Pulse Rate ◽  
Normal Saline ◽  
Sensory Block ◽  
Sensory Level ◽  
Motor Blockade ◽  
Hemodynamic Stability ◽  
Sensory Blockade

We conducted a double blinded randomized control study in 60 patients belonging to ASA I and II undergoing elective lower abdominal surgeries. Patients of both sexes ranging between 22 to 65 years of age were included. Our aim was to evaluate the effects of intrathecal midazolam 2mg and clonidine 30 mcg as adjuvant to bupivacaine for hemodynamic stability and postoperative analgesia. Patients were divided randomly using closed cover technique into two groups of 25 each.Group BM received 3ml of 0.5% heavy bupivacaine 0.4ml midazolam (preservative free) and 0.1ml of normal saline. Group BC received 3ml of 0.5% heavy bupivacaine, 0.2ml clonidine and 0.3 ml of normal saline. The total volume of the injected solution was 3.5ml in both groups. The onset of sensory and motor blockade, the duration of sensory and motor blockade, peak sensory level, time to achieve maximum sensory level, changes in pulse rate, changes in mean arterial pressure, duration of analgesia, respiratory rate, o saturation, 2 sedation score and adverse effects were noted in both groups. The data collected were analyzed by Chi square test and students't' tests. We found that onset of sensory and motor blockade, time to achieve maximum sensory level, and duration of complete motor recovery was earlier in BM group than BC group. Duration of Sensory block and duration of analgesia were prolonged in BM group than BC group. In both groups, no signicant changes were observed in respiratory rate, O saturation and sedation in our study. Intrathecal Midazolam as an adjuvant to bupivacaine 2 comparing to Clonidine resulted Rapid onset of sensory and motor blockade, Achieves maximum sensory level at a shorter interval, Increased duration of sensory blockade and decreased duration of Motor blockadeIt gives stable mean arterial pressure and pulse rate.

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 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.

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