scholarly journals Comparision of dexmedetomidine and clonidine with hyperbaric bupivacain in spinal anaesthesia

2021 ◽  
Vol 8 (12) ◽  
pp. 3563
Author(s):  
Anshul Agrawal ◽  
Sunita Jain ◽  
Ashish Goyal

Background: Alpha-2 adrenergic agonists used as adjuvant to spinal anaesthesia produce substantial sensory and motor blockade of bupivacaine. This study was planned to compare the sensory and motor blockade characteristics of intrathecal combinations of adjuvants dexmedetomidine and clonidine with hyperbaric bupivacaine in the cases who underwent lower limb surgery under spinal anaesthesia.Methods: This was prospective, randomized, double blind study. 90 patients of age group between 18-60 years, ASA grade I and II were allotted into 3 equal groups. Group B received 15 mg bupivacaine plain, group BD and BC received dexmedetomidine (5mcg) and clonidine (50mcg) as adjuvants to bupivacaine respectively.Results: The duration of 2 dermatome regression time, sensory blockade and motor blockade were longest in dexmedetomidine group (129.37±4.87; 386±58.43; 353±48.87) in compared to clonidine (109.77±5.95; 296.53±57.19; 269.7±51.2) and bupivacaine group (81.03±6.83; 211.1± 30.47;181.03±20.8). Both drugs do not affect the peak level of sensory blockade, sensory block onset and motor block onset time. Dexmedetomidine and clonidine do not cause sedation in intraoperative and postoperative period.Conclusions: We conclude that addition of dexmedetomidine and clonidine in spinal anesthesia with hyperbaric bupivacaine increase the duration of ‘2 dermatome regression’ time, sensory and motor blockade and both are more with dexmedetomidine than with 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.


2019 ◽  
Vol 6 (6) ◽  
pp. 1792
Author(s):  
Kiranpreet Kaur ◽  
Sanjay Johar ◽  
Anil Kumar ◽  
Mamta Jain ◽  
Prashant Kumar ◽  
...  

Background: The present study was conducted to compare the effects of 0.5% isobaric levobupivacaine and 0.5% hyperbaric bupivacaine in pregnant females undergoing caesarean section.Methods: Study was conducted on 100 pregnant females undergoing caesarean section. They were randomly divided into two groups B and L receiving 2 ml of 0.5% hyperbaric bupivacaine and 0.5% levobupivacaine respectively. Two groups were compared with regard to sensory block, motor block, haemodynamic stability and complications if any.Results: Time to achieve sensory blockade till T6 dermatome was prolonged in group B (162.52±80.55 sec) as compared to group L (139.40±49.79 seconds) (p value= 0.087). Prolonged duration of motor blockade was observed in group B (160.76±6.56 minutes) as compared to group L (131.48±14.42 minutes) (p<0.001). Less haemodynamic stability was seen in patients of group B with more incidence of hypotension and bradycardia.as compared to group L.Conclusions: Levobupivacaine is nearly equally effective to bupivacaine to produce sensory and motor blockade with comparable onset time and better haemodynamic stability with lesser side effects.


2019 ◽  
pp. 1-3
Author(s):  
Dhananjay Yadav

[1] Kanazi GE, Aouad Mt, KJabbour-Khoury SI et al: Effect of low dose dexmedetomidine or clonidine on the characteristics of spinal bupivacaine block. Act a Anaesthesiol Scand 2006;50:222-7 [2] Hala EEA, Mohamed SA, Hend Y. Dose related prolongation of hyperbaric bupivacaine spinal anaesthesia by dexmedetomidine. Ain Shams J Anaesthesiology 2011;4:83-95 [3] Kim JE, Kim NY, Lee HS, Kil HK. Effects of intrathecal dexmedetomidine on low dose bupivacaine spinal anaesthesia in elderly patients undergoing transurethral prostectomy. Bio Pharm Bul 2013;36;959-965. [4] Mahendru V, Tewari A, Katyal S et al. A Comparison of intrathecal dexmedetomidine, clonidine, & fentanyl as adjuvants to hyperbaric bupivacaine for lower limb surgery: A double blind controlled study. J Anaesthesiol Clin Phrmacol 2013;29:496-502 [5] Soumya samal et al: Intrathecal buterphenol or intrathecal dexmedetomidine for post operative analgesia a comparative study: healt agenda, vol 2. Issue 1. Jan 2014 [6] Dexmedetomidine in anaesthesia practice: a wonder drug? IJAaug 2014 by S K Harsoor [7] Sudheesh K, Raghvendra Rao R S, Kavya M, Aarthi J, Rani D D, Nethra S S. Comprative study of 2 doses of intrathecal dexmedetomidine as adjunct with low dose hyperbaric bupivacaine in ambulatory perianal surgeries. A prospective randomized controlled study. Indian J Anaesth 2015;59:648-52 [8] El-Attar A, Aleen MA, Beltagy R, Ahmed W. A comparative study of intrathecal dexmedetomidine and fentanyl as additives to bupivacaine. Res Opin Anesth Intensive care 2015;1:43-9 [9] Kurhekar P, Kumar SM, Sampath D. Comparative evaluation of intrathecal morphine and intrathecal dexmedetomidine in patients undergoing gynecological surgeries under spinal anaesthesia. A prospective randomized double blind study. Indian J anaestg 2016;60:382-7


2017 ◽  
Vol 4 (6) ◽  
pp. 1653
Author(s):  
Amitha S. ◽  
Pradeep R.

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.


Author(s):  
Wasimul Hoda ◽  
Abhishek Kumar ◽  
Priodarshi Roychoudhury

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.


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.


2021 ◽  
Vol 8 (8) ◽  
pp. 420-426
Author(s):  
Saba Wani ◽  
Sadia Ali Wani ◽  
Salma Mariyam

Introduction:- Ketamine and Fentanyl used intrathecally as adjuvant to 0.5% hyperbaric bupivacaine for patients undergoing TAH to shorten the onset of sensory and motor blockade and prolonging the duration of block. Aims and Objective:-We evaluated onset and duration of sensory and motor blockade and timing of regression of sensory blockade to T 12 and motor blockade to Bromage scale 3. Material and Methods:-This analytical Comparative Study was conducted in Department of Anaesthesiology, Era’s Lucknow Medical College and Hospital, Era University, Lucknow over a period of eighteen months from 2016 -2018 following approval from institutional ethical committee and written informed patient consent. The sample size of 162 female patient aged 40 to 60 years, belonging to ASA physical status 1 and 2 undergoing TAH were randomly allocated to three groups in double blind manner. Group I Received Inj. Bupivacaine (0.5% Heavy) 3.0ml + Inj. Ketamine (25 mg), Group II Received Inj. Bupivacaine (0.5% Heavy) 3.0 ml + Inj. Fentanyl (25 µgm), Group III (Control Group): Received Inj. Bupivacaine (0.5% Heavy) 3.0 ml + Normal saline 0.5 ml. Onset and Duration of Sensory and Motor Blockade and time taken for regression of sensory level to T12 and motor level to Bromage scale 3 noted. Results:- The present study showed that both Ketamine as well as Fentanyl shortened the onset time and prolonged the block duration. However, with respect to onset time, ketamine has shorter onset of blockade than fentanyl. Conclusion:- Both the modalities independently assured quicker onset and prolonged duration of block, thus suggesting that adjuvant use of either of two could be beneficial. Keywords: TAH, Ketamine, Fentanyl, Bupivacaine.


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.


2020 ◽  
Vol 5 (1) ◽  
pp. 126-130
Author(s):  
Tuhin Vashishth ◽  
Sangeeta Varun

Background: Spinal anesthesia is a preferred technique of choice in infraumbilical surgeries. The spinal anesthesia effect can be improved by adding various adjuvant like Fentanyl, clonidine, dexmedetomidine. Dexmedetomidine is a highly selective alpha 2 adrenergic agonists. The aim of study to compare efficacy and safety between Dexmedetomidine and Fentanyl with Bupivacaine.Subjects and Methods:A prospective randomized, double-blind study was conducted on 100 patient by dividing them into two groups. Group D: 2.5ml (12.5mg) of 0.5% hyperbaric bupivacaine with 5mcg (0.5ml) dexmedetomidine and Group F : 2.5ml(12.5mg) of 0.5% hyperbaric bupivacaine with 2 5mcg(0.5ml)  fentanyl. The total volume injected intrathecally was 3.0ml in ASA I and II grade patient undergoing lower limb surgery.Results:Patients in dexmedetomidine groupD had a significantly longer sensory and motor block time than patients in fentanyl group F.The mean time of sensory regression to level S1 was 306.00 ± 13 .32 in group D and 206.14± 16.69 in group F(P<0.001). The regression time of motor block to reach modified Bromage 0 was 257.70±14.61 in group D and 178.54±14.23 in group F(P<0.001).Conclusion:Intrathecal Dexmedetomidine is associated with prolonging motor and sensory block as compare to Fentanyl.


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