Bolus dose versus fractionated dose injection of hyperbaric bupivacaine in spinal anaesthesia among adult patients undergoing lower limb surgery: A prospective study

Introduction: The use of intrathecal adjuvants in spinal anaesthesia in enhancing and prolonging it’s action has been well established and is widely used for surgery below the umbilicus. Dexmedetomidine, a selective α2A receptor agonist is a suitable adjuvant due to its selective activity. Objectives: To evaluate the effect of a single bolus dose of intravenous dexmedetomidine as an adjuvant in cases undergoing lower limb surgeries under spinal anaesthesia. Methodology: One hundred patients posted for lower limb surgery under spinal anaesthesia with hyperbaric bupivacaine, were equally divided into two groups. In group D, in addition to spinal, intravenous dexmedetomidine 0.5mcg/kg over 10 min was given whereas group C patients received spinal and intravenous normal saline . Results: The onset of sensory and motor block was faster in group D (2.09 ± 0.71 min, 3.18 ± 1min)compared to group C (3.5 ± 0.82 min, 6.19 ± 1.87 min) which was statistically significant . The duration of sensory and motor block was also significantly prolonged in Group D (174.5 ± 14.04 min, 133.4 ± 10.42 min) as compared to Group C(138.2 ± 11.51 min, 120.4 ± 8.8 min).The duration of analgesia in Group D (225.3 ±20.11 min)was prolonged when compared to Group C (168.3 ± 15.11). Conclusion: Intravenous dexmedetomidine as a single bolus dose before spinal anaesthesia can fasten the onset of sensory and motor block, prolongs the duration of sensory and motor block and also increased the duration of analgesia.

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Compare the Analgesic Efficacy of Dexmedetomidineand Fentanyl as an Adjuvant to Bupivacaine for Lower Limb Surgery

10.53350/pjmhs211562153 ◽

2021 ◽

Vol 15 (6) ◽

pp. 2153-2155

Author(s):

Arshi Naz ◽

Mirza Shahzad Baig ◽

Vijai Kumar ◽

Samita S Khan ◽

Sidra Javed ◽

...

Keyword(s):

Spinal Anaesthesia ◽

Lower Limb ◽

P Value ◽

Hyperbaric Bupivacaine ◽

Rescue Analgesia ◽

Sensory Blockade ◽

Significant Difference ◽

Lower Limb Surgery ◽

Group A ◽

Group B

Objective: To compare the analgesic effectiveness of Dexmedetomidine and Fentanyl as an adjuvant to 0.5% Bupivacaine in spinal anaesthesia for patients undergoing lower limb surgery. Study Design: Randomized controlled trial. Place & Duration:The study was conducted at department of Anesthesia, Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi for duration from 15thJuly2020 to 15thFebruary 2021. Methods: In this study 52 patients of both genders undergoing lower limb surgeries were included. Patient’s ages were ranging from 20 to 70 years. All the patients were divided into two Groups. Group A included 26 patients and received Inj. Dexmedetomidine 10 μg in 0.5ml normal saline with 12.5mg of 0.5% hyperbaric bupivacaine, Group B had 26 patients and received 25mg fentanyl with 12.5mg of 0.5% hyperbaric bupivacaine. Time to achieve T10 blockade, time to first rescue analgesia were examined and compare between both groups. All the statistical data was analyzed by SPSS 24.0. P-Value <0.05 was significantly considered. Results: Mean age of group A was 40.52±12.28 years and in group B it was 40.14±13.34 years. There were 18 (69.23%) male patients and 8 (30.77%) females in group A while in Group B 19 (73.08%) patients were male and 7 (26.92%) were females. No significant difference was observed between both groups regarding time to T10 blockade with p-value >0.05. A significant difference was found regarding time to rescue analgesia, in Group A it was 426.58±92.44 minutes and in Group B, it was 206.44±48.47 minutes (p-value <0.0001). Patients’ satisfaction was high in dexemedetomidine group as compared to fentanyl group. Conclusion: Dexmedetomidine 10 μg with 0.5% bupvicaine showed better effectiveness regarding time to first rescue analgesia as compared to fentanyl. No significant difference was observed regarding time to sensory blockade between both medications. Keywords: Dexmedetomidine, Fentanyl, Spinal Anaesthesia, Lower Limb Surgery, Sensory Block, Analgesia

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Comparison of anesthetic effect of ropivacaine with dexmedetomidine and clonidine in patients undergoing lower limb surgery: A prospective study

MedPulse International Journal of Anesthesology ◽

10.26611/101513216 ◽

2020 ◽

Vol 13 (2) ◽

pp. 122-126

Author(s):

Ravishankar V ◽

◽

Sathesh Kumar BM ◽

Keyword(s):

Prospective Study ◽

Lower Limb ◽

Anesthetic Effect ◽

Lower Limb Surgery ◽

A Prospective Study

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Haemodynamic Effects and Complications of Unilateral Spinal versus Standard Spinal Anesthesia in Elderly with Low Ejection Fraction Undergone Lower-Limb Surgery

Delta Medical College Journal ◽

10.3329/dmcj.v5i1.31426 ◽

2017 ◽

Vol 5 (1) ◽

pp. 20-24

Author(s):

Md Mushfiqur Rahman ◽

Md Mahbubul Hasan Munir ◽

Raihanuddin ◽

Shafiul Alam Shaheen ◽

Md Abdus Salam Khan ◽

...

Keyword(s):

Spinal Anesthesia ◽

Spinal Anaesthesia ◽

Lower Limb ◽

Motor Block ◽

Sympathetic Block ◽

Hyperbaric Bupivacaine ◽

Unilateral Spinal Anesthesia ◽

Lower Limb Surgery ◽

Group A ◽

Group B

Background: Cardiovascular system may be profoundly affected by spinal anaesthesia due to unavoidable sympathetic blockade which is more prominent in elderly.A restricted sympathetic block during spinal anesthesia may minimize hemodynamic changes.Objective: To assess whether a unilateral spinal anaesthesia using 0.5% hyperbaric bupivacaine will restrict the sympathetic block to avoid the undesired cardio vascular effects.Materials and method: In this prospective study 60 ASA Ill and IV patients aged between 60-90 years undergoing unilateral lower limb surgery were included. Patients were divided into two groups. In group-A, dural puncture was performed with the patient in the lateral decubitus position with 1.5 mL of hyperbaric bupivacaine. In group-B, it was performed with the patient in a seated position using 1.5 mL hyperbaric bupivacaine. Each patient was then placed in supine position. The speed of injection was 1 mL/30s. Patients were placed in the lateral position with operated side down and kept in this position for 10 minutes. Motor and sensory levels were assessed, and haemodynamic alterations were monitored just after block, 5, 10, 15 and 30 minutes of spinal anaesthesia.Results: The demographic data were found similar in both groups. The time to the onset of the sensory and motor block was significantly shorter in group-B. The duration of motor and sensory block was significantly shorter in group-A. Haemodynamically all the parameters revealed better out come in unilateral spinal anesthesia. The incidence of complications (nausea, headache, and hypotension) was also lower in group A.Conclusion: When unilateral spinal anesthesia was performed using a low-dose, low-volume and low-flow injection technique, it provides adequate sensory-motor block and helps to achieve stable hemodynamic parameters during surgery on a lower limb. Furthermore, this technique avoids unnecessary paralysis on the non-operated side.Delta Med Col J. Jan 2017 5(1): 20-24

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