Comparative study of intrathecal fentanyl with bupivacaine and fentanyl midazolam with bupivacaine in spinal anaesthesia

Spinal anaesthesia is preferred for lower abdominal and lower limb surgeries. Bupivacaine is the most popular local anaesthetic for subarachnoid blockade because of less neurotoxicity. Intrathecal bupivacaine alone may be insufficient to provide prolonged post-operative analgesia, even with high sensory block. So, various adjuvants are used like ketamine, midazolam, clonidine, opioids, neostigmine etc. to prolong the effect of local anaesthetic.To compare the effect of intrathecal fentanyl and fentanyl-midazolam combination with hyperbaric bupivacaine for quality of anaesthesia and post-operative analgesia.Study was conducted on 60 patients aged 20-60 years and were randomly divided into two groups of 30 patients each. Group A received 0.5% bupivacaine heavy 3 ml (15mg) + fentanyl 0.5 ml (25µg) and Group B 0.5% bupivacaine heavy 2.8 ml (14mg) +fentanyl 0.5 ml (25 µg) + midazolam 0.2 ml (1mg). Total volume is 3.5 ml in both groups. They were assessed for quality of block, post-operative analgesia and perioperative complications.Data were compared using t- test(unpaired). The level of significance used was p<0.05. There was a significant difference in onset and duration of sensory and motor block, time to administer first rescue analgesia in group B. Addition of midazolam (1mg) to fentanyl with bupivacaine intrathecally gives better onset & duration of sensory & motor blockade and longer duration of post-operative 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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Effects of Intrathecal Dexmedetomidine as an Adjuvant to Hyperbaric Bupivacaine for Spinal Anaesthesia in Adults Undergoing Elective Infra-umbilical Surgery

Journal of Nepal Medical Association ◽

10.31729/jnma.3394 ◽

2017 ◽

Vol 56 (208) ◽

pp. 379-87 ◽

Cited By ~ 3

Author(s):

Binod Gautam ◽

Sujata Niroula ◽

Mona Sharma ◽

Sushila Moktan Lama

Keyword(s):

Spinal Anaesthesia ◽

Local Anaesthetic ◽

Visceral Pain ◽

Sensory Block ◽

P Value ◽

Double Blind Study ◽

Hyperbaric Bupivacaine ◽

Double Blind ◽

Group A ◽

Group B

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.

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EFFICACY OF ANALGESIA PROVIDED BY ULTRASOUND GUIDED FASCIA ILIACA COMPARTMENT BLOCK WITH AND WITHOUT PARACETAMOL (I.V) IN FACILITATING POSITION FOR CENTRAL NEURAXIAL PROCEDURE

10.36106/ijar/4601354 ◽

2020 ◽

pp. 33-34

Author(s):

Preethi HN ◽

Pawan Kumar C ◽

Ravishankar BM

Keyword(s):

Spinal Anaesthesia ◽

Onset Time ◽

Sensory Block ◽

Ultrasound Guided ◽

Significant Difference ◽

Group A ◽

Fascia Iliaca Block ◽

Group B ◽

Fascia Iliaca Compartment Block

Introduction: The use of ultrasound reduces the onset time, improves the quality of sensory block, and minimizes the risks associated with the block. There are few studies supporting the efficacy of ultrasound guided fascia iliaca block Methodology: 60 patients posted for femur surgeries admitted in Orthopaedics Department, were assessed for the inclusion and exclusion criteria and were included in the study after obtaining written informed consent. Results: Among the patients undergoing spinal anaesthesia in fracture femur surgery, 3.3% of patients of both the groups had not satisfactory positioning, 36.7% of Group A and 33.3% of Group B had satisfactory positioning, 50% of Group A and 53.4% of Group B patients had good positioning, 10% of patients of both groups had optimal positioning. Conclusion: Therefore the positioning of the patients for spinal anaesthesia is comparable and is no significant difference is seen among both the groups.

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

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2020/44242.13949 ◽

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.

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A COMPARATIVE STUDY OF CLONIDINE VERSUS NALBUPHINE AS INTRATHECAL ADJUVANTS TO 0.5% HYPERBARIC BUPIVACAINE DURING LOWER ABDOMINAL SURGERIES – A RANDOMIZED DOUBLE BLIND INTERVENTIONAL STUDY.

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v4i3.1004 ◽

2020 ◽

Vol 4 (3) ◽

Author(s):

Trishala Jain ◽

Jaipal .

Keyword(s):

Motor Block ◽

Sensory Block ◽

Double Blind Study ◽

Hyperbaric Bupivacaine ◽

Double Blind ◽

Rescue Analgesia ◽

Institutional Ethics ◽

Group A ◽

Group B ◽

Intrathecal Clonidine

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.

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Comparison between isobaric levobupivacaine 0.5% and hyperbaric bupivacaine 0.5% in spinal anesthesia in lower limb surgeries and lower abdominal surgeries in adult patients

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20210417 ◽

2021 ◽

Vol 9 (2) ◽

pp. 418

Author(s):

Preeti Parashar ◽

Anisha Singh ◽

Manoj Kumar Sharma ◽

Dipak L. Raval

Keyword(s):

Blood Pressure ◽

Lower Limb ◽

Motor Block ◽

Total Duration ◽

Sensory Block ◽

Hyperbaric Bupivacaine ◽

Significant Difference ◽

The Mean ◽

Group B ◽

Mean Time

Background: The aim of our study was to compare sensory and motor block characteristics and hemodynamic changes following intrathecal hyperbaric bupivacaine (0.5%) and isobaric levobupivacaine (0.5%) in elective lower limb and lower abdominal surgeries.Methods: 60 patients of either sex, aged 18-60 years, ASA grade I or II scheduled for elective lower abdominal and lower limb surgeries were randomized into two groups, group B (n=30) and group L (n=30) and received either 3 ml of intrathecal hyperbaric bupivacaine or isobaric levobupivacaine intrathecally.Results: The mean time of onset of sensory block at shin of tibia in both the groups was comparable i.e. levobupivacaine (1.19±0.2 minutes) and bupivacaine (1.1+0.2 minutes). The mean time for total duration of sensory block was 211.1±8.2 minutes in group L, while 193.13±13.7 minutes in group B. Time for total duration of motor block in group L was 198.76±8.428 minutes and in group B was 182.6±13.989 minutes. Statistically significant difference was observed in total duration of sensory and motor block in both levobupivaciane and bupivacaine group (p<0.0001). Patients in group L were hemodynamically more stable with significantly less decrease in pulse rate, systolic blood pressure and diastolic blood pressure as compared to group B.Conclusions: We observed that 0.5% isobaric levobupivacaine provided better hemodynamic stability, longer duration of sensory and motor block as compared to bupivacaine.

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Subanalgesic doses of ketamine and morphine but not morphine alone, prolong the sensory block time of hyperbaric bupivacaine in unilateral spinal anaesthesia

The Pain Clinic ◽

10.1163/1568569042664495 ◽

2004 ◽

Vol 16 (4) ◽

pp. 435-439

Author(s):

Emin Alp Yentür ◽

Demet Tok ◽

Gönül Tezcan Keleş ◽

Verda Toprak ◽

Füsun Aslan

Keyword(s):

Spinal Anaesthesia ◽

Sensory Block ◽

Hyperbaric Bupivacaine ◽

Block Time

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Spinal Anaesthesia with Hyperbaric Prilocaine in Day-Case Perianal Surgery: Randomised Controlled Trial

The Scientific World JOURNAL ◽

10.1155/2014/608372 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 4

Author(s):

Ozden Gorgoz Kaban ◽

Dilek Yazicioglu ◽

Taylan Akkaya ◽

M. Murat Sayin ◽

Duray Seker ◽

...

Keyword(s):

Spinal Anaesthesia ◽

Controlled Trial ◽

Sensory Block ◽

Local Anaesthetics ◽

Day Case ◽

Hyperbaric Bupivacaine ◽

Versus Group ◽

Group B ◽

Randomised Controlled ◽

Fentanyl Group

Background. The local anaesthetics used in day-case spinal anaesthesia should provide short recovery times. We aimed to compare hyperbaric prilocaine and bupivacaine in terms of sensory block resolution and time to home readiness in day-case spinal anaesthesia.Methods. Fifty patients undergoing perianal surgery were randomized into two groups. The bupivacaine-fentanyl group (Group B) received 7.5 mg, 0.5% hyperbaric bupivacaine + 20 μg fentanyl in total 1.9 mL. The prilocaine-fentanyl group (Group P) received 30 mg, 0.5% hyperbaric prilocaine + 20 μg fentanyl in the same volume.Results. Time to L1 block and maximum block was shorter in Group P than in Group B (Group P4.6±1.3 min versus Group B5.9±01.9 min,P=0.017, and Group P13.2±7.5 min versus Group B15.3±6.6 min,P=0.04). The time to L1 regression and S3 regression of the sensorial block was significantly shorter in Group P than in Group B (45.7±21.9 min versus59.7±20.9 min,P=0.024, and133.8±41.4 min versus200.4±64.8 min,P<0.001). The mean time to home readiness was shorter for Group P than for Group B (155±100.2 min versus207.2±62.7 min(P<0.001)).Conclusion. Day-case spinal anaesthesia with hyperbaric prilocaine + fentanyl is superior to hyperbaric bupivacaine in terms of earlier sensory block resolution and home readiness and the surgical conditions are comparable for perianal surgery.

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Comparison of Fentanyl and Dexmedetomidine as Intrathecal Adjuvants to Spinal Anaesthesia for Abdominal Hysterectomy

Journal of Nepal Medical Association ◽

10.31729/jnma.3739 ◽

2018 ◽

Vol 56 (213) ◽

pp. 848-855 ◽

Cited By ~ 1

Author(s):

Binod Gautam ◽

Sushila Tabdar ◽

Ujma Shrestha

Keyword(s):

Spinal Anaesthesia ◽

Visceral Pain ◽

Sensory Block ◽

Abdominal Hysterectomy ◽

Hyperbaric Bupivacaine ◽

Double Blind ◽

Number Of Patients ◽

First Choice ◽

Group A ◽

Group B

Introduction: Spinal anaesthesia, although advantageous for conducting abdominal hysterectomy, is not the first choice amongst surgeons for fear of intra-operative visceral pain. Intrathecal adjuvants may improve quality of spinal anaesthesia. This study aims to compare efficacy of intrathecal Fentanyl and Dexmedetomidine to reduce visceral pain during abdominal hysterectomy performed under spinal anaesthesia. Methods: Sixty women undergoing abdominal hysterectomy for benign indications were randomly assigned to two equal groups in a double-blind fashion. Fentanyl 25 micrograms in group A or Dexmedetomidine 10 micrograms in group B was co-administered with hyperbaric Bupivacaine 15 milligrams for spinal anesthesia. Surgery through Pfannenstiel incision proceeded once sensory block reached eighth thoracic dermatome. The intra-operative visceral pain was assessed using a five-point scale: none, mild, intermediate, severe, and failed spinal anaesthesia. Duration of analgesia and peri-operative events were studied for 24 hours. Chi-square test, Mann-Whitney U-test and Student’s t-test were used for analysis. Level of significance used was P<0.05. Results: Fifty eight participants completed the study. Demographic variables and sensory block were similar between groups. General anaesthesia was not required in both groups. Significantly greater number of patients in group A required medications for visceral pain with Relative Risk of 2.8 (1.16-6.7). Pruritus and shivering occurred significantly higher in group A. Hypotension was significantly higher in group B. Post-operatively, group B patients showed a significantly longer duration of analgesia. Conclusions: Dexmedetomidine is better than Fentanyl as an intrathecal adjuvant to spinal anaesthesia in minimizing visceral pain during abdominal hysterectomy and in prolonging post-operative analgesia.

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Comparision of dexmedetomidine and fentanyl as adjuvants to 0.5% hyperbaric bupivacaine in spinal anesthesia in elective lower abdominal surgeries

Indian Journal of Clinical Anaesthesia ◽

10.18231/j.ijca.2021.049 ◽

2021 ◽

Vol 8 (2) ◽

pp. 257-264

Author(s):

P Indira ◽

V Sai Divya ◽

Rajola Raghu ◽

Sadhana Roy

Keyword(s):

Spinal Anesthesia ◽

Spinal Anaesthesia ◽

Sensory Block ◽

Hyperbaric Bupivacaine ◽

Hemodynamic Stability ◽

Haemodynamic Stability ◽

Valuable Adjunct ◽

Sparing Effect ◽

Group D

Spinal anesthesia has become most commonly used and choice of anaesthesia for surgeries on lower half of body after first planned spinal anaesthesia for surgery in man was administered by August Bier (1861–1949) on 16 August 1898, in Kiel(1), Germany. Coadministration of adjuvant drugs improve the quality and duration of anesthesia and analgesia and patient safety. To compare effects of Dexmedetomidine and Fentanyl as adjuvants to 3ml of 0.5% heavy bupivacaine injected intrathecally, in lower abdominal surgeries. Prospective randomized comparative study. The study was approved by ethics committee and was conducted in 100 randomly selected patients posted for elective lower abdominal surgeries in the age group 18-60yrs belonging to both sex. Patients were divided into two groups- Group D (n=50) - received 5μg Dexmedetomidine+3ml 0.5% heavy bupivacaine, Group F(n=50)-received 25μg Fentanyl +3ml 0.5% heavy bupivacaine, intrathecally respectively.In groupD patients onset of sensory block was significantly faster 2.62±0.56 mins (p<0.001) with better haemodynamic stability, intraoperative sedation, less incidence of side effects and analgesic sparing effect in post operative period when compared to group F.αadrenergic agonist dexmedetomidine is a valuable adjunct to spinal anaesthesia it augments quality of spinal anaesthesia provides intraoperative sedation and hemodynamic stability.

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