scholarly journals Comparison of Hypobaric Bupivacaine, With and Without Fentanyl for Patients Undergoing Surgeries around Hip: A Randomized Double Blind Study from North India

2020 ◽  
Vol 5 (1) ◽  
pp. 52-56
Author(s):  
Anshuman Shukla ◽  
Sumita Kumari ◽  
Vinita Singh ◽  
Satyajeet Verma ◽  
Sujeet Rai
Keyword(s):  
Spinal Anesthesia ◽  
Motor Block ◽  
Sensory Block ◽  
Motor Recovery ◽  
P Value ◽  
Sensory Level ◽  
Single Shot ◽  
Distilled Water ◽  
Spinal Injection ◽  
Operating Side

Background: Hip surgeries are frequently performed using single shot spinal anesthesia with 15-17.5 mg plain bupivacaine 0.5% which provides surgical anesthesia for 3-4 hours but is difficult to make the patients with hip fractures to lie in lateral decubitus position with the operating side dependent and to make them sit also. Using hypobaric local anesthetic for surgeries around hip, preparation time may be reduced for performing spinal anesthesia and surgery in the same position without waiting for establishment of spinal anesthesia in the supine position. Furthermore, hypobaric local anesthetics can produce more selective block on the operating side and avoid unnecessary paralysis of the nonoperating side potentially resulting in hemodynamic stability and better mobilization of patients during recovery period.Subjects and Methods:In the present study, we compared the anesthetic and hemodynamic effects of hypobaric bupivacaine with and without fentanyl in 100 ASA physical status I and II patients undergoing surgeries around hip. Patients received spinal injection of either 2.5ml (12.5mg) of isobaric bupivacaine with 1.5ml of distilled water (total 4ml) making it hypobaric or 2.5 ml (12.5mg) of isobaric bupivacaine with 1ml of distilled water and 0.5ml(25 µg) of fentanyl (total 4ml) with operative side up, in a double blinded manner. Sensory level and motor block were evaluated on the operative and non-operative sides until regression to L2 and full motor recovery. Hemodynamic changes after spinal injection and the first analgesic request for VAS >3 were noted.Results:Demographic characteristics of both the groups were comparable. Time to maximal fall in MAP and patients requiring vasopressor were similar in both the groups. None of the patients in any of the two group required atropine for bradycardia. Co-administration of fentanyl in hypobaric bupivacaine hastened the onset of sensory block (12±3 vs. 20±9.0, p value <0.001) and the time required was less on the operative side than on the contralateral (non-operative) side in both the groups. The median upper level of block was higher on the operative than on the contralateral side in both the groups. Co-administration of fentanyl in hypobaric bupivacaine prolonged the sensory regression to L2 (298±40 vs. 256±35, p value <0.001). Co-administration of fentanyl had no effect on the time to complete motor recovery as at the end of surgery, all the patients had complete motor recovery on the contralateral (non-operative) side, while none of the patient in any of the two groups had complete motor recovery on the operative side. Time to first analgesic requirement was significantly higher (318±27 vs. 288±28, p value <0.001) with the addition of fentanyl to the hypobaric bupivacaine.Conclusion:So we conclude that the use of hypobaric bupivacaine produces spinal anesthesia with a faster sensory motor recovery on the contralateral (non-operative) side. Co-administration of fentanyl further prolongs the sensory block on the operative side without significantly affecting the motor block, so delays the use of first analgesic without further compromising the systemic hemodynamics.

scholarly journals Influence of Positioning on Plain Levobupivacaine Spinal Anesthesia in Cesarean Section

2010 ◽  
Vol 2010 ◽  
pp. 1-4 ◽  
Author(s):  
Fabio Gori ◽  
Francesco Corradetti ◽  
Vittorio Cerotto ◽  
Vito Aldo Peduto
Keyword(s):  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Supine Position ◽  
Motor Block ◽  
Sensory Block ◽  
Sensory Level ◽  
Physical Status ◽  
Gravitational Forces ◽  
Block Level ◽  
Dermatomal Level

Background. The behaviour of isobaric levobupivacaine in relation to gravity when used in obstetric spinal anesthesia is unclear.Methods. 46 women with ASA physical status 1 undergoing cesarean section were randomly allocated to 2 groups. Spinal anesthesia with 12.5 mg levobupivacaine was performed in the sitting position in all women. Those in the first group were placed in the supine position immediately after the injection, while those in the second group were asked to remain seated for 2 minutes before assuming the supine position. The sensory block level, the onset of sensory and motor blocks, the regression of the sensory block for 2 dermatomes of the sensory block, the first request for analgesics, and the regression of motor block were recorded.Results. No differences in onset times, sensory level, or Bromage score were observed between the two groups. The time of first analgesic request was earlier in the seated group (supine131±42 min, seated106±29 min,P=.02).Conclusion. Isobaric levobupivacaine in women at term produces a subarachnoid block the dermatomal level of which does not depend on gravitational forces.

scholarly journals Effects of addition of Magnesium sulphate to heavy Bupivacaine for spinal anesthesia in vaginal hysterectomy

2014 ◽  
Vol 2 (2) ◽  
pp. 63-68
Author(s):  
Sushila Tabdar ◽  
Uzma Shrestha ◽  
Ekraj Kadariya
Keyword(s):  
Spinal Anesthesia ◽  
Spinal Anaesthesia ◽  
Magnesium Sulphate ◽  
Vaginal Hysterectomy ◽  
Motor Block ◽  
Sensory Block ◽  
P Value ◽  
Double Blind ◽  
Medical College ◽  
To Receive

Background: Adequate pain management is essential for every patient to recover and return to their normal activity quickly. Central sensitization is one of the mechanism which increases excitability of spinal neurons and results persistent pain postoperatively. Objectives: The aim of the study was to investigate the effects of addition of 100 mg 50% Magnesium Sulphate intrathecally to 0.5% heavy Bupivacaine on sensory onset up to T4 level, complete motor block, post-operative analgesia and complications in patients planned for vaginal hysterectomy under spinal anesthesia. Methods: The design of the study was prospective randomized and double blind. With the Institutional improvements and informed consent in Kathmandu Medical College from January 2011 till December 2012, 60 American society of Anesthesiologist class (I, II) patients of age between (40 to 70) years, weight between (45 to 70) kg and height between (4.8 to 5.2) feet undergoing routine vaginal hysterectomy not exceeding one and half hour in spinal anaesthesia were included in the study. The exclusion criteria were patients not following above criteria, having coagulopathy, renal function derangements, uncontrolled hypertension or severe hypotension and having dysarrhythmias. Total patients were randomized into two groups of thirty each. Group A was allocated to receive four ml 0.5% Bupivacaine +0.25 ml normal saline and group B was allocated to receive four ml 0.5% Bupivacaine + 100 mg of 50% Magnesium Sulphate. The anaesthesiologist who was double blind to the drug preparation performed spinal anaesthesia with either of the drug for the whole study.The recorded parameters were time of onset of sensory block upto T4 level, onset of complete motor block, total duration of analgesia and complications in both the groups. Data analysis was done by Computer software polystat XLS using Student’s “t” test. P value <0.05 was considered statistically significant.  Result: The addition of 100 mg of 50% Magnesium sulphate to 0.5% Bupivacaine intrathecally resulted early onset of sensory block upto T4 level in (Mean± SD) (3.79 ± 0.25) min Vs (9.61 ± 0.75) min with sole 0.5% Bupivacaine where p value was < 0.05. Similarly onset of complete motor block with 0.5% Bupivacaine plus Magnesium Sulphate was (1.9 ± 0.23) min verses (10.4 ± 0.63) min with 0.5 % Bupivacaine only. Here again p value was < 0.05. Duration of analgesia with 0.5 % Bupivacaine plus Magnesium Sulphate was (176.8 ± 19. 85) min than that of 0.5% Bupivacaine (105 ± 26.82) min with P value< 0.05. Conclusion: The study concluded that onset as well as analgesic effect of 0.5% Bupivacaine was potentiated by intrathecal Magnesium Sulphate without major side effects.DOI: http://dx.doi.org/10.3126/jkmc.v2i2.10628Journal of Kathmandu Medical College, Vol. 2, No. 2, Issue 4, Apr.-Jun., 2013, Page: 63-68

A study of intrathecal low dose bupivacaine and fentanyl versus conventional dose of bupivacaine alone for elective caesarean section

2021 ◽  
Vol 19 (3) ◽  
pp. 86-90
Author(s):  
Rama Rao V M ◽  
Keyword(s):  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Elective Caesarean Section ◽  
Sensory Block ◽  
Rapid Onset ◽  
P Value ◽  
Sensory Level ◽  
Lipid Solubility ◽  
Hyperbaric Bupivacaine ◽  
Sensory Blockade

Background: Spinal anesthesia is the most common method of the regional block in cesarean section, because it is easy to perform, economical produces rapid onset of anesthesia, and good muscle relaxation, and most importantly, it gives immense pleasure to the conscious mother. To improve the quality of subarachnoid block, intrathecal opioids are used as adjuvants to Bupivacaine. Fentanyl has a rapid onset of action as a lipophilic opioid following intrathecal administration. Because of high lipid solubility, it undergoes rapid uptake by the spinal cord, and hence the chances of delayed respiratory depression are less. Methods: We randomly selected 60 patients belonging to the American Society of Anesthesiologists (ASA) class I and II, who are scheduled for elective LSCS. These patients were divided randomly into two groups of 30 each. Group B received 10mg of 0.5% hyperbaric bupivacaine (2ml). Group BF received 7.5mg of 0.5% hyperbaric bupivacaine (1.5ml) with 25mcg of Fentanyl (0.5ml). Lumbar puncture was performed at the level of L3-L4 with 23 Guage Quincke Babcock's needle with the patient in the right lateral position. The sensory block was assessed with the loss of pin prick sensation, and the motor block was set using the Bromage scale technique. We also recorded the hemodynamic parameters like pulse rate, blood pressure, oxygen saturation. Results: No significant statistical difference was found in demographic data between the two groups. Group BF showed early onset of the sensory block with a P value of 0.001. Time taken to attain peak sensory level was early in the BF group with a P value of 0.001. The total duration of sensory block and duration of effective analgesia was longer in the BF group with a P value of 0.001. The onset of motor blockade was early in the bupivacaine only group with a P value of 0.02. Conclusion: The intrathecal fentanyl 25mcg reduces the dose of 7.5 mg of 0.5% hyperbaric Bupivacaine for spinal anesthesia in cesarean section, thus reducing the incidence of side effects associated with it. By its synergistic effect with 0.5% hyperbaric bupivacaine, it provides better excellent sensory blockade and postoperative analgesia, good hemodynamic stability, less incidence of complications like Nausea, vomiting, and shivering without compromising the safety of mother and fetus in comparison to intrathecal 10mg of 0.5% hyperbaric Bupivacaine alone.

scholarly journals Comparative Effects of Single Shot Intrathecal Bupivacaine with Dexmedetomidine and Bupivacaine with Fentanyl on Labor Outcome

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
S. Fyneface-Ogan ◽  
O. Gogo Job ◽  
C. E. Enyindah
Keyword(s):  
Motor Block ◽  
Neonatal Outcome ◽  
Stress Hormones ◽  
Sensory Block ◽  
Pain Scale ◽  
Labor Pain ◽  
Single Shot ◽  
Hyperbaric Bupivacaine ◽  
Multiparous Women ◽  
Beta Endorphins

Background. Effective intrapartum analgesia attenuates pain, stress, and anxiety which cause release of stress hormones as well as beta-endorphins. Aim. The purpose of this study was to determine the effect of adding dexmedetomidine to hyperbaric bupivacaine for neuraxial analgesia for labor. Methods. Ninety laboring multiparous women were allocated to have single shot intrathecal bupivacaine alone (B), bupivacaine with fentanyl (BF), or bupivacaine with dexmedetomidine (BD). Sensory and motor block characteristics; time from injection to two dermatome sensory regression, sensory regression to S1 dermatome, and motor block regression to Bromage 1 were recorded. Labor pain was assessed with a 10 cm verbal pain scale. Results. Peak sensory block levels in the three groups were essentially the same (). The time for sensory and motor blocks to reach T10 dermatome and Bromage 1, respectively, was faster in group BD than in the other groups (). The time for sensory regression to S1 was significantly prolonged in the group BD (). Motor block regression time to Bromage 1 was also prolonged in the group BD (). Neonatal outcome was normal in all groups. Conclusion. Single shot intrathecal bupivacaine/dexmedetomidine significantly prolonged sensory block in laboring women.

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 A Comparative Study of Intravenous Clonidine and Dexmedetomidine on Characteristics of Bupivacaine Spinal Anesthesia

2020 ◽  
Vol 5 (1) ◽  
pp. 165-167
Author(s):  
Shailender Bamel ◽  
Nandita Kad ◽  
Vinit ◽  
Shilpa Popli ◽  
Devender Chahal
Keyword(s):  
Single Dose ◽  
Spinal Anesthesia ◽  
Postoperative Analgesia ◽  
Orthopedic Surgery ◽  
Lower Limb ◽  
Motor Block ◽  
Sensory Block ◽  
Well Being ◽  
Control Group ◽  
Sensory Blockade

Background: Spinal anesthesia with bupivacaine is administered routinely for lower abdominal and lower limb surgeries. The ensuing nerve block is sufficient to ensure patient’s well being, while motor block facilitates the surgeon’s work. In patients receiving spinal anaesthesia, with local anesthetic agents like bupivacaine, the addition of another drug as adjuvant prolongs the analgesia. The present study is designed to study the effect of dexmedetomidine (D) and Clonidine (C) on the duration of motor and sensory block as well as postoperative analgesia by intrathecal bupivacaine in patients undergoing lower limb orthopedic surgery. Subjects and Methods: This study was carried out on 90 patients in the age group of 18 to 50 years, belonging to the American Society of Anesthesiologists(ASA) physical status I and II presenting for lower limb orthopedic surgery were included in the study. Patients were divided randomly into 3 groups. Group D received 1μg kg-1of dexmedetomidine, group C received 2 μg kg-1 of clonidine and group NS Control group received an equivalent amount of normal saline. Results: From the current study we observed that single dose of 1 μg kg-1 dexmedetomidine over 20 minutes started 20 minutes after spinal block and a single dose of 2 μg kg-1 Clonidine resulted in a significant prolongation of time to two-segment regression, postoperative analgesia,  sensory block and motor block with the maintenance of hemodynamic parameters. Intravenous dexmedetomidine was more effective than Clonidine at the prolongation of time to two-segment regression, postoperative analgesia, sensory block and motor block of spinal anesthesia with 0.5% hyperbaric bupivacaine. Conclusion:  Dexmedetomidine (1μg kg-1) in comparison to Clonidine (2 μg kg-1) and placebo is far more effective in the motor blockade, sensory blockade and duration of postoperative analgesia.

scholarly journals A randomised prospective comparative study of evaluation of dexmedetomidine an adjuvant to ropivacaine for ultrasound guided supraclavicular block

2018 ◽  
Vol 5 (3) ◽  
pp. 127
Author(s):  
V. S. S. N. Murthy ◽  
N. Hari Kiran Verma ◽  
Anand Acharya
Keyword(s):  
Motor Block ◽  
Sensory Block ◽  
Study Patient ◽  
P Value ◽  
Ultrasound Guided ◽  
Group A ◽  
Prospective Comparative Study ◽  
Group B ◽  
Supraclavicular Block ◽  
Other Regarding

<p class="abstract"><strong>Background:</strong> There are clinical evidences for efficacy of dexmedetomidine as an adjuvant to local anaesthetic for peripheral nerve block, but very few published study are available on continuation of dexmedetomidine, with ropivacaine for ultrasound guided supraclavicular block. The present study has been designed to elucidate the effect of dexmedetomidine, in combination ropivacaine on various parameters.</p><p class="abstract"><strong>Methods:</strong> During period of 2 year and 3 months 84 patients were enrolled for this study. Patient in Group A were received 15 ml of 0.5% ropivacaine with 100 microgram one ml dexmedetomidine and Group B were received 15ml of 0.5% of ropivacaine with 1 ml of normal saline. Drug solution was prepared by same individual and was not part of study.</p><p class="abstract"><strong>Results:</strong> Both the group were comparable to each other regarding demography profile. The duration of sensory block 644.96±72.4 min in group A and the duration of sensory block in Group B was 731.53±131.54 min with p value 0.00354. The duration of motor block was 661.5±29.25 in group A and 559.77±29.25 in Group B with P value 0.0001. Duration of analgesia in Group A was 457.06±34.47 min and it was 345.70±38.032 min in Group B. The supplementation of intravenous opioid was required in 3 patients in Group A and 10 patients in group B with P value 0.037.</p><p class="abstract"><strong>Conclusions: </strong>When 100 microgram of dexmedetomidine was added as an adjuvant to ropivacaine is associated with early onset of sensory and motor block, prolongation of sensory and motor block and duration of analgesia in comparison with ropivacaine alone.</p>

scholarly journals A comparison of efficacy and tolerablity of epidural Levobupivacaine 0.5% with 0.5% Racemic mixture Bupivacaine for lower abdominal surgery

2020 ◽  
Vol 11 (4) ◽  
pp. 6800-6809
Author(s):  
Ashok Kumar Balasubramanian
Keyword(s):  
Abdominal Surgery ◽  
Motor Block ◽  
Study Drug ◽  
Maximum Level ◽  
Epidural Injection ◽  
Sensory Block ◽  
Local Anaesthetics ◽  
Racemic Mixture ◽  
P Value ◽  
Fluid Requirement

This study was performed to compare the efficacy and tolerability of 0.5% racemic Bupivacaine and 0.5% Levobupivacaine, in patients undergoing lower abdominal surgery.56 patients, ASA grade 1 and 2, were randomized to receive an epidural injection of study drug (17 ml 0.5% racemic Bupivacaine in group R and 17 ml of 0.5% Levobupivacaine in group L). The time to onset of adequate sensory block (T10 dermatome), maximum dermatome reached, time taken to reach maximum dermatome, time for 2 segment regression, time taken to regress to T10 were comparable. Although the onset of motor block was comparable in both the groups, Group L showed earlier commencement of motor block at 5 min after zero time. (P value 0.002). The regression of motor block was faster in group L (p value 0.042). The time to obtain maximum level of motor blockade was found to be faster in L group. (p value of 0.043). The number of patient obtaining MBS score of 3 was 62.5% in R group and 37.5% in L group. The grade of motor block showed that, the L group had lesser grade than that of Racemic group (p value of 0.016). The duration of motor block was similar in both the groups. The need for rescue analgesics, total IV fluid requirement and ephedrine usage, MAP,HR and the time of request for post-operative analgesia were similar. Both local anaesthetics were well tolerated and effective in producing epidural anaesthesia for patients undergoing lower abdominal surgery.

scholarly journals Comparison of effects of Bupivacaine and Ropivacaine in patients undergoing elective Caesarean section

2020 ◽  
Vol 4 (3) ◽  
pp. 859-863
Author(s):  
Sangeeta Subba ◽  
Arjun Arjun Chhetri ◽  
Rupak Bhattarai
Keyword(s):  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Motor Block ◽  
Elective Caesarean Section ◽  
Sensory Block ◽  
Elective Cesarean Section ◽  
Hyperbaric Bupivacaine ◽  
Safe Alternative ◽  
Elective Cesarean ◽  
Group B

Introduction: Spinal anesthesia is considered a reasonable choice for cesarean section. Bupivacaine and ropivacaine have been used as intrathecal drugs alone or in combination with various opioids. Ropivacaine is considered a valid and safe alternative to bupivacaine for spinal anesthesia. Objectives: To compare the efficacy and safety of hyperbaric ropivacaine with hyperbaric bupivacaine in spinal anesthesia for elective cesarean section. Methodology: Sixty pregnant women undergoing elective cesarean section were allocated into two groups. Group R received 3 ml of 0.5% hyperbaric ropivacaine (2 ml 0.75% plain ropivacaine mixed with 1 ml of 25 %dextrose) and Group B received 2.5 ml of 0.5% hyperbaric bupivacaine. Both the groups were compared in terms of onset of sensory and motor block, regression of sensory and motor block, duration of analgesia and side effects. Results: The onset of sensory block was comparable in both groups but was statistically insignificant. The onset of motor block in Bupivacaine(7.53 ± 1.72) min was faster when compared to Ropivacaine group(14.33 ± 6.19) min. Regression of sensory and motor block both were faster in Ropivacaine group. Duration of analgesia was longer in Bupivacaine group(131.17 ± 32.95)min than Ropivacaine group(125.33 ± 30.54)min. Conclusion: Ropivacaine can be used as an alternative to Bupivacaine for spinal anesthesia in cesarean section but has a shorter duration of sensory and motor block.

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