scholarly journals Comparison of Ropivacaine-Fentanyl with Bupivacaine-Fentanyl for Labour Epidural Analgesia

2020 ◽  
Vol 14 (1) ◽  
pp. 108-114
Author(s):  
Kalpana Kulkarni ◽  
Rahul Patil

Background: Bupivacaine with opioid is commonly used for labour epidural analgesia. Ropivacaine is considered as an alternative to bupivacaine due to its lower cardiovascular complications. However, there is a controversy regarding the efficacy of these drugs as some studies suggest equivalent action, whereas others report that ropivacaine produces less motor blockade. The study aimed to compare the effect of ropivacaine-fentanyl and bupivacaine-fentanyl for labour analgesia. Materials and Methods: The prospective randomized study was performed on 60 parturients, divided into two groups of 30 subjects each. Group I received 10ml of bupivacaine 0.1% + fentanyl 2µg/ml and Group II received 10ml of ropivacaine 0.1% + fentanyl 2µg/ml by epidural catheter. Pre-anaesthetic evaluation was performed on all the participants and all were administered metoclopramide 0.25mg/kg and ondansetron 0.08-0.1mg/kg intravenously as premedication. The baseline and post anaesthesia systolic, diastolic blood pressure, heart rate, VAS score, degree of motor block, sedation and APGAR score of the baby were recorded. The data were tabulated and statistically analyzed. Results: When compared, there was no significant difference in systolic/diastolic blood pressure in two groups except at 360 min where diastolic pressure was low in group II. Significantly higher heart rate at 30 min (P=0.0003), 120 min (0.006), and 300 min (P=0.001) was observed in group I subjects. VAS score was significantly less at 180 min (P=0.019) and 300 min (P=0.019) in group II. Adverse effects such as fetal bradycardia, nausea/vomiting and hypotension observed were clinically insignificance when compared in two groups. Conclusion: Bupivacaine and ropivacaine produce an equal degree of analgesia and hemodynamic stability in 0.1% of concentration when added with 2µg/ml fentanyl . However, heart rate was well maintained with lower VAS scores in group II receiving ropivacaine. No significant difference in the side effects between the two groups. Hence, Ropivacaine can be used as a safe alternative to bupivacaine for labour epidural analgesia.

2020 ◽  
Vol 7 (3) ◽  
pp. 781
Author(s):  
Saidingpuii Sailo ◽  
Micky Zodinpuia ◽  
Naveen P.

Background: Caudal epidural analgesia is one of the most popular and commonly performed regional blocks in pediatric anesthesia. It is reliable and safe technique that can be used with general anesthesia for intraoperative and postoperative analgesia. The aim of this research is to study the effect of morphine (15 µg/kg) with ropivacaine (0.2%) and ropivacaine (0.2%) alone through caudal epidural route on duration of analgesia in children.Methods: The study was performed on 60 ASA grade I and II patients, aged 1 to 7 years scheduled for elective infraumbilical surgeries. After induction of general anesthesia, caudal epidural block was performed. Each group consisted of 30 pediatric patients: group I-caudal epidural 0.2% ropivacaine (1 ml/kg) and group II- caudal epidural 0.2% ropivacaine (1 ml/kg) with morphine 15 µg/kg. Intra-operatively heart rate, blood pressure was recorded at pre-induction, immediately after induction, 5 minutes after administration of caudal block and thereafter every 10 minutes till the completion of surgery. Postoperative heart rate, blood pressure, pain score was assessed periodically till 24th hour.Results: The duration of analgesia was more in group II (7.30±1.78 hour) in comparison to group I (3.93±0.83 hour). The fall in mean arterial pressure and heart rate were not significant in group II as compared to group I.Conclusions: Addition of low dose morphine to ropivacaine resulted in prolonging the duration of analgesia by almost double the duration as compared to ropivacaine alone.


2014 ◽  
Vol 52 (194) ◽  
pp. 775-779 ◽  
Author(s):  
Pradeep Kumar Rajbhandari

Introduction: Laryngoscopy and tracheal intubation causes significant sympathetic response resulting in hypertension and tachycardia. In individuals with systemic hypertension, coronary artery disease, cerebrovascular disease and intracranial aneurysm, the effect of this transient sympathetic response can evoke life threatening conditions like pulmonary oedema, cardiac failure and cerebrovascular haemorrhage. Methods: Patients were randomly divided into two groups, 30 in each group. Group I received 50 mg of esmolol and group II received lignocaine 2 mg/kg. Haemodynamic parameters like pulse, systolic blood pressure, diastolic blood pressure and mean arterial pressure were measured before induction of anaesthesia, immediately after intubation then at intervals of one minute, three minutes, five minutes, seven minutes and 10 minutes. Results: There was no significant difference in demographic or base line vital signs between two groups (Table 1). The mean systolic blood pressure increased on laryngoscopy and tracheal intubation by 15 mmHg in the group I whereas in group II it was 17.4 mmHg. There was a significant rise in diastolic blood pressure (DBP) in both the groups, but the rise was lesser in group II than in group I. Conclusion: Both esmolol and lignocaine were not effective in attenuating hemodynamic stress response to laryngoscopy and tracheal intubation; however esmolol was superior to lignocaine in blunting the stress response.  Keywords: esmolol; intubation; laryngoscopy; lignocaine; stress response.  


AYUSHDHARA ◽  
2020 ◽  
pp. 1-10
Author(s):  
Prerna ◽  
Vijay Chaudhary ◽  
B.L. Mehra

The present study was conducted to evaluate the antihypertensive effect of an Ayurvedic formulation Trinpanchmool Kwath in the management of essential hypertension. The study was conducted in 30 patients selected from OPD and IPD of R.G.G. P.G.A.C. and Hospital, Paprola. Patients were randomly divided into three groups. Group- I patients were managed with Trinpanchmool Kwath , Group- II patients were managed with Tab Chlorthalidone and Group– III patients were managed with both Trinpanchmool Kwath and Tab. Chlorthalidone. The results obtained were analysed on the basis of various objective and subjective parameters. However change in blood pressure was the main criteria for assessing the effect of the therapy. Statistically highly significant reduction was observed in systolic and diastolic blood pressure after 45 days of therapy. In Group-I systolic blood pressure reduced by 9.374%, in Group-II systolic blood pressure decreased by 15.46% and in Group-III systolic blood pressure decreased by 16.86%. Similarly in Group-I diastolic blood pressure decreased by 8.195% , in Group-II showed 11.250% reduction and in Group-III diastolic blood pressure decreased by 12.17% after completion of therapy. Results revealed that therapy given in Group-III i.e. the combination of Trinpanchmool Kwath and Tab. Chlorthalidone showed best results as compared to other groups. Group-II, in which patients were managed with Tab Chlorthalidone showed better results over Group-I where only Trinpanchmool Kwath was given to the patients. However statistically highly significant reduction in both systolic and diastolic pressure was observed in all three groups.


2021 ◽  
Vol 8 (4) ◽  
pp. 492-500
Author(s):  
Manish Kumar Singh ◽  
Pragya Verma ◽  
Sarita Singh ◽  
Gyan P Singh ◽  
Hemlata Verma

Patients suffering from advanced upper abdominal malignancies have pain as predominant symptom affects their quality of life and survival. USG guided coeliac plexus neurolysis become benevolence in these patients on part of their pain management and quality of life improvement. To compare the efficacy of USG guided coeliac plexus neurolysis for pain relief in upper abdominal malignancies by using different concentration of alcohol (50% vs 75%).This Prospective, comparative, randomised double blinded study was conducted during Sep 2019 – Aug 2020 at our tertiary care centre. Total 60 cases were taken as per following inclusion and exclusion criteria and randomly divided into 2 groups i.e. 30 each group, we compare Visual Analogue Scale (VAS) score, quality of life (QOL) and need of rescue analgesia profile between the groups to know the efficacy of USG guided coeliac plexus block. In our study, we observed that the baseline mean VAS score in group I was 8.26±0.78 while in group II was 8.03±0.76. No significant difference was found in mean VAS score at this time between the groups (p=0.24). The baseline mean QOL score in group-I was 77.46±3.40 while for the cases of group II the mean QOL score was 77.36±3.33. No significant difference was found in mean QOL score at baseline between the groups (p=0.90). The baseline mean morphine consumption in group-I was 113.33±39.24 mg while for the cases of group-II the mean morphine consumption was 120.33±38.37mg. No significant difference was found in mean morphine consumption at this time between the groups (p=0.48).Both groups having 50% alcohol and 75% alcohol decreases the VAS score from baseline in patients having upper abdominal malignancies along with QOL and dosages of rescue analgesia whereas no significant difference in VAS score in patients of both groups.


2020 ◽  
Vol 9 (1) ◽  
pp. 8-15
Author(s):  
Arya Justisia Sani ◽  
Ardhana Tri Arianto ◽  
Muhammad Husni Thamrin

Latar Belakang dan Tujuan: Peningkatan respon hemodinamik yang disebabkan oleh nyeri dapat menyebabkan peningkatan aliran darah otak dan tekanan intrakranial. Blok scalp pada kraniotomi menumpulkan respon hemodinamik karena rangsangan nyeri serta mengurangi penambahan analgesi lain. Penelitian ini bertujuan untuk mengetahui efektifitas blok scalp sebagai analgetik pada kraniotomi.Subjek dan Metode: Penelitian ini menggunakan uji klinik acak tersamar ganda pada 36 pasien dengan status fisik ASA 1–3 dilakukan operasi kraniotomi eksisi dan memenuhi kriteria inklusi. Sampel dibagi menjadi kelompok I (dengan blok scalp) dan kelompok II (tanpa blok scalp). Blok dilakukan sesaat setelah induksi anestesi. Digunakan levobupivakain 0,375% sebanyak 3 ml tiap insersi, pada masing-masing saraf. Tekanan darah, tekanan arteri rata-rata, detak jantung sebelum intubasi dan setelah intubasi, pemasangan pin, insisi kulit dan insisi duramater serta total kebutuhan fentanyl tambahan dicatat. Data yang diperoleh dianalisis dengan program komputer SPSS versi 17 lalu diuji menggunakan uji Kruskal-Wallis atau One-way ANOVA. Batas kemaknaan yang diambil adalah p < 0,05.Hasil: Selama kraniotomi, detak jantung, tekanan darah, tekanan arteri rata-rata secara signifikan lebih tinggi pada pasien tanpa blok scalp terutama pada saat pemasangan pin. Hasil uji statistik menunjukkan perbedaan signifikan, penambahan fentanyl pada pasien dengan blok scalp lebih sedikit dibandingkan tanpa blok scalp, p=0,000 (p<0,05).Simpulan: Blok scalp levobupivakain efektif dalam menurunkan respon hemodinamik terutama pada saat pemasangan pin. Pasien kraniotomi dengan blok scalp membutuhkan penambahan fentanyl lebih sedikit. Differences on Hemodynamic Response with Levobupivacaine Scalp Block in Craniotomy SurgeryAbstractBackground and Objective: Increased hemodynamic response caused by pain can lead to increased cerebral blood flow and intracranial pressure. Scalp block in craniotomy blunts hemodynamic response due to pain and reduce other analgesics addition. This study aims to determine effectiveness of scalp blocks as analgesic in craniotomy.Subject and Method: This study used a double-blind randomized clinical trial in 36 patients with physical status ASA 1-3 who underwent craniotomy and met inclusion criteria. Samples were divided into group I (with scalp block) and group II (without scalp block). Scalp Block was performed right after anesthesia induction. Using levobupivacaine 0.375% 3 ml for each insertion. Blood pressure, mean arterial pressure, heart rate before and after intubation, during pin placement, skin incision and duramater incision and total need for additional fentanyl were recorded. SPSS version 17 was used and data were analysed using Kruskal-Wallis or One-way ANOVA. Statistical significance was accepted at p < 0.05.Result: During craniotomy, heart rate, blood pressure, mean arterial pressure were significantly higher in patients without scalp block especially during pin placement. Statistical test showed significant difference, additional fentanyl in patients with scalp blocks was lesser, p = 0.000 (p <0.05). Conclusion: Levobupivacaine scalp block was effective to blunt hemodynamic response especially during pin placement. Scalp block also decreased additional fentanyl in craniotomy.


2017 ◽  
Vol 4 (4) ◽  
pp. 1218
Author(s):  
Balakrishnan Nadesan ◽  
Mani Madhavan Sachithananthamoorthi ◽  
Sivaraman Thirumalaikumarasamy ◽  
Ezhilarasu Ramalingam

Background: Hypertension is considered as a major health issue in developed as well as developing countries and its possible origin during childhood prompts pediatricians to routinely include measurement of blood pressure (BP) as an integral part of pediatric physical examination. The objectives of the study were to evaluate the normal range of blood pressure in adolescent school going students of 12-16 years, prevalence of hypertension and relationship of BP with variables like age, body mass index (BMI), socioeconomic status and family history of hypertension.Methods: A cross sectional study was undertaken for a period of one year in adolescent school children in age groups between 12-16 years. Detailed clinical examination was done in 1060 adolescent school children and BP was recorded in right upper limb and correlation of BP with BMI, family history of hypertension and diabetes were studied.Results: Mean systolic and diastolic pressure showed linear relationship with age. There was a highly statistically significant difference between mean systolic and diastolic blood pressure between lower and middle socio-economic class. Prevalence of obesity in our study was 1.13%, overweight was 7.83%. Prevalence of hypertension in obese children was 33.33% and in overweight children 18.07%. Family history of hypertension and diabetes carry a significant correlation with elevated systolic and diastolic blood pressure in adolescents.Conclusions: This study revealed that socio economic factors play a significant role in determining the blood pressure of the individual. Children of middle class have significantly elevated mean systolic pressure and mean diastolic pressure than low socio-economic groups. 


2021 ◽  
Author(s):  
Endalkachew hailu ◽  
Gashaw Kasse

Abstract Background: Caudal epidural anesthesia commonly utilized in veterinary practice to allow diagnostic, obstetrical, and surgical interventions in the perineal region of cows. An experimental study conducted on epidural anesthesia from October 2018 to March 2019 on 6 cows with repeated treatments after one week by two groups of anesthetic drugs. Methods and materias First Lignocaine is given for Group-I of cows in the first intercoccygeal space and then the same animals after one week injected Lignocaine-Xylazine together in the intercoccygeal space. The Clinical-physiological parameters such as the onset of analgesia, duration of analgesia, ataxia, sedation, heart rate, respiratory rate, and rectal temperature between the two groups studied by compression. Finally, the significance of the change in the study unit between Lignocaine and Lignocaine-Xylazine analyzed according to SPSS version 19 for t-test and P-value <0.05 taken as statistically significant. Results: There was no significant change that appeared between the onset of analgesia of Lignocaine (4.3±0.6min) alone and Lignocaine-Xylazine (4.9±1.1min) injection together (t=1.17; P>0.05). This indicates that the addition of Xylazine to Lignocaine does not significantly delay the onset of anesthesia. However, there was a significant difference observed in the duration of analgesia between two groups (t=13.2; P<0.05) with Lignocaine-Xylazine (259.5±12.38min) longer duration than Lignocaine alone (84±4.05min). This indicates that Lignocaine and Xylazine have an additive effect on the duration of analgesia. In the case of physiological parameters, there were significant variations in heart rate (t=7.5; P<0.05) with Group II cows lower in heart rate than Group I cows. Statistically, a significant difference was also observed on respiratory rate (t=2.13; P<0.05) in which the addition of Xylazine on Lignocaine significantly lower breathing rate than Lignocaine injection alone. Finally, on rectal temperature, there was no statistically significant difference appeared (t=1.7; P>0.005) with rectal temperature in Group I cows (0.15± 0.28 OC) and in Group II cows (0.9±0.31 OC) which indicate that addition of Xylazine to Lignocaine lower rectal temperature similar to Lignocaine injection alone. Mild ataxia was observed in three groups I, cows, and there was no sedation and salivation noted at all. In Group II, cows mild to severe ataxia, deep sedation, salivation, and falling observed. In both groups, there was no anesthetic complication during epidural analgesia and after recovery noted.Conclusion: generally this study showed that, combination of Lignocaine and Xylazine have an additive effect on the duration and quality of analgesia.


2021 ◽  
pp. 56-63
Author(s):  
Mariana Seliuk ◽  
Marianna Peshkova ◽  
Mykola Kozachok

Cardiovascular diseases are the leading diseases in Ukraine and are the cause of more than half of deaths. They are inextricably linked to lifestyle, diet, bad habits, physical activity, stressors and are the cause of other risk factors. The most common of these are unmodified factors, such as: gender, age, heredity; and modified: dyslipidemia, arterial hypertension, overweight and obesity, diabetes mellitus, smoking, psychosocial factors. According to the results of the published STEPS study in 2019, conducted together with the WHO, which analyzed risk factors among the civilian population of Ukraine aged 18 to 69 years. It was noted that 32,8% of the population had risk factors for CVD. High blood pressure or hypertension was observed in 34,8% of the population. The prevalence of hyperglycemia was 7,1%. Only 39,6% of the population of Ukraine had a normal weight for BMI, 59,1% were overweight, including 24,8% of the population were obese. 33,9% were active smokers, and alcohol consumption was observed in 19,7% of the population. Given the data from the STEPS study, we were interested in the frequency of detection of the main risk factors for cardiovascular events among servicemen. The objective: of the study is to determine the frequency of detection of the main risk factors for cardiovascular events among active servicemen and retirees of the Ministry of Internal Affairs at the stage of inpatient treatment in the conditions of NVMKC «GVKG». Materials and methods. Random sampling was used to analyze 104 case histories of patients in the cardiology department of NVMKC «GVKG» for the period from January 2018 to December 2019. Risk factors and the frequency with which they occur in different categories of patients were studied. The examination group consisted of male patients (100% of cases) aged 33 to 93 years, the average was 66,55±1,47 years. To study the age characteristics of the prevalence of CVD risk factors, patients were divided into two groups: Group I active servicemen, whose average age was 46,41±1,78 years; Group II retirees MOU, whose average age was 71,95±1,26 years. Statistical processing of the results was performed by methods of variation, parametric and non parametric statistics of medical and biological profile using a package of original applied statistical programs «Microsoft Ecxel», «Statistica 7.0». Results. According to the results of the study, the indicators of blood pressure in group I were analyzed: the indicators of mean systolic and diastolic pressure were 129,09±3,86 / 80,45±2,71 mm Hg (n=22). In group II, the average systolic and diastolic pressure were: 138,84±2,41 / 82,99±1,22 mm Hg (n=82). To assess blood pressure, we chose the classification proposed by the WHO in the study (STEPS-2019) for the possibility of compara tive analysis. The percentage of patients in group I with normal blood pressure was 77,27%; high blood pressure was observed in 22,73% of patients, according to the results of their own study, high blood pressure was not detected. In patients of group II normal blood pressure was registered in 63,41%, elevated in 26,83% of patients and high blood pressure was observed in 9,76% of patients. Examining the indicators of laboratory studies, we found that an increase in cholesterol was observed in 45,5% of cases in group I, and in 22,7% of cases the level of cholesterol was not determined. In group II, an increase in cholesterol levels was found in 35,4% of cases, in 13,4% of cases the cholesterol level was not determined. According to the results of the study, an increase in blood glucose levels was observed in 10,6% of cases and 55,8% of cases in group II. Normal blood glucose levels were in 33,7% of patients. The percentage of patients with concomitant type II diabetes was 1,9% of cases of group I, and 14.4% of cases of group II. 72,2% of Group I servicemen and 64.6% of Group II servicemen had an elevated BMI. 50% had a bad habit – smoking in the first group and 18,3% in the second group. Conclusions. We found that the indicators of high blood pressure in groups I and II were 22,73% and 26,83%, which is 12,07% and 6,77% less than among the civilian population of Ukraine where the rate of high blood pressure was 34,8%. The level of total cholesterol is 4,8% higher in patients of group I (45,5%) than among the civilian population of Ukraine (40,7%). In group II by 5,3% less (35,4%), respectively, from the study. The rate of elevated fasting blood glucose in group I (10,6%) is 3,5% higher, and in group II (55,8%), 48,7% higher than the results obtained among the civilian population of Ukraine, where the level of glycemia was 7,1%. The incidence of type II diabetes mellitus in group I (1,9%), which is 1,9% less than the results obtained among the population of Ukraine, where the result was 3,8%, and in group II (14,4%) by 10,6% more, respectively. The increase in BMI in patients of groups I and II was 40,9% and 46,3%, which is 18,2% and 12,8% lower than the data obtained among the civilian population of Ukraine, where the percentage of overweight was 59,1%. The prevalence of smoking among servicemen is 6,68% lower than among the civilian population of Ukraine (33,9%) and amounted to 27,04%.


2018 ◽  
Vol 6 (12) ◽  
pp. 2363-2368
Author(s):  
Sherif Abdallah Mohamed ◽  
Ayman Mohamed Hussam ◽  
Sarah Ahmed Abdallah ◽  
Khaled Abdelfattah Sarhan ◽  
Abdelkhalek Mahmoud Shaban

BACKGROUND: One of the important and predicted physiological effects of spinal anaesthesia is hypotension. A range of strategies including mechanical interventions, intravenous fluids and vasoconstrictor drugs have been used to minimise or prevent spinal anaesthesia-induced hypotension. Observational studies suggest that ondansetron reduces the incidence of post-spinal hypotension (PSH) and support the use of combined fluid preloading and vasoconstrictors for this purpose (but with limited doses) to avoid side effects as fluid overload and tachycardia respectively. AIM: As no RCT had ever compared the use of Ondansetron alone with combined vasoconstrictors and fluid preload, so, this randomised controlled trial has evaluated the efficacy of the use of ondansetron alone compared to the combined use of fluid preload and vasoconstrictors to decrease the incidence of spinal hypotension. METHODS: Ninety patients of ASA grade I between the age of 18 and 45 years scheduled to undergo elective surgical procedures on the lower extremity or lower abdomen under spinal anaesthesia were included in the study. The patients were randomly allocated into two groups of 45 each. Group I patients (ondansetron group) received 4 mg ondansetron in 5 ml normal saline (IV) 15 minutes before induction of spinal anaesthesia. Group II patients (combination group) received preloading with 7.5 ml/kg/min of Ringer's lactate over 10 minute period preceding the spinal block followed by intravenous bolus of 2.5 mg ephedrine in the first and second minute and 2.5 mg ephedrine every 5 minutes for the next 20 minutes after the injection of spinal anesthetic drug. Non-invasive measurement of mean arterial pressures, heart rate, reactive hypertension, nausea and vomiting were documented. RESULTS: The incidence of hypotension following the subarachnoid block in Group I (ondansetron group) was 17.6% versus group II (combination group) was 13.3%, while difference among the groups is statistically insignificant (P = 0.082). Group IV fluids alone could reverse hypotension in 57.1% of patients in group I 33.3% in group II. 42.9% of patients in group I and 67.7% in group II could not be managed with IV fluids alone and had to be treated with 5 mg boluses of ephedrine for reversal of hypotension. The difference in the mean number of fluid boluses and a dose of ephedrine used between both groups was statistically insignificant (P = 0.11 and P = 0.21). HR showed a significant increase in group II and a statistically insignificant change in group I with a statistically significant difference in the heart rate (HR) between both groups (P < 0.05). Reactive hypertension, nausea and vomiting between both groups were statistically insignificant. CONCLUSION: The preemptive use of Ondansetron alone versus combined vasoconstrictors with fluid preload significantly reduces the incidence of post-spinal hypotension (PSH) with no significant difference between both regimens. Furthermore, they also reduced consumption of the used vasoconstrictors and fluids to correct hypotension.


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