scholarly journals EFFECT OF INTRAVENOUS VERSUS INTRATHECAL DEXMEDETOMIDINE ON CHARACTERISTICS OF HYPERBARIC BUPIVACAINE SPINAL ANESTHESIA IN LOWER LIMB SURGERY

2018 ◽  
Vol 11 (7) ◽  
pp. 427
Author(s):  
Laxman K Senapati ◽  
Priyadarsini Samanta
Keyword(s):  
Side Effects ◽  
Spinal Anesthesia ◽  
Lower Limb ◽  
Motor Block ◽  
Infusion Pump ◽  
Controlled Study ◽  
Sensory Level ◽  
Hyperbaric Bupivacaine ◽  
Rescue Analgesia ◽  
Lower Limb Surgery

Objectives: Dexmedetomidine was shown to prolong the duration of spinal anesthesia and enhance post-operative analgesia. The aim of the study was to compare the effect of intravenous (IV) versus intrathecal (IT) administration of dexmedetomidine on bupivacaine spinal anesthesia in patients undergoing lower limb surgery.Methods: A prospective randomized controlled study was conducted during the year 2014–15. 60 American Society of Anesthesiologists physical status I–II aged 18–60 years scheduled for lower limb surgery under spinal anesthesia were assigned randomly to two groups: (1) IT group (IT group) (n=30) patients received 3 ml of 0.5% hyperbaric bupivacaine and 5 μg of dexmedetomidine intrathecally (100 μg/1 ml ampoule drawn in 40 IU/ml insulin syringe making 5 μg=2 IU=0.05 ml) and (2) IV group (IV group) (n=30) received 3 ml of 0.5% hyperbaric bupivacaine and 0.05 ml of normal saline intrathecally followed 5 min later by IV dexmedetomidine 0.5 μg/kg by infusion pump over 10 min as a single dose.Results: The IT group had a statistically significantly earlier sensory onset to T10 and shorter time from injection to highest sensory level (p<0.001). The regression times of two dermatomes, regression time to S1 dermatome and time to reach Bromage 3 motor block were significantly less in the IT group, whereas regression time to Bromage 0 was prolonged (p<0.001). The IT group showed a significantly longer time to the use of rescue analgesia and less analgesic consumption in first 24 h than the IV group (p<0.001). Furthermore, the intensity of pain was significantly less in the IT group as compared to IV group (p<0.001). Compared with IV group, the IT group had low sedation score, fewer overall side effects, which was statistically not significant (p>0.05).Conclusion: In bupivacaine spinal anesthesia for limb surgeries, dexmedetomidine, when administered intrathecally, has greater augmentation to sensory and motor block, more hemodynamic stability, better analgesic properties, and fewer overall side effects compared to the IV route of administration.

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

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

scholarly journals Comparative Study of Hyperbaric Bupivacaine and Isobaric Ropivacaine for Lower Limb Surgery under Spinal Anesthesia

2019 ◽  
Vol 2 (2) ◽  
pp. 22-27
Author(s):  
Gunjan Regmi ◽  
Rejina Shahi ◽  
Kanak Khanal ◽  
Kumud Pyakurel ◽  
Chetan Bohora ◽  
...  
Keyword(s):  
Heart Rate ◽  
Comparative Study ◽  
Spinal Anesthesia ◽  
Lower Limb ◽  
Motor Block ◽  
Hyperbaric Bupivacaine ◽  
Subarachnoid Block ◽  
Arterial Blood ◽  
Group I ◽  
Lower Limb Surgery

Introduction: Subarachnoid block is commonly employed technique for lower abdominal and lower limb procedures. Bupivacaine and ropivacaine are commonly used local anesthetics for subarachnoid block. The aim of this study is to compare the efficacy and safety of isobaric Ropivacaine over hyperbaric Bupivacaine. Methods: This was a prospective comparative study for a duration of six months. 60 ASA grade I-II adult patients between 16-60 years undergoing lower limb surgery under spinal anesthesia were randomized into two groups. Group I including patients who received 15 mg of hyperbaric bupivacaine 0.5% and group II including patients who received 22.5 mg of isobaric ropivacaine 0.75%. The onset and duration of sensory and motor block and hemodynamics including heart rate (HR), non invasive mean arterial blood pressure (MAP) and respiratory depression were recorded. Data were entered in Microsoft excel and statistical analysis was done by chi square test and T test using SPSS (version 23.0). Results: Both the groups were demographically statistically insignificant. Successful block was attained in all patients in both groups. The sensory onset and motor onset were significantly delayed in the Ropivacaine Group compared to the Bupivacaine Group P<0.001. There was no significant difference in the hemodynamics (heart rate and mean arterial pressure ). Conclusions: Though isobaric ropivacaine provided lesser degree of sensory and motor block with delayed onset compared to hyperbaric bupivacaine, it can effectively and safely used in subarachnoid block in lower limb surgeries without any major hemodynamic changes and adverse effects.

scholarly journals Clinical Comparative Study between Fentanyl and Dexmedetomidine with Bupivacaine for Lower Limb Surgery in Spinal Anaesthesia

2020 ◽  
Vol 5 (1) ◽  
pp. 126-130
Author(s):  
Tuhin Vashishth ◽  
Sangeeta Varun
Keyword(s):  
Spinal Anesthesia ◽  
Lower Limb ◽  
Motor Block ◽  
Sensory Block ◽  
Double Blind Study ◽  
Hyperbaric Bupivacaine ◽  
Double Blind ◽  
Block Time ◽  
Lower Limb Surgery ◽  
Group D

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.

COMPARISONS OF EFFECTS OF DIFFERENT DOSES OF DEXMEDETOMIDINE AS ADDITIVE IN INTRATHECAL BLOCKADE WITH 0.5% HYPERBARIC BUPIVACAINE IN LOWER LIMB ORTHOPEDIC SURGERIES

2021 ◽  
pp. 21-23
Author(s):  
Shantanu Hazra ◽  
Debabanhi Barua ◽  
Sudeshna Mondal ◽  
Arpita Laha
Keyword(s):  
Lower Limb ◽  
Controlled Study ◽  
Sensory Level ◽  
Hyperbaric Bupivacaine ◽  
Duration Of Action ◽  
Stable Conditions ◽  
Study Results ◽  
The Mean ◽  
Group D

INTRODUCTION Lower limb surgeries may be performed under local, regional (spinal or epidural) or general anaesthesia, but neuraxial blockade is the preferred mode of anaesthesia. Spinal block is still therst choice because of its rapid onset, superior blockade, low risk of infection as from catheter in situ, 1 less failure rates and cost-effectiveness. Intrathecal local anaesthesia alone is associated with relatively short duration of action and thus early analgesic intervention is needed in post-operative period. AIMS AND OBJECTIVES With use of dexmedetomidine in 3 different graded doses with hyperbaric bupivacaine intrathecally as regional anaesthesia for lower limb surgeries. MATERIALS AND METHODOLOGY This Prospective double blinded randomized controlled study. The study will be conducted in adult patients aged between 18-50 years undergoing lower limb surgeries under spinal anaesthesia in orthopedic OT, dept. of Anaethesiology, Medical college & hospital, Kolkata. Duration of the study One year (9 months for data collection & 3 months for data analysis, review& report writing). Total 63 patients in our study. RESULTS We found the mean of two segment regression time from highest sensory level in Group B was 130.56min; in group C was 171.34min; ingroup D was 217.85min So, block regression was signicantly slower with the addition of intrathecal dexmedetomidine (Group D) as compared to group C & B ( P < 0.0001) The mean regression time to S1 from highest sensory level for Group Bwas 289.43 min ( SD- 12.43) For Group C, the mean regression time to S1 from highest sensory level was 402.71 min ( SD- 28.60) For Group D, the mean regression time to S1 from highest sensory level was 584.43min ( SD- 38.92) Overall the mean regression time to S1 from highest sensory level was 425.52 min ( SD- 125.71) The sensory regression time to S1 from highest sensory level was signicantly higher with increasing dose of dexmedetomidine i. e. D>C>B . (P< 0.0001). CONCLUSION We recommend the use of 10mcg of intrathecal dexmedetomidine as an adjuvant to bupivacaine as it seems to be a good alternative to other additives for long duration surgical procedures due to its profound intrathecal anesthetic and analgesic properties. It provides good quality of intraoperative analgesia, thermodynamically stable conditions, minimal side effects, and excellent quality of postoperative analgesia.

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

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

A comparative study of post-operative analgesia after caesarean section with intrathecal hyperbaric bupivacaine combined with different doses of buprenorphine

2021 ◽  
Vol 20 (1) ◽  
pp. 07-09
Author(s):  
Veereshkumar Angadi ◽  
Keyword(s):  
Side Effects ◽  
Pain Relief ◽  
Controlled Study ◽  
Hyperbaric Bupivacaine ◽  
Rescue Analgesia ◽  
Post Operative Pain ◽  
Analgesia Requirement ◽  
Group A ◽  
Group B ◽  
Different Doses

Background: Post-operative pain relief after caeserean section is challenging to both anesthetista and obstetricians. Injection buprenorphine can be used intrathecally for post operative analgesia. Aim: the aim of the study was to compare the efficacy of two different doses(30ug and 60ug) of buprenorphine intrathecally with hyperbaric bupivacaine for post operative pain relief in caserean section. Methods and Materials: A prospective randomised controlled study was done on 60 subjects undergoing elective casarean section where in two groups were made, Group A (n=30) and Group B (n=30) who received inj bupivacaine 0.5% hyperbaric 2ml plus inj buprenorphine 30ug and inj bupivacaine 0.5% hyperbric plus inj buprinorphine 60ug intrathecally respectively. Following parameters were observed, onset and duration of sensory block, postopertive pain measured on VAS(visual analogue scale),rescue analgesia requirement, maternal side effects. Results: Unpaired t test and Chi square test were used for statistical analysis. Duration of analgesia was longer significantly in group A compared to group B. rescue analgesia requirement and VAS were significantly lower in group A as compared to group B.No major side effects were seen. Conclusion: Increasing the dosage of buprenorphine intrathecally increased the duration and quality of post operative analgesia. with no major adverse effects.

scholarly journals Anesthetic effects of varying doses of Fentanyl combined with spinal Bupivacaine in caesarean delivery

2018 ◽  
Vol 17 (2) ◽  
pp. 3
Author(s):  
Puja Thapa ◽  
Amir Babu Shrestha ◽  
Mallika Rayamajhi
Keyword(s):  
Side Effects ◽  
Adverse Effects ◽  
Caesarean Delivery ◽  
Motor Block ◽  
Optimal Dose ◽  
Sensory Level ◽  
Hyperbaric Bupivacaine ◽  
Spinal Opioids ◽  
Effective Analgesia

<p><strong>Introduction</strong></p><p>Spinal opioids have gained popularity in recent years as they augment the analgesia produced by local anesthetics. Fentanyl is one of the opioids used for such purpose however the optimal dose has not been described adequately in the literature available so far in our setup. The aim of this study is to find out the effect of adding various doses of Fentanyl to low dose hyperbaric Bupivacaine intrathecally.</p><p><strong>Materials and methods</strong></p><p>Seventy-five parturients scheduled for caesarean delivery were randomly allocated into three groups (Bupivacaine-Fentanyl) BF10, BF20 and BF30 who received intrathecal 0.5% hyperbaric Bupivacaine 1.6 ml with Fentanyl 10µg, 20 µg and 30 µg respectively. Total volume was made to 2.2ml by adding normal saline. The outcomes measured were peak sensory level, degree of motor block, quality of intraoperative anesthesia, duration of effective analgesia, neonatal APGAR score and side effects were noted if any.</p><p><strong>Results</strong></p><p>Peak sensory level and degree of motor block was similar in all the groups. Peak sensory level (Thoracic Dermatome) was 4.52± 0.82, 4.32± 0.62 and 4.32± 0.74 (p=0.540) in BF10, BF20 and BF30 respectively. Degree of motor block was not significantly different (p=1.000). Quality of intraoperative anesthesia improved from BF10 to BF20 (P=0.040) but did not improve significantly from BF20 and BF30 (P=0.189). Duration of effective analgesia prolonged as the dose of Fentanyl increased which was in minutes 173.64±41, 216.80±32 and 273.16±35 (p=0.000) in BF10,BF20 and BF30 respectively. Neonatal APGAR scores were similar in all groups and very little adverse effects in higher doses.</p><p> <strong>Conclusion</strong></p><p>The combination of 1.6 ml of 0.5% hyperbaric Bupivacaine and 20 µg of Fentanyl intrathecally provides excellent surgical anesthesia, prolonged postoperative effective analgesia with very few side effects. Increasing the dose of Fentanyl beyond it could prolong the postoperative pain relief but at the cost of increased adverse effects.</p>

scholarly journals Influence of injection rate of hyperbaric bupivacaine 0.75% on spinal anaesthesia in elderly patients with lower limb orthopaedic surgeries. A randomized controlled trial.

2019 ◽  
Vol 26 (08) ◽  
pp. 1251-1255
Author(s):  
Manzoor Ahmed Faridi (Retd) ◽  
Shaheen Mahmood ◽  
Muhammad Safi ur Rehman
Keyword(s):  
Elderly Patients ◽  
Spinal Anaesthesia ◽  
Lower Limb ◽  
Motor Block ◽  
Sensory Block ◽  
Injection Rate ◽  
Ethical Review ◽  
Sensory Level ◽  
Double Blind Study ◽  
Hyperbaric Bupivacaine

To determine the effect of speed of hyperbaric bupivacaine (0.75%) injection on clinical characteristics of spinal anaesthesia in elderly patients undergoing lower limb orthopaedic surgeries. Study Design: Prospective, randomized, double-blind study. Setting: This study was conducted in the operating theatre of Fauji Foundation Hospital, Rawalpindi. Period: August 2018 - March 2019. Materials and Methods: 60 elderly patients undergoing lower limb orthopaedic surgery were randomized into two groups based on injection rate (fast and slow). 1.5 ml of 0.75% hyperbaric bupivacaine was injected over 5 seconds (fast group) and 50 seconds (slow group). Study was undertaken after taking permission from institutional ethical review committee. Level of sensory block, motor block, and systolic blood pressure were recorded at pre-specified intervals. Incidences of hypotensive episode, nausea, phenylephrine and antiemetic use were also documented. Results: Our study did not reveal any difference in maximum level of sensory block attained (fast = median T4, interquartile range [T4–T6] vs slow = T4 [T4–T6], P = 0.77). There was no difference in mean time (minutes) to reach T10 sensory level (fast = 2.5 ± 1.2 vs slow = 2.2 ± 0.8, P = 0.27); maximum sensory level (fast = 4.2 ± 1.5 vs slow = 3.8 ± 1.2, P = 0.26) and maximum motor block level (min) (fast = 5.9 ± 1.4 vs slow = 5.7 ± 1.2, P = 0.56). The rate of hypotension (fast = 8/30 vs slow = 4/30, P = 0.33), nausea (fast = 5/30 vs slow = 3/30, P = 0.99) and phenylephrine use (fast = 5/30 vs slow = 3/30, P = 0.71) and antiemetic requirement (fast = 1/30 vs slow = 2/30, P = 0.99) was also alike. Conclusion: There is no effect of injection speed of intrathecal (0.75%) bupivacaine on the clinical features of spinal anaesthesia in older patients undergoing lower limb orthopedic surgery.

scholarly journals COMPARATIVE STUDY OF INTRATHECAL FENTANYL WITH HYPERBARIC BUPIVACAINE TO IMPROVE PERIOPERATIVE ANALGESIA IN PATIENT UNDERGOING ORTHOPEDIC SURGERY

2021 ◽  
pp. 55-58
Author(s):  
Rahul Wagh ◽  
Swapnil Sangale ◽  
Nagesh Jambure
Keyword(s):  
Side Effects ◽  
Lower Limb ◽  
Motor Block ◽  
Control Group ◽  
Study Group ◽  
Hyperbaric Bupivacaine ◽  
Analgesic Requirement ◽  
Sensory Blockade ◽  
Group I ◽  
Group Ii

Background: Various methods exist for treating post-operative pain which includes systemic narcotics, NSAIDS, patient-controlled analgesia, regional anaesthesia techniques, epidural local anaesthetic – narcotic mixtures, cryoanalgesia, transcutaneous electric nerve stimulation, psychological methods. Various opioides intrathecally and epidurally have been tried for post-operative analgesia. These include - morphine, pethidine, pentazocine, methadone, tramadol, Fentanyl, sufentanyl. In present study, we tried to find out analgesic effectiveness of intrathecal Fentanyl for post-operative analgesia, combined with 0.5 % Bupivacaine and side effects if any, in patients undergoing lower limb surgeries. Materials and Methods: After approval from the local ethics committee and with written informed consent from patient, a randomized controlled prospective study is carried out in the medical college and hospital.100 patients belonging to American Society of Anesthesiologists (ASA)classification I &amp; II, aged between 18-60 years, posted for elective lower limb surgeries, were randomly allocated for the study. Group-I: 50 patients received intrathecal 3 ml of 0.5 % hyperbaric Bupivacaine only. Group-II : 50 patients received intrathecal 3 ml of 0.5% hyperbaric Bupivacaine and Fentanyl 25 mcg.The patients studied across the group did not vary much with respect to age,height, weight and sex distribution. Results: The onset of sensory blockade was faster by 1.27 min in Group-BF. The perioperative and postoperative hemodynamic parameters were comparable in both the groups. The sensory analgesia in Group II was significantly prolonged by 159 mins, thus increasing the duration of analgesia. The time of first request of analgesics by the patients in group-II is prolonged compared to group-I thus prolonging the duration of analgesia. Analgesic requirement is also reduced in study group in early post-operative period. The onset of motor block was faster when Fentanyl was added to intrathecal Bupivacaine and it was 1.1 min earlier in study group. The duration of motor block to Bromage III was prolonged by almost 22 min in study group as compare to control group. Visual analogue scores were significantly lower in group-II compared to group-I after two hours of surgery thus reducing the frequency of supplemental postoperative analgesics. Conclusion: With the present study we can summarize that intrathecal Fentanyl potentiates the action of Bupivacaine thereby bringing about better quality and longer duration of analgesia, intense motor block, no hemodynamic disturbance and better postoperative outcome with/ minimum side effects.

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