Intravenous Palonosetron for Attenuation of Hypotensive Response and Bradycardia during Spinal Anaesthesia

Aim: This study was conducted to evaluate the role of intravenous (IV) palonosetron during spinal anesthesia. Method: A total of 100 patients undergoing elective lower limb and lower abdominal surgeries were randomly divided into two groups. Group P was given 0.25mg palonosetron diluted in 10 ml normal saline slowly before spinal anesthesia. Group S was given 10 ml of normal saline slowly before spinal anesthesia. Heart rate (HR) , systolic blood pressure (SBP) , diastolic blood pressure (DBP) , mean arterial pressure (MAP), oxygen saturation (SpO2) were monitored at an interval of 2 minutes for the initial 20 minutes, then at an interval of every 5 minutes till the end of the surgery. Time to reach the maximum sensory level and its regression two levels below and then till S1 was noted. The incidence of nausea, vomiting, shivering, use of intravenous mephenteramine, level of motor block and its regression were also recorded. Results: Decreases in HR were more observed in Group S and the differences were statistically significant at 25 min [p=0.048] and 30 min [p=0.047]. The decrease in MAP were observed more in Group S and statistically significant difference noted at 20 min [ p = 0.026], 25 min [ p = 0.046] and at 30 min [ p = 0.047]. The use of intravenous mephentermine [p = 0.009] and development of nausea [p = 0.049] were significantly more common in Group S, Sensory block regression was faster in group P. [p=0.054]. Conclusion: Premedication with 0.25mg IV palonosetron before spinal anesthesia reduces hypotension, bradycardia.

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CLONIDINE AS AN ADJUVANT TO HYPERBARIC BUPIVACAINE FOR SPINAL ANESTHESIA IN ELDERLY PATIENTS UNDERGOING INFRAUMBLICAL SURGERIES

10.36106/ijsr/3217567 ◽

2021 ◽

pp. 72-74

Author(s):

Purushottam Singhal ◽

Suresh Pandey ◽

. S. P. Chittora

Keyword(s):

Blood Pressure ◽

Elderly Patients ◽

Systolic Blood Pressure ◽

Spinal Anesthesia ◽

Sensory Block ◽

Primary Study ◽

Control Group ◽

Sensory Level ◽

Hyperbaric Bupivacaine ◽

Small Doses

Background: Use of adjuvant with small doses of local anesthetics is a preferred technique for spinal anesthesia for lower limb surgeries. This study tested the hypothesis that addition of small doses of clonidine augments the spinal block levels produced by hyperbaric bupivacaine in patients without affecting the side-effects. Materials and Methods: This was a prospective, randomized, double-blind study. Above 60 years patients were allocated to three equal groups. Group C received 10 mg hyperbaric bupivacaine without clonidine while Group C and Group C received 15 μg and 30 μg clonidine with 15 30 hyperbaric bupivacaine respectively for spinal anesthesia. Effect of clonidine on sensory block levels was the primary study outcome measure. Motor blockade and hemodynamic parameters were also studied. Results:Asignicantly higher median block levels were achieved in Group C (P < 0.05) and Group C (P <0.05) than Group C. Highest median 15 30 sensory block level, the mean times for sensory regression to T12 level and motor block regression were statistically signicant between Groups C15 and C and between Groups C and C. On comparison of fall in systolic blood pressure trends, there was no signicant difference in the clonidine 30 groups as compared with the control group. Conclusions: In elderly patients, clonidine when used intrathecally in doses of 15 μg or 30 μg with bupivacaine, signicantly potentiated the sensory block levels and duration of analgesia without affecting the trend of systolic blood pressure as compared to bupivacaine alone. Clonidine in doses of 30 μg however facilitated the ascent of sensory level block to unexpectedly higher dermatomes for a longer time.

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Perbedaan Efektivitas Parasetamol Oral Dengan Tramadol Oral Sebagai Tatalaksana Nyeri Pasca Operasi Transurethral Resection of The Prostate

Jurnal Kesehatan Andalas ◽

10.25077/jka.v2i1.66 ◽

2013 ◽

Vol 2 (1) ◽

pp. 38

Author(s):

Ismail Muhammad ◽

Alvarino Alvarino ◽

Nasman Puar ◽

Hafni Bachtiar

Keyword(s):

Postoperative Pain ◽

Pain Intensity ◽

Spinal Anesthesia ◽

Transurethral Resection ◽

Prostate Gland ◽

Chi Square ◽

Anesthesia Group ◽

Significant Difference ◽

Spinal Anesthesia Group ◽

People Group

AbstrakPendahuluan. Transurethral Resection of The Prostate (TURP) merupakan tindakan operasi endoskopi yang sudah menjadi standar baku untuk penatalaksanaan pembesaran kelenjar prostat jinak yang memerlukan tindakan bedah. Nyeri pasca operasi TURP disebabkan karena trauma (reseksi jaringan prostat), iritasi foley kateter dan traksi kateter pasca TURP pada luka operasi. Metode. Merupakan jenis penelitian eksperimental yang membandingkan efektivitas pemakaian parasetamol oral 500 mg dengan tramadol oral 50 mg sebagai tatalaksana nyeri pasca TURP. Penelitian ini melibatkan 30 orang pasien yang dibagi 2 kelompok yaitu 15 orang kelompok parasetamol dan 15 orang kelompok tramadol. Intensitas nyeri dengan skala VAS dan efek samping obat dinilai pada 3jam, 5jam, 7jam pasca spinal anesthesia. Hasil penelitian kemudian diuji dengan independen T.test dan Chi-square. Hasil. Rata-rata nilai VAS 3 jam pasca spinal anastesia kelompok parasetamol adalah 0,6267 cm dan tramadol 0,6400 cm. Pada 5 jam pasca spinal anastesi rata-rata nilai VAS kelompok parasetamol 1,5800 cm, kelompok tramadol 1,4933 cm. Pada 7 jam pasca spinal anesthesia rata-rata nilai VAS kelompok parasetamol 3,5800 cm dan kelompok tramadol 3,1667 cm. Setelah uji statistik baik pada 3jam, 5jam, 7jam pasca spinal anesthesia tidak terdapat perbedaan yang bermakna intensitas nyeri pada ke 2 kelompok dengan p > 0,05. Sedangkan kejadian mual dan alergi juga tidak ada perbedaan yang bermakna pada kedua kelompok. p > 0,05. Kesimpulan. Parasetamol 500 mg oral versus tramadol 50 mg oral memiliki efektifitas yang sama dalam mengatasi nyeri pasca operasi TURP. Sedangkan kejadian mual dan alergi tidak ada perbedaan yang bermakna pada ke 2 kelompok.Kata kunci: TURP, parasetamol, tramadol, VASAbstractArial 9 italic Introduction. Transurethral Resection of the Prostate (TURP) is an endoscopic surgery that become the gold standard for the treatment of benign enlargement of the prostate gland that requires surgery. Postoperative pain due to trauma TURP (resection of prostate tissue), irritation foley catheters and catheter traction after TURP surgery on the wound. Methods. This study was an experimental research that compares the effectiveness of the use of oral paracetamol 500 mg with 50 mg oral tramadol as a pain management of post-TURP. This study involved 30 patients divided into 2 groups: 15 people group of paracetamol and 15 people group of tramadol. Pain intensity with the VAS scale and drug side effects rated at 3 hours, 5 hours, 7 hours after spinal anesthesia. Results were then tested with independent T.test and Chi-square Results were then tested with independent T.test and Chi-square. Results. Mean VAS values after 3 hours spinal anesthesia group of paracetamol and tramadol were 0.6267 cm 0.6400 cm. At 5 hours after spinal anesthesia the mean VAS value of paracetamol group was 1.5800 cm, group of tramadol was 1.4933 cm. At 7 hours after spinal anesthesia mean VAS value group of paracetamol was 3.5 800 cm and group of tramadol was 3.1667 cm. After a statistical test at 3 hours, 5 hours, 7 hours after spinal anesthesia, we conclude that there was no significant difference in pain intensity on the 2 groups with P> 0.05. While the incidence of nausea and allergies also had no significant difference in both groups. P> 0.05. Conclusion. Paracetamol 500 mg orally versus tramadol 50 mg orally had the same effectiveness in addressing postoperative pain TURP. While there was no significant difference in the 2 groups in the incidence of nausea and allergies

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Comparison between Nalbuphine and Ketamine as an adjuvant to Heavy Bupivacaine on Post Dural Puncture Headache

QJM ◽

10.1093/qjmed/hcab086.060 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Mohammad A El Gendy ◽

Gamal M Elewa ◽

Mina Z Wadea ◽

Ashraf M Hazem

Keyword(s):

Spinal Anesthesia ◽

Normal Saline ◽

Dural Puncture ◽

Sensory Block ◽

Saline Group ◽

Controlled Study ◽

Normal Saline Group ◽

Hyperbaric Bupivacaine ◽

Post Dural Puncture Headache ◽

Significant Difference

Abstract Background Incidence of post dural puncture headache (PDPH) is relatively high, and many methods have been tried to prevent or treat it, but results are not satisfactory. Both Nalbuphine and Ketamine have analgesic effects, and have been used intrathecally with local anesthetics, but their effects on PDPH were not studied. Objective To study the incidence and severity of PDPH when nalbuphine or ketamine was added as an adjuvant to hyperbaric bupivacaine in spinal anesthesia (primary outcome). Secondary outcomes were the effects of adding nalbuphine or ketamine as an adjuvant to hyperbaric bupivacaine on motor and sensory effects, duration of analgesia, hemodynamics and side effects of both of them. Patients and Methods This prospective double-blind, randomized controlled study was conducted on 320 patients, aged 21–60 years of both sexes, ASA physical status I and II, and allocated for lower abdominal, pelvic, or lower limb surgeries under spinal anesthesia, after approval from ethical committee (Assurance No. FWA 000017585) of Faculty of Medicine, Ain, Shams University, Cairo, Egypt. Contact with 17 patients was lost. So, 303 patients completed the study. Patients were divided into 3 equal groups (101 each) according to drugs injected intrayhecally. Group (N): 3 ml of 0.5% hyperbaric bupivacaine with 0.5 mg nalbuphine hydrochloride diluted in 0.5 ml normal saline. Group (K): 3 ml of 0.5% hyperbaric bupivacaine with 25 mg ketamine hydrochloride diluted in 0.5 ml normal saline. Group (C): 3 ml of 0.5% hyperbaric bupivacaine with 0.5 ml normal saline. Results Incidence of PDPH was statistically significantly less in group N in comparison to Groups K and C, in the first day. But, no statistically significant difference was found between the three groups at 2nd and 3rd days. There was no statistically significant difference between groups according to severity of PDPH by visual analog score (VAS). Group N has the most rapid onset and long duration of sensory block in comparison with groups K and C. There was no statistically significant difference between groups according to onset and duration of motor block and hemodynamic changes. Conclusion Adding nalbuphine, and not ketamine, with hyperbaric bupivacaine in spinal anesthesia decreased incidence of post dural puncture headache, and prolonged the duration of sensory block. Both groups provided adequate anesthesia and analgesia with good hemodynamic stability.

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Role of pulse plethysmograph in the prediction of hypotension in caesarean section patient under spinal anesthesia

MedPulse International Journal of Anesthesology ◽

10.26611/10151936 ◽

2021 ◽

Vol 19 (3) ◽

pp. 77-80

Author(s):

Sheetal K Desai ◽

Keyword(s):

Blood Pressure ◽

Caesarean Section ◽

Spinal Anesthesia ◽

Characteristic Curve ◽

Elective Caesarean Section ◽

Rank Test ◽

Chi Square ◽

Significant Difference ◽

Chi Square Test

Background: Spinal anesthesia is a commonly employed technique for anesthesia for caesarean section and is associated with hypotension which may cause maternal morbidity. Prediction of hypotension before the procedure can reduce complications. The study aimed to evaluate the role of pulse plethysmograph in the prediction of hypotension in caesarean section patients under spinal anesthesia. Methods: The observational study was conducted on 50 patients who were undergoing emergency or elective caesarean section. Spinal anesthesia was performed by anaesthesiologist using a 25 or 26-gauge spinal needle with bupivacaine at L3-4 interspinous space. Pre and post-anesthesia observations such as the width of pulse plethysmograph, non-invasive blood pressure in another arm, and heart rate were recorded. Paired T-test, Wilcoxon sign rank test, and chi-square test was used to analyse data using R Studio V 1.2.5001 software. Results: Post spinal anesthesia minor fall in systolic blood pressure (SBP) was observed in 11 patients, moderate fall in 21 patients, severe fall in 8 patients and a massive fall in 10 patients. A significant difference was observed between mean pre- and post-spinal anesthesia SBP (P<0.001). Width of pulse plethysmograph (PPG) was maintained in 14 patients whereas, narrowed and significantly narrowed PPGs were observed in 29 and 7 patients, respectively. Significant association was observed between grades of SBP and width of PPG (P<0.05). Receiver operating characteristic curve showed the width of PGG was good for prediction of hypotension in patient (AUC=0.828). Conclusion: Width of PPG can be used to predict SA induced maternal hypotension.

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Intrathecal Nalbuphine versus Intrathecal fentanyl as adjuvant to 0.5% bupivacaine for caesarian section surgery under subarachnoid block

QJM ◽

10.1093/qjmed/hcab086 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Amr Essam El-Din Abdel Hameed ◽

Noha Sayed Hussien ◽

Marwa Mamdouh Mohamed ◽

Abdelrahman Mostafa Mohamed El Kenawy

Keyword(s):

Blood Pressure ◽

Side Effects ◽

Postoperative Analgesia ◽

Tissue Injury ◽

Sensory Block ◽

Sensory Level ◽

Significant Difference ◽

Block Level ◽

Duration Of Operation ◽

Fentanyl Group

Abstract Background One of the main objectives of anesthesia is to relieve the patient’s pain and agony, by ensuring the performance of surgical procedures without any discomfort. Elimination of postoperative pain is indispensable due to the central, peripheral and immunological stress response to tissue injury. So there is a need for extended analgesia without any side effects to achieve this goal. Aim of the Work To compare the post-operative analgesic effect of intrathecal-nalbuphine and fentanyl as adjuvant to bupivacaine during cesarean delivery. The secondary aim is to compare side effects between using nalbuphine and fentanyl as adjuvants to bupivacaine. Patients and Methods After Approval is obtained from the research Medical Ethical Committee of Faculty of Medicine, Ain Shams University. The study was conducted on 60 patients that were randomly selected. Randomly divided into 2 groups 30 patients each. Group F which received fentanyl as adjuvant while group N received nalbuphine as adjuvant. Results The addition of a small dose of nalbuphine or fentanyl to bupivacaine in spinal anesthesia prolonged the time of postoperative analgesia. In this study, there was no significant difference regarding the age, height, weight, and duration of operation, maximum sensory level, and maximum motor blockade level. The duration of the postoperative analgesia was prolonged with Nalbuphine group in comparison to the fentanyl group, the results were highly significant. Conclusion We concluded that either intrathecal nalbuphine (0.8 mg) or intrathecal fentanyl (25 µg) combined with Bupivacaine improves intraoperative analgesia and prolongs early post-operative analgesia in cesarean section. There was no significant difference with regard to: Peak sensory block level, Maximum motor block level, systolic blood pressure, diastolic blood pressure, oxygen saturation, and heart rate.

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A comparison of the effect of dexamethasone and pethidine for prevention of shivering after spinal anesthesia in caesarean section: randomization clinical trial

Biomedical Research and Therapy ◽

10.15419/bmrat.v5i9.473 ◽

2018 ◽

Vol 5 (9) ◽

pp. 2646-2650 ◽

Cited By ~ 2

Author(s):

Hamideh Gholami ◽

Yousef Moradi ◽

Zaher Khazaei ◽

Shahrzad Tehrani

Keyword(s):

Clinical Trial ◽

Caesarean Section ◽

Spinal Anesthesia ◽

Normal Saline ◽

Saline Group ◽

Elective Cesarean Section ◽

Double Blind ◽

Dexamethasone Group ◽

Postanesthetic Shivering ◽

Significant Difference

Background: Postanesthetic shivering is one of the most common complications and problems after operations. Medications and drugs can be used to prevent postanesthetic shivering. The aim of this study is to compare the effects of Dexamethasone and Pethidine in preventing postanesthetic shivering after spinal anesthesia in Iranian women undergoing caesarean section. Method: This double-blind randomized clinical trial was performed in 66 pregnant women who were referred to Ayatollah Moosavi Hospital in Zanjan, Iran for elective cesarean section, from December 2011 to November 2012. All participants who have ASA I-II were randomly classified into three groups: Dexamethasone receivers (Group A), Pethidine receivers (Group B), and Normal Saline receivers (Group C). Data were collected and analyzed using SPSS16 software. IRCT registration number of this study is IRCT201112198469N1. Conclusion: Although statistically there was no significant difference between the three groups of Dexamethasone, Pethidine and Normal Saline receivers regarding shivering reduction; clinical complication rate in Dexamethasone group was lower comparedto Pethidine and Normal Saline groups. Results: There was no significant difference between three groups regarding shivering reduction. There were 11 (72.5%) trembling cases in Normal Saline group, 6 cases (27.3%) in Dexamethasone group, and 12 cases (54.5%) in Pethidine group.

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Comparison of Epidural and Spinal Anesthesia Techniques for Transurethral Resections

JOURNAL OF SURGICAL AND CLINICAL RESEARCH ◽

10.20398/jscr.v9i1.15729 ◽

2018 ◽

Vol 9 (1) ◽

pp. 1-10

Author(s):

Elif Copuroglu ◽

Gonul Sagiroglu ◽

Beliz Bilgili ◽

Sevtap Hekimogl

Keyword(s):

Mean Arterial Pressure ◽

Arterial Pressure ◽

Spinal Anesthesia ◽

Epidural Anesthesia ◽

Total Duration ◽

Satisfaction Score ◽

Patient Satisfaction Score ◽

Group I ◽

Anesthesia Group ◽

Spinal Anesthesia Group

Purpose: Transurethral resections (TUR) are commonly performed for elderly population who have multiple comorbidities which can cause intraoperative and postoperative complications. The type of anesthesia has an impact on patient outcome. The aim of the study is to compare the effectiveness of epidural and spinal anesthesia techniques for TUR. Methods: A total of 158 elective TUR cases were evaluated. The patients were randomized into 2 groups: Epidural anesthesia was applied to Group I (n=82) and spinal anesthesia was applied to Group II (n=76). Both groups were compared for intraoperative hemodynamic parameters (mean arterial pressure, heart rate, peripheral oxygen saturations), total duration of hospital stay, perioperative complications, and satisfaction of the patients and surgeons. Results: The patients in the spinal anesthesia group experienced more frequent intraoperative hypotensive episodes during TUR (n=2 vs. n=10; p=0.026) and had lower mean arterial pressure values for the first 30 minutes of anesthesia compared to epidural anesthesia group. The postoperative duration of bed stay was longer in the spinal anesthesia group (402.96±49.61 min) than the epidural anesthesia group (205.91±28.27 min) (p<0.001). The patient satisfaction score was significantly higher in the epidural anesthesia group (2.54±0.63) than the spinal anesthesia group (2.23±1.22) (p=0.04) where as the surgeon satisfaction score were similar in both groups. Conclusion: Epidural anesthesia can be considered as an effective and safe technique for ambulatory interventions especially for elderly patients providing perioperative hemodynamic stability and postoperative early mobilization.

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Could spinal anesthesia be a choice for retrograde intrarenal surgery

Urologia Journal ◽

10.1177/0391560318758936 ◽

2018 ◽

Vol 85 (4) ◽

pp. 169-173 ◽

Cited By ~ 5

Author(s):

Ibrahim Karabulut ◽

Erdem Koc ◽

Ali Haydar Yilmaz ◽

Elif Oral Ahiskali ◽

Ercument Keskin ◽

...

Keyword(s):

Visual Analogue Scale ◽

General Anesthesia ◽

Spinal Anesthesia ◽

Analogue Scale ◽

Complication Rates ◽

Retrograde Intrarenal Surgery ◽

General Anesthesia Group ◽

Group I ◽

Anesthesia Group ◽

Spinal Anesthesia Group

Objective: In this study, we aimed to compare cases of retrograde intrarenal surgery performed under spinal or general anesthesia through investigating relevant parameters for the first time in the literature. Material and method: In total, 86 patients with diagnosis of kidney stone who were treated by retrograde intrarenal surgery were included in this randomized controlled prospective study. In total, 43 of these operations were performed under spinal anesthesia (group I) and 43 were performed under general anesthesia (group II). The groups were compared in terms of demographic features, American Society of Anesthesiologists score, duration of operation, complication rates, postoperative visual analogue scale, postoperative hospitalization period, stone-free rates, and cost value ratios. Results: There were no significant differences between the two groups in terms of demographic findings, preoperative stone loads, postoperative stone-free rates, complication rates and postoperative hospitalization periods (p > 0.05). Postoperative visual analogue scale scores and cost value ratios were found statistically significantly lower in the spinal anesthesia group (group I) when compared with the general anesthesia group (group II; p < 0.001). Conclusion: Performing retrograde intrarenal surgery in the presence of spinal anesthesia is equally effective with general anesthesia. Spinal anesthesia also appears to be a more advantageous method due to statistically significantly lower mean postoperative pain scores and treatment cost value ratios.

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Comparison of the Effects of Pre-Anesthetic Administration of Normal Saline, Ringer and Voluven on the Spread of Sensory Block With Hyperbaric Bupivacaine Spinal Anesthesia

Anesthesiology and Pain Medicine ◽

10.5812/aapm.17939 ◽

2014 ◽

Vol 4 (2) ◽

Author(s):

Elham Memary ◽

Alireza Mirkheshti ◽

Morteza Jabbari Mogddam ◽

Dariush Abtahi ◽

Mehdi Yaseri ◽

...

Keyword(s):

Spinal Anesthesia ◽

Normal Saline ◽

Sensory Block ◽

Hyperbaric Bupivacaine

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Dexmedetomidine versus magnesium sulfate as an adjuvant to local anesthetics in spinal anesthesia: a meta-analysis of randomized controlled trials

Journal of International Medical Research ◽

10.1177/0300060520946171 ◽

2020 ◽

Vol 48 (8) ◽

pp. 030006052094617

Author(s):

Jinguo Wang ◽

Zaitang Wang ◽

Xuesong Song ◽

Na Wang

Keyword(s):

Randomized Controlled Trials ◽

Magnesium Sulfate ◽

Spinal Anesthesia ◽

Local Anesthetics ◽

Sensory Block ◽

Cochrane Library ◽

Controlled Trials ◽

Sensory Blockade ◽

Randomized Controlled ◽

Significant Difference

Objective To compare the efficacy of dexmedetomidine and magnesium sulfate as an adjuvant to local anesthetics in spinal anesthesia. Methods A search of PubMed, Medline, Embase, the Cochrane Library, and Google Scholar was performed. Randomized controlled trials comparing the efficacy of dexmedetomidine and magnesium sulfate as a local anesthetic adjuvant in spinal anesthesia were identified. The primary outcome was sensory block duration. The mean difference (MD) or odds ratio along with the 95% confidence interval (CI) was used to analyze the outcomes. Results Six studies involving 360 patients were included. Intrathecal dexmedetomidine was associated with a significantly longer sensory block duration (MD = −73.62; 95% CI = −101.09 to −46.15), faster onsets of sensory blockade and motor blockade, and a longer motor block duration than intrathecal magnesium sulfate. There was no significant difference between the regarding the rates of hypotension, bradycardia, shivering, and postoperative nausea and vomiting between the groups. Conclusions Dexmedetomidine is superior to magnesium sulfate as an adjuvant to local anesthetics in spinal anesthesia because of its more rapid onset and longer duration of spinal block without significant adverse effects.

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