scholarly journals Study of duration and efficacy of chloroprocaine for spinal anesthesia in infraumbilical surgeries

2021 ◽  
Vol 12 (11) ◽  
pp. 156-162
Author(s):  
Nazima Memon ◽  
R.G. Pathak ◽  
Meenakshi S. Pradeep
Keyword(s):  
Spinal Anesthesia ◽  
Day Care ◽  
Motor Block ◽  
Sensory Block ◽  
Secondary Outcome ◽  
Sensory Blockade ◽  
Suitable Alternative ◽  
Long Acting ◽  
Care Surgery ◽  
Mean Time

Background: Spinal anesthesia is a reliable and safe technique for infraumbilical surgeries. Nevertheless, some of its characteristics may limit its use for day care surgery. Use of long-acting anesthetic drugs like bupivacaine in spinal anesthesia may lead to side effects such as delayed ambulation and risk of urinary retention. Chloroprocaine is an amino-ester local anesthetic with a very short half-life now being extensively evaluated in volunteer studies and clinical practice with a favorable safety profile and efficacy, suggesting that it may be a suitable alternative to long-acting local anesthetics like bupivacaine in day care surgeries. Aims and Objective: This study aims at evaluating the duration and efficacy of chloroprocaine in spinal anesthesia for infraumbilical surgeries. The primary outcome of the study was to evaluate the duration and efficacy of chloroprocaine 1% in spinal anesthesia for infraumbilical surgeries and the secondary outcome was to find out the incidence of adverse effects if any. Materials and Methods: In this randomized single-blinded clinical evaluation, after institutional ethical committee approval, 30 adult patients (18–70 years, ASA physical Status I-III, BMI < 36 kg/m2) scheduled for infraumbilical surgeries received chloroprocaine 40 mg intrathecally. Patients were evaluated for onset and regression of sensory and motor blockade, peak level of sensory blockade, and time of ambulation postoperatively. Results: The average duration of the surgeries was 46.87±15.24 min. Anesthesia was sufficient for the planned surgery. Only three patients required sedation intraoperatively. The median peak sensory block height was T8. The mean time for peak height sensory block was 6.6±1.673 min and complete motor block was 2±1.05 min. Mean time for complete sensory block regression was 95.37±20.79 min and complete motor block regression was 81.43±20.33 min. Four patients required inj. atropine following bradycardia and three patients required vasopressors following hypotension. Conclusion: Spinal anesthesia with chloroprocaine provides reliable sensory and motor block for short duration infraumbilical surgeries with fewer intraoperative and post-operative complications.

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 Isobaric levobupivacaine a better and safer substitute for spinal anaesthesia in patients undergoing prolonged lower abdominal and lower limb surgeries

2018 ◽  
Vol 6 (9) ◽  
pp. 3111
Author(s):  
Wasimul Hoda ◽  
Abhishek Kumar ◽  
Priodarshi Roychoudhury
Keyword(s):  
Spinal Anesthesia ◽  
Spinal Anaesthesia ◽  
Lower Limb ◽  
Motor Block ◽  
Sensory Block ◽  
Double Blind Study ◽  
Double Blind ◽  
Sensory Blockade ◽  
Group A ◽  
Group B

Background: Bupivacaine being the drug of choice for spinal anaesthesia is associated with serious cardiac toxicity. Levobupivacaine and ropivacaine, both being the two S enantiomers of bupivacaine can be a safer alternatives with better cardiovascular safety. Hence, the clinical efficacy of both were assessed and compared in patients undergoing spinal anesthesia.Methods: A prospective randomized controlled double blind study was done in 68 adult posted for elective lower abdominal and lower limb surgeries under spinal anesthesia. They were randomized into 2 groups. About 3ml isobaric levobupivacaine 0.5% (15mg) was given in group A and 3ml isobaric ropivacaine 0.5% (15mg) was given in group B. Onset, duration of sensory and motor blocks, time for maximum sensory and motor block, time for 2 segment sensory regression and haemodynamic parameters were recorded and analyzed.Results: All patients achieved a sensory block of T10 dermatome. Onset of sensory blockade at T10 was similar in both groups, group A (5.71±1.31min) and group B (5.94±1.72min). Time from injection to two dermatomal regression was 129.68±15.54min in group A and 111.38±22.35min in group B. Onset of Bromage score of 1 in group A was 4.68±1.27min and in group B was 6.44±1.64min. The mean duration of motor and complete motor block was prolonged in group A patients (197.74±18.51min, 168.82±17.90 min) as compared to group B (131.88±20.41min, 106.71±10.85min).Conclusions: Isobaric levobupivacaine was found to be a better and safer substitute for spinal anesthesia in patients undergoing prolonged lower abdominal and lower limb surgeries.

Study of Spinal anesthesia in patients with Scoliosis at a tertiary hospital

2021 ◽  
Vol 12 (2) ◽  
pp. 44-48
Author(s):  
Akshi Goel ◽  
Tahleel Mohd Jeelani ◽  
Basharat Saleem
Keyword(s):  
Spinal Anesthesia ◽  
Motor Block ◽  
Preoperative Assessment ◽  
Sensory Block ◽  
Complete Recovery ◽  
Tertiary Hospital ◽  
Soft Tissue Release ◽  
Sensory Blockade ◽  
Female Ratio ◽  
American Society

Background: Scoliosis is a complex deformity of the vertebral spines resulting in lateral curvature, rotation of the vertebrae and deformity of the rib cage. 75 -90% of cases of scoliosis are of the idiopathic type, out of which the adolescent type is most common. Patients with scoliosis present challenges in administration of anesthesia during surgical procedures. The common problems are airway management and respiratory conditions. Aims and Objectives: The present study was aimed to study spinal anaesthesia in patients with scoliosis at a tertiary hospital. Materials and Methods: The present study was a prospective, observational study conducted in department of anesthesiology, in patients between age group 18 and 60 years with scoliosis (Cobb’s angle of >15°), American Society of Anesthesiology physical grade I/II, posted for elective, lower limb orthopedic soft tissue release procedures under spinal anesthesia. All details were noted in case proforma and entered in Microsoft excel sheet. Statistical analysis was done using descriptive statistics. Results: A total of thirty-two patients were included in present study. The mean age was 25.27 ± 4.81 years. Male (63%) were more than female (37%). Male to female ratio 1.7:1. As per American society of anaesthesiologist physical grading grade I patients were 78% while grade II was 22%. The onset of sensory block was in 7.9 ± 2.3 mins and onset of motor block was in 4.9 ± 2 mins. Maximum extent of sensory blockade till T5-T4 was noted in 66% patients. Time taken for complete recovery of motor block to its preoperative level was 94.3 ± 26.2 min. Conclusion: With proper preoperative assessment, spinal anesthesia can be safely used in patients with scoliosis. Patients with scoliosis needs good preoperative assessment, well equipped setup and team efforts for good outcome.

scholarly journals Bupivacaine 0.5% vs. levobupivacaine 0.5% for epidural anaesthesia for caesarean section: a comparative study

2018 ◽  
Vol 7 (2) ◽  
pp. 343 ◽  
Author(s):  
Heena D. Pahuja ◽  
Megha P. Tajne ◽  
Anjali R. Bhure ◽  
Savita M. Chauhan
Keyword(s):  
Caesarean Section ◽  
Epidural Anaesthesia ◽  
Motor Block ◽  
Elective Caesarean Section ◽  
Sensory Block ◽  
Epidural Block ◽  
Elective Cesarean Section ◽  
Significant Difference ◽  
Elective Cesarean ◽  
Mean Time

Background: Levobupivacaine has been purported to be as efficacious as Bupivacaine for epidural anaesthesia in recent literature.Methods: With the intent to study the same in caesarean section cases in our set up, we observed various intra- and post-operative variables in two groups (Levobupivacaine and Bupivacaine) of 60 healthy parturients. Sixty parturients for elective caesarean section were allocated randomly to receive epidural block with 10-20 ml of either 0.5% Levobupivacaine with Fentanyl 25µg or 0.5% Bupivacaine with Fentanyl 25µg to reach T6 level.Results: Mean total volume in Bupivacaine group was 15.23ml and in Levobupivacaine group was 12.76 ml. The difference was statistically significant. There was significant difference between the groups in the sensory block. The onset of analgesia was earlier in Levobupivacaine group. Mean time was 6.20 minutes in Bupivacaine group and 4.36 minutes in Levobupivacaine group. The duration of motor block was significantly short in Levobupivacaine group. Mean Time for recovery from motor block in Bupivacaine group was 2.5 hours and in Levobupivacaine group 1.5 hours. Mean time to achieve T6 height was earlier in Levobupivacaine group i.e. 16.46 minutes in Bupivacaine group and 13.26 minutes in Levobupivacaine group. Duration of postoperative analgesia was similar. There was no significant difference in neonatal outcome.Conclusions: Levobupivacaine was found to fare better than Bupivacaine in the studied intra and post-operative parameters and is hence recommended over racemic Bupivacaine for epidural block in patients undergoing elective cesarean section.

scholarly journals A comparative clinical study of intrathecal hyperbaric bupivacaine with and without fentanyl for hysterectomy

2020 ◽  
Vol 11 (2) ◽  
pp. 59-63
Author(s):  
Hari Poudel ◽  
Surinder Nath Bawa ◽  
Surendra Mohan Sharma
Keyword(s):  
Side Effects ◽  
Spinal Anesthesia ◽  
Sensory Block ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Maximum Height ◽  
Hyperbaric Bupivacaine ◽  
Sensory Blockade ◽  
Group I ◽  
Group Ii

Background: Spinal anaesthesia has been widely used for lower abdominal surgeries like hysterectomy.Hyperbaric bupivacaine is the most extensively used local anesthetic. Addition of fentanyl can allow the reduction in the dose of bupivacaine, increase the height and duration of sensory blockade, and reduces complications of spinal anesthesia. Aims and Objective: The aim of the study was to examine whether adding fentanyl to hyperbaric bupivacaine would increase the height of sensory blockade, accelerate the onset of sensory blockade and increase the duration of the sensory blockade. Material and Methods: This study was done in Manipal Teaching Hospital, Pokhara, Nepal that included hundred patients who underwent total abdominal hysterectomy. The patients were randomly allocated in two groups; Group I: received 0.5% hyperbaric bupivacaine 2.5 ml (12.5 mg) plus normal saline 0.5 ml. Group II: received 0.5% hyperbaric bupivacaine 2.5 ml (12.5 mg) plus 0.5 ml fentanyl (25 μg). Hemodynamic variables, onset of motor and sensory blockade, duration of sensory and motor blockade and any side effects were observed and recorded. Results: The highest and lowest sensory block in Group I was T-7 and T-9 whereas in Group II was T-5 and T-9 respectively. In group I, the mean onset till maximum height of sensory blockade was 7.04 min whereas in group II it was 5.96 min (P<0.00).There was no significant statistical difference in the incidence of side effects in both the groups. Conclusion: Intrathecal fentanyl with hyperbaric bupivacaine for spinal anesthesia significantly accelerated the onset of sensory blockade and increased its maximum height and duration.

scholarly journals Efficacy of Low Dose Levobupivacaine (0.1%) for Axillary Plexus Block using Multiple Nerve Stimulation

2008 ◽  
Vol 36 (6) ◽  
pp. 850-854 ◽  
Author(s):  
X. Zhao ◽  
Y.-W. Wang ◽  
H. Chen ◽  
Z. Zhang ◽  
X.-M. You ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Motor Block ◽  
Hand Surgery ◽  
Sensory Block ◽  
Sensory Blockade ◽  
Significant Difference ◽  
Brachial Plexus Blockade ◽  
Plexus Block ◽  
To Receive ◽  
Higher Doses

The purpose of this study was to investigate if low doses of levobupivacaine (0.1%) produce complete sensory blockade in preoperative axillary brachial plexus block and to compare the effect of different doses of levobupivacaine on sensory and motor blockade. A total of 110 patients scheduled for elective forearm or hand surgery were randomly allocated to receive 36 ml or 72 ml of levobupivacaine 0.1% or 36 ml of levobupivacaine 0.25%. In each group, volumes were equally distributed in the four nerve territories. In all patients, the sensory and motor block was assessed at five, 10, 20 and 30 minutes after the placement of axillary block. Complete sensory block was obtained in 94.4% of patients receiving 36 ml of levobupivacaine 0.1%, 92.1% of those receiving 72 ml of levobupivacaine 0.1%, and 97.1% of those receiving 36 ml of levobupivacaine 0.25%. There was no significant difference either in the onset of the sensory and motor block or duration of the sensory and motor block. This study demonstrates that 36 ml of levobupivacaine 0.1% (36 mg) is as effective as higher doses and volumes in axillary brachial plexus blockade.

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

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.

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

2021 ◽  
Vol 9 (2) ◽  
pp. 418
Author(s):  
Preeti Parashar ◽  
Anisha Singh ◽  
Manoj Kumar Sharma ◽  
Dipak L. Raval
Keyword(s):  
Blood Pressure ◽  
Lower Limb ◽  
Motor Block ◽  
Total Duration ◽  
Sensory Block ◽  
Hyperbaric Bupivacaine ◽  
Significant Difference ◽  
The Mean ◽  
Group B ◽  
Mean Time

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

scholarly journals A PROSPECTIVE RANDOMISED COMPARITIVE DOUBLE BLIND STUDY TO DETERMINE THE DURATION OF ANALGESIA OF BUPRENORPHINE AND DEXAMETHASONE AS ADJUNCTS TO BUPIVACAINE IN SCIATICO-POPLITEAL AND SAPHENOUS NERVE BLOCK FOR BELOW KNEE SURGERIES.

2020 ◽  
pp. 1-3
Author(s):  
Renjith I ◽  
Renu Devaprasath ◽  
Geo Navin Jude ◽  
T. S. Ambujam
Keyword(s):  
Side Effects ◽  
Nerve Block ◽  
Normal Saline ◽  
Motor Block ◽  
Sensory Block ◽  
Saphenous Nerve ◽  
Double Blind Study ◽  
Double Blind ◽  
The Mean ◽  
Mean Time

BACKGROUND: Adjuvants to local anaesthetics improve the block properties and reduce opioid consumption. This study compared combination of local anaesthetic bupivacaine with buprenorphine and dexamethasone in ultrasound guided sciatico-popliteal and saphenous nerve block for below knee surgeries. STUDY DESIGN:A prospective, double-blind, randomized, comparative study. MATERIAL AND METHODS: 82 patients posted for elective or emergency below knee surgeries were randomly divided into 2 groups. Group X received 25ml block solution made up of 2mg/kg of 0.5% bupivacaine with 2mcg/kg buprenorphine and normal saline and group Y received 25ml block solution made of 2mg/kg of 0.5% bupivacaine with 0.1mg/kg dexamethasone and normal saline. Onset of sensory block, onset of motor block, duration of analgesia, hemodynamic parameters, and side effects were noted in each group. RESULTS: The mean time of onset of sensory block was earlier in group X (6.730±1.871 min) as compared to group Y (11.340±3.038min). The mean time of onset of motor block was also rapid in group X (9.000±2.121 min) than in group Y (13.020±2.286min). The mean total duration of analgesia was longer in group Y (1098.000±169.216) as compared to group X (794.070±145.084). There was no signicant difference in the mean duration of motor block between the groups. Both the groups were hemodynamically stable, and no signicant side effects were noted. CONCLUSIONS: Onset of sensory and motor blockade was faster in the buprenorphine group, however duration of analgesia was much longer in the dexamethasone group without any signicant side effects.

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