scholarly journals Two different volume of local anaesthetic in subarachnoid block for Minipercutaneous Nephrolithotomy in prone position

2012 ◽  
Vol 1 (1) ◽  
pp. 10-15
Author(s):  
BR Shrestha ◽  
S Khadgi ◽  
S Shrestha ◽  
P Thapa
Keyword(s):  
Prone Position ◽  
Local Anaesthetic ◽  
Spinal Block ◽  
Sensory Level ◽  
Hyperbaric Bupivacaine ◽  
Subarachnoid Block ◽  
Number Of Patients ◽  
Group A ◽  
The Difference ◽  
Group B

Aims: To see the maximum sensory level in supine and prone position after subarachnoid block in patients undergoing Minipercutaneous Nephrolithotomy with two different volumes of local anaesthetic. Methods: Prospective randomized comparative study in 500 patients undergoing Minipercutaneous Nephrolithotomy for finding out the extensiveness of sensory level spread after spinal anaesthesia using two different volumes of local anaesthetic before and after keeping patients in prone position. Patients were divided into two groups: Group A (three ml hyperbaric Bupivacaine) and Group B (four ml hyperbaric Bupivacaine) consisted of 250 patients each. Spinal block was performed in sitting position. Sensory level and hemodynamic measurements were carried out at different time points while patients were on supine and on prone position. Results: Patients attaining T4 sensory level at five minutes in Group B was significantly higher than in Group A (p=0.001). After 10-15 minutes of spinal block, greater number of patients in Group B reached T4 sensory level while being in supine position than those in Group A and the difference was statistically significant (p=0.000). After keeping the patients in prone position for in 10-15 minutes the number of patients reaching T4 level was found to be significantly higher in group A than in Group B (p=0.063). Decrease in heart rate and blood pressure in prone position were significant from baseline value and while during supine (p<0.05). Conclusion: Prone positioning extends the sensory level of subarachnoid block to higher level (T4) when three ml of hyperbaric solution is used. DOI: http://dx.doi.org/10.3126/jkmc.v1i1.7249 Journal of Kathmandu Medical College, Vol. 1, No. 1, Issue 1, Jul.-Sep., 2012 pp.10-15

Effects of Delayed Supine Positioning after Induction of Subarachnoid Block on Post-spinal Hemodynamic Changes Compared to Traditional Subarachnoid Block: prospective observational randomized controlled dose response clinical study

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Karim saad Abd Elhalim Moustafa ◽  
Hala Gomaa Salama ◽  
Sherif George Anis ◽  
Rehab Abd Elfattah Abd Elrazik
Keyword(s):  
Blood Pressure ◽  
Supine Position ◽  
Local Anaesthetic ◽  
Prospective Observational Study ◽  
Sensory Level ◽  
Invasive Blood Pressure ◽  
Subarachnoid Block ◽  
Non Invasive ◽  
Group A ◽  
Group B

Abstract Background This is a prospective observational study to examine if the delayed supine positioning after induction of subarachnoid block will be of value in minimizing hemodynamic derangement following subarachnoidblock for knee Arthroscopein the teaching hospital of Misr University for science and technology Methods Fifty healthy patients are undergoing knee Arthroscope under spinal Anesthesia were randomized into 2 groups Group A(immediate supine position after Subarachnoid block) and Group B (delayed supine position after Subarachnoid block by 2.5 minutes) each group includes 25 patients. After the injection of local anaesthetic, Heart rate (HR), non-invasive blood pressure (Systolic Blood pressure (SBP), diastolic Blood pressure (DBP) and mean blood pressure(MBP)) were measured at 3 min intervals for the first 15 min following administration of local anaesthetic, and then every 5 min until completion of the surgical intervention. Results Hemodynamic readings (SBP, DBP, MBP, HR) showed more stability in Group(B) than Group(A), group(A) showed higher anesthetic sensory level but adequate anesthetic sensory level to perform Knee Arthroscope surgery was achieved in group (B) Conclusion Under the conditions of this study delayed supine positioning after induction of SAB for 2.5 minutes is of great value in gaining an adequate level of anesthesia with more hemodynamic stability and less vasopressor need as a management of hypotension compared to the conventional SAB in Knee Arthroscope surgery.

scholarly journals A comparative study between dexmedetomidine and dexamethasone as an intrathecal adjuvant for prevention of perioperative shivering in cesarean section

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Mohamed Abdul Mohsen Abdul Naiem Ismaiel ◽  
Omar Mohamed Taha El Safty ◽  
Ashraf El Sayed El-Agamy ◽  
Omar Mohamed Zafer Mohamed ◽  
Mohamed Mourad Mohsen Mohamed Ali
Keyword(s):  
Cesarean Section ◽  
Statistical Difference ◽  
Sensory Block ◽  
List Type ◽  
Hyperbaric Bupivacaine ◽  
Analgesic Requirement ◽  
Number Of Patients ◽  
Duration Of Surgery ◽  
Group A ◽  
Group B

Abstract Background One of the most common problems in parturients receiving regional anesthesia during cesarean section is shivering. It usually interferes with the readings of the oxygen plethysmography (SpO2) and electrocardiogram (ECG). It expands the needs for oxygen and increases creation of carbon dioxide about four folds. The aim of this work is to compare the efficacy of dexamethasone and dexmedetomidine in prevention of perioperative shivering when added to hyperbaric bupivacaine intrathecally in cesarean sections (CS) and their effect on the intraoperative hemodynamics, intensity of the block, sedation, and postoperative analgesic requirement. Results Study included 60 obstetric patients who fulfilled all the inclusion criteria and were randomized into 2 equal groups, each consisting of 30 patients, namely group A (dexmedetomidine group) and B (dexamethasone group). Group A patients received 5 μg dexmedetomidine with 12.5 mg hyperbaric bupivacaine 0.5% intrathecally. Group B patients received 8 mg dexamethasone then 12.5 mg hyperbaric bupivacaine 0.5% intrathecally. The comparison included assessment of intra- and postoperative hemodynamics, duration of surgery, assessment of sensory and motor block, assessment for shivering and sedation, and assessment of adverse events. This study showed that there were a small number of patients complaining of shivering (five patients in group A and seven patients in group B) with no statistical difference between both groups in the incidence and intensity of shivering. Time to two segment regression (minutes) was longer in group B compared to group A, and also, time to first analgesic rescue was longer in group B compared to group A. For sedation intensity, there was statistical difference between both groups as all patients in group A were sedated compared to six patients only in group B. There was no statistical difference between both groups as regards incidence of adverse effects. Conclusion We concluded that both drugs can be added safely to bupivacaine, and both dexmedetomidine and dexamethasone decreased the incidence and the intensity of shivering. Dexamethasone was found to prolong the duration of sensory block and delay opioid requirements post-operatively, while dexmedetomidine is more effective in sedating the patients intra- and postoperatively.

scholarly journals PERIOPERATIVE EFFECTS OF INTRATHECAL CLONIDINE AND FENTANYL WITH HYPERBARIC BUPIVACAINE IN SPINAL ANESTHESIA FOR VAGINAL HYSTERECTOMY

2016 ◽  
Vol 9 (5) ◽  
pp. 245
Author(s):  
Suman Chattopadhyay ◽  
Mallika Datta ◽  
Biswanath Biswas
Keyword(s):  
Placebo Group ◽  
Spinal Anesthesia ◽  
Low Dose ◽  
Mechanisms Of Action ◽  
Spinal Block ◽  
Hyperbaric Bupivacaine ◽  
Prolonged Duration ◽  
Group A ◽  
Group B ◽  
Intrathecal Clonidine

ABSTRACTObjectives: Intrathecal fentanyl and clonidine are effective analgesics with different mechanisms of action. This study compares 25 µg of both thesedrugs given intrathecally regarding onset, quality, and duration of hyperbaric bupivacaine-induced spinal block and side effects.Methods: A total of 90 patients of ASA I and II were randomly allocated into three equal groups. Group A received 0.5 ml of 0.9% normal saline(placebo), Group B and Group C received 25 µg fentanyl and clonidine intrathecally added to 2.5 ml of 0.5% hyperbaric bupivacaine, respectively. Theonset and regression time of sensory and motor blocks were recorded along with hemodynamic change, side effects, pain intensity (in terms of visualanalog score (VAS), and time to first rescue analgesic.Results: Intrathecal clonidine (25 μg) significantly prolongs sensory and motor blocks, with prolonged duration of analgesia in comparison withintrathecal fentanyl (25 µg) (325±15 minutes vs. 240±7.6 minutes). VAS score was similar, but sedation was more in clonidine group.Conclusion: We conclude that low-dose intrathecal clonidine is an effective adjuvant to bupivacaine for spinal anesthesia and provides betterpostoperative analgesia in comparison with intrathecal fentanyl.Keywords: Clonidine, Fentanyl, Bupivacaine, Regional, Spinal, Postoperative pain.

scholarly journals Comparison of hemodynamic effect between the spinal anesthesia and saddle block during transurethral resection of the prostate

2021 ◽  
Vol 23 (09) ◽  
pp. 817-828
Author(s):  
Dr. Farooq Taher Abdulqader ◽  
◽  
Dr. Ali Abd-Alhameed Mohammed ◽  
Keyword(s):  
Spinal Anesthesia ◽  
Transurethral Resection ◽  
Major Complication ◽  
Hemodynamic Effect ◽  
Spinal Block ◽  
Transurethral Resection Of Prostate ◽  
Hyperbaric Bupivacaine ◽  
Significant Difference ◽  
Group A ◽  
Group B

Background: The best technique for transurethral resection of prostate (TURP) is regional anesthesia. The hypotension is the major complication following spinal anesthesia. The hemodynamic changes is less with saddle block than spinal block. Aim and Objective: To compare hemodynamic effect between the spinal block and saddle block in TURP. Patients and methods: 50 patients between 50-70 years old ASA I – II prepared for TURP, divided randomly in two groups 25 pt. in each group. Group A received spinal 10 mg of hyperbaric bupivacaine (2 ml of 0.5%), were group B received saddle block 10 mg of hyperbaric bupivacaine (2 ml of 0.5%). The blood pressure, oxygen saturation, heart rate measured and recorded subsequently. The hypotension treated by 100 mcg bolus of phenylephrine. Results: In our study there was statically significant difference (p < 0.05) between group A which received spinal anesthesia and group B which received saddle block in hemodynamic effect. In which the incidence of hypotension and vasopressor requirement more in group A. Conclusion: Under saddle block the TURP can safely performed with low risk of hypotension and less requirement of vasopressor.

scholarly journals Comparison of Fentanyl and Dexmedetomidine as Intrathecal Adjuvants to Spinal Anaesthesia for Abdominal Hysterectomy

2018 ◽  
Vol 56 (213) ◽  
pp. 848-855 ◽  
Author(s):  
Binod Gautam ◽  
Sushila Tabdar ◽  
Ujma Shrestha
Keyword(s):  
Spinal Anaesthesia ◽  
Visceral Pain ◽  
Sensory Block ◽  
Abdominal Hysterectomy ◽  
Hyperbaric Bupivacaine ◽  
Double Blind ◽  
Number Of Patients ◽  
First Choice ◽  
Group A ◽  
Group B

Introduction: Spinal anaesthesia, although advantageous for conducting abdominal hysterectomy, is not the first choice amongst surgeons for fear of intra-operative visceral pain. Intrathecal adjuvants may improve quality of spinal anaesthesia. This study aims to compare efficacy of intrathecal Fentanyl and Dexmedetomidine to reduce visceral pain during abdominal hysterectomy performed under spinal anaesthesia. Methods: Sixty women undergoing abdominal hysterectomy for benign indications were randomly assigned to two equal groups in a double-blind fashion. Fentanyl 25 micrograms in group A or Dexmedetomidine 10 micrograms in group B was co-administered with hyperbaric Bupivacaine 15 milligrams for spinal anesthesia. Surgery through Pfannenstiel incision proceeded once sensory block reached eighth thoracic dermatome. The intra-operative visceral pain was assessed using a five-point scale: none, mild, intermediate, severe, and failed spinal anaesthesia. Duration of analgesia and peri-operative events were studied for 24 hours. Chi-square test, Mann-Whitney U-test and Student’s t-test were used for analysis. Level of significance used was P<0.05. Results: Fifty eight participants completed the study. Demographic variables and sensory block were similar between groups. General anaesthesia was not required in both groups. Significantly greater number of patients in group A required medications for visceral pain with Relative Risk of 2.8 (1.16-6.7). Pruritus and shivering occurred significantly higher in group A. Hypotension was significantly higher in group B. Post-operatively, group B patients showed a significantly longer duration of analgesia. Conclusions: Dexmedetomidine is better than Fentanyl as an intrathecal adjuvant to spinal anaesthesia in minimizing visceral pain during abdominal hysterectomy and in prolonging post-operative analgesia.

scholarly journals Effects of Intrathecal Dexmedetomidine as an Adjuvant to Hyperbaric Bupivacaine for Spinal Anaesthesia in Adults Undergoing Elective Infra-umbilical Surgery

2017 ◽  
Vol 56 (208) ◽  
pp. 379-87 ◽  
Author(s):  
Binod Gautam ◽  
Sujata Niroula ◽  
Mona Sharma ◽  
Sushila Moktan Lama
Keyword(s):  
Spinal Anaesthesia ◽  
Local Anaesthetic ◽  
Visceral Pain ◽  
Sensory Block ◽  
P Value ◽  
Double Blind Study ◽  
Hyperbaric Bupivacaine ◽  
Double Blind ◽  
Group A ◽  
Group B

Introduction: Various adjuvants to local anaesthetic are used to improve quality and duration of spinal anaesthesia. Dexmedetomidine, a novel alpha-2 adrenergic agonist, has been proposed to augment local anaesthetic effects. This study aims to investigate effects of intrathecal Dexmedetomidine on duration of analgesia and duration of sensory block during spinal anaesthesia. Methods: In this randomized double-blind study 38 patients were allocated into each of two groups. Otherwise healthy patients (18 to 75 years) scheduled for inguinal hernia repair or vaginal hysterectomy were included. For spinal anaesthesia, Group A received 2.5 ml hyperbaric Bupivacaine 0.5%, whereas Group B received five micrograms intrathecal Dexmedetomidine in addition. Characteristics of sensory and motor blocks, duration of analgesia, analgesic requirements, and side effects were studied for 24 hours. Student’s t-test for quantitative variables and Chi- squared test for qualitative variables were used for statistical analysis. Results: Duration of analgesia was prolonged in Group B (326 min ±91) as compared to 217 min ±98 in Group A (P value <0.05). Sensory and motor block durations were significantly prolonged in Group B. Time taken to reach significant peak sensory block level was earlier in Group B. Significant reductions in incidence of visceral pain, shivering and analgesic requirements were observed in Dexmedetomidine group, without increased need of medications for altered hemodynamic parameters. Conclusions: Dexmedetomidineas an intrathecal adjuvant to hyperbaric Bupivacaine in spinal anaesthesia prolongs duration of analgesia and sensory block with minimal adverse effects. Keywords: Bupivacaine; Dexmedetomidine; intrathecal adjuvant; spinal anaesthesia.

scholarly journals Effects of Adding Intrathecal Dexmedetomidine to Hyperbaric Bupivacaine for Saddle Spinal Block in Adults Undergoing Peri-anal Surgeries

2018 ◽  
Vol 16 (1) ◽  
pp. 43-48 ◽  
Author(s):  
Binod Gautam ◽  
Sushila Moktan Lama ◽  
Mona Sharma
Keyword(s):  
Side Effects ◽  
Motor Block ◽  
Sensory Block ◽  
Categorical Variables ◽  
Spinal Block ◽  
Hyperbaric Bupivacaine ◽  
Analgesic Requirement ◽  
First Choice ◽  
Group A ◽  
Group B

Background: Saddle spinal block is the first choice anesthetic technique for adults undergoing peri-anal surgeries. It prevents unnecessary high levels of analgesia and sympathetic block. However, it may not provide prolonged analgesia. This study aims to investigate analgesic effects of dexmedetomidine when added to hyperbaric bupivacaine in saddle spinal block.Methods: Fifty otherwise healthy adults scheduled for uncomplicated peri-anal surgery were randomly allocated into two equal groups in this double-blinded study. Group A received hyperbaric bupivacaine five milligrams; group B received hyperbaric bupivacaine five milligrams plus dexmedetomidine five micrograms intrathecally. Patients remained seated for ten minutes. Time to first analgesic request by patients was the primary end point. Onset and extent of sensory block, and, magnitude and duration of motor block were assessed. Post-operative analgesic consumption and side effects were studied for 24 hours. Student’s t-test for quantitative variables and Chi-square test for categorical variables were used for statistical analysis.Results: Patients in group B had a significantly prolonged duration of analgesia (group B, 501 ± 306 minutes; group A, 284 ± 58 minutes) and significantly reduced analgesic requirement than patients in group A. Sensory block in first sacral dermatome appeared significantly earlier in group B. Peak sensory block, magnitude of motor block, and side effects were not significantly different between groups A and B.Conclusions: Dexmedetomidine as an intrathecal adjuvant to hyperbaric bupivacaine in saddle spinal block prolongs duration of analgesia and decreases analgesic requirement with no added side effects.

scholarly journals Comparison of marginal adaptation of fiber reinforced composite and metal ceramic full veneer crown

2015 ◽  
Vol 5 (1) ◽  
pp. 1-5
Author(s):  
Tareq Hassan ◽  
Sohana Ferdous ◽  
Aslam Md Aurangjeb
Keyword(s):  
Marginal Adaptation ◽  
Fiber Reinforced ◽  
Female Ratio ◽  
Fiber Reinforced Composite ◽  
Reinforced Composite ◽  
Number Of Patients ◽  
Metal Ceramic ◽  
Group A ◽  
The Difference ◽  
Group B

Fiber reinforcement was introduced to clinical dentistry for the first time in the 1960s when investigators attempted to reinforce polymethyl-methacrylate dentures with glass or carbon fibers. It has recently been shown that crowns, bridges and posts made of FRC can be used successfully in dental practice and on the basis of marginal adaptation they are more acceptable than conventional metal ceramic crown. A prospective comparative cross-sectional study was performed involving 60 patients who attended in the out patients department of Prosthodontics, Faculty of Dentistry, BSMMU during the period of January 2007 to December 2008. Clinical data were recorded for the selected 60 patients who were divided into two groups “experimental” and “control”. Marginal adaptation was indexed after California Dental Associations quality evaluation system. The age of the patients ranged from 18 to 42 years in group A and 17 to 38 years in group B. The highest number of patients was in the age group 21-30 years in both the groups. The mean age was 24.9±5.8 years and 25.0±4.8 years in group A and group B respectively. There were 26 male and 34 female patients in the study and male female ratio was 1:1.3. In group A patients, 12(40.0%) were male and 18(60.0%) female. In group B patients 14(46.7%) were male and 16(53.3%) were female. After 4 months all the patients were in grade I in both the groups. After 8 months all the patients were in grade I in group A and 27(90.0%) patients in grade I in group B.  After 12 months all the patients were in grade I in group A and 25(83.3%) patients were in grade I in group B. The difference was not statistically significant (p>0.05) after 8 months, however after 12 months the difference was significant (p<0.05). The Fiber Reinforced Composite crown represents a valuable development in the field of Prosthetic Dentistry. DOI: http://dx.doi.org/10.3329/bjdre.v5i1.22450 Bangladesh Journal of Dental Research and Education Vol.5(1) 2015: 01-05

scholarly journals 050419-OA- Spinal-Beena

2019 ◽  
pp. 162-167
Author(s):  
Tariq H Khan
Keyword(s):  
Spinal Anaesthesia ◽  
Motor Block ◽  
Sensory Block ◽  
Primary Objective ◽  
Spinal Block ◽  
Hemodynamic Parameters ◽  
Hyperbaric Bupivacaine ◽  
Voiding Function ◽  
Group A ◽  
Group B

Background: Spinal anaesthesia is a reliable and safe technique for infra-umbilical surgeries. Preservative-free 2-chloroprocaine has re-emerged for use in spinal anaesthesia. We compared onset and duration of sensory block with intrathecal use of 1% 2-Chloroprocaine (30 mg) or 0.5% Hyperbaric Bupivacaine (15 mg) as primary objective. Secondary objectives being onset and duration of motor block, duration of analgesia, time to return of voiding function, hemodynamic parameters and side effects. Materials and Methods: 90 patients of age group 18-60 years, either sex, belonging to ASA physical status I/II undergoing infra-umbilical surgeries were randomly divided into two groups, 1% 2-chloroprocaine Group A (n=45) and 0.5% hyperbaric bupivacaine Group B (n=45). Each group received intrathecally either 30 mg of 2-Chloroprocaine or 15 mg of hyperbaric bupivacaine 15 mg. For statistical analysis unpaired-t-test and chi-square test were used.  Results: Earlier onset and shorter duration of sensory block were observed in Group A as compared to Group B respectively (p < 0.001). Similarly, onset was earlier and duration of motor block, duration of analgesia and time to return of voiding function were shorter in Group A as compared to Group B respectively (p < 0.001). Hemodynamic parameters (HR, MAP) were comparable in both groups. Conclusion: Intrathecal 1% 2-Chloroprocaine 30 mg provides spinal anaesthesia of adequate duration for infra-umbilical surgeries with the advantage of earlier onset and faster regression of spinal block resulting in earlier voiding with stable hemodynamics as compared to 0.5% hyperbaric bupivacaine 15 mg. Keywords: Infra-umbilical surgeries, 2- chloroprocaine, Bupivacaine, Spinal Anaesthesia, Sensory Block, Motor Block.

Efficacy and Safety of Oral Ivermectin and Topical Permethrin in the Treatment of Scabies

2020 ◽  
Vol 33 (1) ◽  
pp. 41-47
Author(s):  
Mohsena Akhter ◽  
Ishrat Bhuiyan ◽  
Zulfiqer Hossain Khan ◽  
Mahfuza Akhter ◽  
Gulam Kazem Ali Ahmad ◽  
...  
Keyword(s):  
Skin Diseases ◽  
Close Contact ◽  
Randomized Study ◽  
Sarcoptes Scabiei ◽  
Efficacy And Safety ◽  
Common Skin ◽  
Group A ◽  
The Mean ◽  
The Difference ◽  
Group B

Background: Scabies is one of the most common skin diseases in our country. It is caused by the mite Sarcoptes scabiei var hominis, which is an ecto-parasite infesting the epidermis. Scabies is highly contagious. Prevalence is high in congested or densely populated areas. Individuals with close contact with an affected person should be treated with scabicidal which is available in both oral and topical formulations. The only oral but highly effective scabicidal known to date is Ivermectin. Amongst topical preparations, Permethrin 5 % cream is the treatment of choice. Objective: To evaluate the efficacy & safety of oral Ivermectin compared to topical Permethrin in the treatment of scabies. Methodology: This prospective, non-randomized study was conducted at the out-patient department of Dermatology and Venereology of Shaheed Suhrawardy Medical College & Hospital over a period of 6 months, from August 2016 to January 2017. The study population consisted of one hundred patients having scabies, enrolled according to inclusion criteria. They were divided into two groups. group A was subjected to oral Ivermectin and the group B to Permethrin 5% cream. Patients were followed up on day 7 and 14 for assessment of efficacy and safety. Result: The mean scoring with SD in group A (Ivermectin) and group B (Permethrin) were 8.26 ± 2.22 and 7.59 ± 2.01 respectively at the time of observation. The difference between the mean score of the two group is not significant (p=0.117) the mean scoring with SD in group A and group B were 4.54 ± 2.05 and 1.64 ± 1.84 respectively at 7thdays. The difference between the mean score of the two group is significant (p<0.001). The mean scoring with SD in group A and group B were 2.68± 2.35 and .36± 1.10 respectively at 14th day difference between the mean score of the group is significant (p<0.001). Conclusion: Topical application of permethrin 5% cream is more effective and safer than oral Ivermectin in the treatment of scabies. TAJ 2020; 33(1): 41-47

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