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

2018 ◽  
Vol 17 (1) ◽  
pp. 3-10
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

Introduction: 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.Materials and methods: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.Results: 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.Conclusion: 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.

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 Comparison of Intrathecal Midazolam and Fentanyl Added to Bupivacaine for Spinal Anesthesia in Patients Undergoing Appendicectomy

2020 ◽  
Vol 3 (2) ◽  
pp. 334-337
Author(s):  
Puja Thapa ◽  
Sunita Panta ◽  
Biswo Ram Amatya ◽  
Mallika Rayamajhi
Keyword(s):  
Spinal Anesthesia ◽  
Motor Block ◽  
Sensory Level ◽  
Tertiary Referral Hospital ◽  
Hyperbaric Bupivacaine ◽  
Duration Of Surgery ◽  
Prolonged Duration ◽  
Ethical Approval ◽  
Effective Analgesia

Introduction: Hyperbaric Bupivacaine is the extensively used local anesthetic but the major disadvantage is profound sympathetic blockade leading to hypotension and prolonged duration of motor block. The addition of Fentanyl or Midazolam can provide excellent quality and prolong the duration of analgesia. The study aims to compare the effect of intrathecal Fentanyl with that of intrathecal Midazolam in combination with 0.5% hyperbaric Bupivacaine on the duration and quality of spinal anesthesia in patients undergoing appendicectomy.Materials and Methods: This is a prospective, comparative and interventional study where patients were randomized into two equal groups. The study was conducted in a tertiary referral hospital from July 2018 to December 2018 after ethical approval. Group BF received Fentanyl and group BM received Midazolam The outcomes measured were, peak sensory level, quality of intraoperative analgesia and motor block, duration of effective analgesia, intraoperative and postoperative complications.Results: A total of 44 patients were studied with 22 in each arm. The two groups were comparable in terms of age, weight, height, duration of surgery, and ASA status of the patients. Peak sensory level and degree of motor block were not statistically different in the two arms. Duration of effective analgesia was 293.16±35 min in the BF group and 267.80±32 min in the BM group (p=0.01). Increased incidence of pruritus was recorded during the postoperative period in the Fentanyl group.Conclusions: Fentanyl and Midazolam both are equally effi cient adjuvant added to hyperbaric Bupivacaine for intrathecal use to improve the quality of spinal anesthesia in patients undergoing appendicectomy.

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 A comparative study of the effect of intrathecal tramadol and buprenorphine used as adjuvants to hyperbaric bupivacaine for postoperative analgesia in infraumbilical surgeries

2019 ◽  
pp. 263-267
Author(s):  
Sana Siddiq ◽  
Naila Asad ◽  
Abaid -ur- Rehman ◽  
Maqsood Ali ◽  
Hafiz M Usman Khalid ◽  
...  
Keyword(s):  
Side Effects ◽  
Adverse Effects ◽  
Comparative Study ◽  
Postoperative Analgesia ◽  
Motor Block ◽  
Onset Time ◽  
Hyperbaric Bupivacaine ◽  
Rescue Analgesia ◽  
Significant Difference ◽  
Group B

Background & Objective: The augmentation of local anesthetics with various adjuvants to enhance the quality and efficacy of subarachnoid block is clinically in practice since long. Comparative studies on effects of adding intrathecal tramadol and buprenorphine has never been studied before. Both drygs are esily available in our country. So, we conducted this study to evaluate and compare the characteristics of subarachnoid blockade, duration of postoperative analgesia, dose of recue analgesic postoperatively, and adverse effects of intrathecal buprenorphine (50 μg) and intrathecal tramadol (30 mg) as adjuvants to 0.5% hyperbaric bupivacaine for lower abdominal surgeries Methodology: This prospective randomized, single blind controlled trial was carried out at Services Hospital Lahore, from January to July 2018. 110 American society of Anesthesiologist I - II male patients, 35 to 45 y of age undergoing subarachnoid block for infra-umbilical surgery were randomized into two groups. Group T (n = 55) patients received 10 mg of 0.5% bupivacaine and 30 mg of tramadol intrathecally, while group B (n = 55) received 10 mg 0.5% bupivacaine with 50 μg of buprenorphine. Sensory testing was done by pin prick method using 25G blunt needle and time taken to reach T10 level noted. Motor block was assessed using Modified Bromage Scale. The time taken to reach modified Bromage 3 was recorded. Side effects and postoperative analgesia noted for 24 h by VAS score every 20 min for first 2 h in PACU and then 4 hourly for 24 h in the ward. Patients with inadequate block were converted into general anesthesia and were excluded from the study. Time to first rescue analgesia, and total analgesic required in 24 h were compared in two groups.Results: Mean VAS scores were less in Group T as compared to Group B. Significant difference was seen among groups at 45 min (p = 0.04), 60 min (p = 0.02), 75 min (p = 0.03), 90 min (p = 0.01), 120 min (p = 0.00), 4h (p = 0.007), 8 h (p = 0.01), 12 h (p = 0.01), 16 h (p = 0.00). After 24 h no significant difference was seen in both groups. Mean onset time for sensory block was earlier in Group B (2.4 min) compared to Group T (2.7 min)(p = 0.001). Mean onset time for motor block was earlier in Group B (4.8 min)as compared to Group T (5.5 min)(p = 0.00). No significant difference was seen among groups in side effects (p > 0.05). Mean time for rescue analgesia in Group B was earlier (4.51 ± 2.8 h.) as compared to Group T (4.94 ± 4.1h). Total dose of analgesic given in 24 h was significantly less in group T. (p = 0.004) The mean dose given in Group B (1.24 ± 0.96 mg/kg) was greater than Group T (0.76 ± 0.71 mg/kg)Conclusion: We conclude that both tramadol and buprenorphine, prolong the duration of postop analgesia without adding any adverse effects, but duration with tramadol is longer; it significantly reduces VAS and the dose of analgesic requirement in 24 h postoperatively.IRB letter No. IRB/2018/427/SIMS Citation: Siddiq S, Asad N, Rehman AU, Ali M, Khalid HMU, Butt Z. A comparative study of the effect of intrathecal tramadol and buprenorphine used as adjuvants to hyperbaric bupivacaine for postoperative analgesia in infraumbilical surgeries. Anesth pain & intensiv care 2019;23(3):263-267

Elucidating the Potential Side Effects of Current Anti- Seizure Drugs for Epilepsy

2021 ◽  
Vol 19 ◽  
Author(s):  
Enes Akyüz ◽  
Mohd. Farooq Shaikh ◽  
Betül Köklü ◽  
Cansu Ozenen ◽  
Alina Arulsamy
Keyword(s):  
Quality Of Life ◽  
Side Effects ◽  
Adverse Effects ◽  
Side Effect ◽  
First Line ◽  
Epileptic Patients ◽  
Life Threatening ◽  
Visual Problems ◽  
Gaba Transmission

: Over the decades, various interventions have been developed and utilized to treat epilepsy. However, majority of epileptic patients are often first prescribed with anti-epileptic drugs (AED), now known as anti-seizure drugs (ASD), as a first line of defense to suppress their seizures and regain their quality of life. ASDs exert their anti-convulsant effects through various mechanisms of action including regulation of ion channels, blocking of glutamate-mediated stimulating neurotransmitter interaction, and enhancing the inhibitory GABA transmission. About one third of epileptic patients are often resistant to anti-convulsant drugs, while others develop numerous side effects which may lead to treatment discontinuation and further deterioration of quality of life. Common side effects of ASDs include headache, nausea and dizziness. However, more adverse effects such as auditory and visual problems, skin problems, liver dysfunction, pancreatitis and kidney disorders may also be witnessed. Some ASDs may even result in life-threatening conditions as well as serious abnormalities, especially in patients with comorbidities and in pregnant women. Nevertheless, some clinicians had observed a reduction in the development of side effects post individualized ASD treatment. This suggest that a careful and well-informed ASD recommendation to patients may be crucial for an effective and side-effect free control of their seizures. Therefore, this review aimed to elucidate the anticonvulsant effects of ASDs as well as their side effect profile, by discussing their mechanism of action and reported adverse effects based on clinical and preclinical studies, thereby providing clinicians with a greater understanding of the safety of current ASDs.

scholarly journals A comparative study of low doses of intrathecal ketamine and midazolam with bupivacaine for postoperative analgesia in infraumbilical surgeries

2019 ◽  
Vol 6 (2) ◽  
pp. 197
Author(s):  
Rajabhushanam M. ◽  
Sunil Kumar K. ◽  
Syed Ali Aasim ◽  
Venkatesh S.
Keyword(s):  
Postoperative Analgesia ◽  
Cost Effective ◽  
Rapid Onset ◽  
Spinal Block ◽  
P Value ◽  
Sensory Level ◽  
Hyperbaric Bupivacaine ◽  
First Choice ◽  
Mean Time

Background: Infra-umbilical surgeries may be performed under local, regional (spinal or epidural) or general anaesthesia, spinal block is still a first choice, because of its rapid onset, high quality of blockade, lack of catheter related infection, less failure rate and also cost effective but the duration of block and postoperative analgesia is limited. The purpose of study was to compare the efficacy of adding ketamine to 0.5% hyperbaric bupivacaine with midazolam to 0.5% hyperbaric bupivacaine in elective infraumbilical procedures.Methods: A randomized, single blinded, clinical study. 60 subjects were enrolled from the patients presenting for elective infraumbilical surgeries after following the inclusion and exclusion criteria laid down for the study. Sixty ASA Grade I and II patients undergoing infra umbilical surgeries were randomly divided into one of the two equal groups (n=30).Results: Total 60 patients were included in this study. The mean time to achieve T10 sensory level and modified bromage scale III was prolonged in group M (4.33±1.09, 6.66±1.26 min) as compared to group K (3.3±0.7, 4.96±1.21 min) which was statistically significant (P value <0.05).Conclusions: The present study concludes that addition of intrathecal midazolam to hyperbaric bupivacaine provide very good and prolonged post-operative analgesia without significant intra-operative and post-operative side effects compared to intrathecal ketamine.

scholarly journals Comparison of the Effects of Adding Dexmedetomidine Versus Midazolam to Intrathecal Bupivacaine on Postoperative Analgesia

2015 ◽  
Vol 18;1 (1;1) ◽  
pp. 71-77
Author(s):  
Aloka Samantaray
Keyword(s):  
Side Effects ◽  
Spinal Anaesthesia ◽  
Postoperative Analgesia ◽  
Sedation Score ◽  
Controlled Study ◽  
Saline Control ◽  
Control Group ◽  
Hyperbaric Bupivacaine ◽  
Midazolam Group ◽  
Effective Analgesia

Background: Dexmedetomidine and midazolam both modulate spinal analgesia by different mechanisms, and yet, no human studies are available to compare them for postoperative analgesia after neuraxial administration. Objectives: We investigated the addition of dexmedetomidine or midazolam to intrathecal bupivacaine on the duration of effective analgesia and clinical safety profile. Study Design: Prospective, randomized, double blind, placebo controlled study. Setting: University teaching hospital. Methods: The study cohort included a consecutive and prospective series of patients, referred for endourological procedures. The patients were randomly allocated into 3 groups (20 patients each) to receive intrathecally 3 mL of 0.5% hyperbaric bupivacaine in combination with 5 mcg of dexmedetomidine (dexmedetomidine group), 1 mg of midazolam (midazolam group) or 0.5 mL of 0.9% saline (control group). The groups were compared to the regression time of sensory block, duration of effective analgesia (defined as the time interval between administration of intrathecal drug to the time of first analgesic request or a numeric rating scale ≥ 4.0), sedation score, and side effects in the first 24 hours. Statistics: One way-ANOVA, Kruskal Wallis test, and Chi-square test (χ2), significance level: P < 0.05. Results: The duration of effective analgesia (time to first analgesic request) was significantly prolonged in the dexmedetomidine group (286 ± 64 minutes, P < 0.01) when compared with midazolam group (236.9 ± 64.9 minutes) and the control group (212.7 ± 70.2 minutes). Pairwise comparisons among the 3 groups with Bonferroni adjustment revealed that patients from the dexmedetomidine group were more sedated in comparison to the midazolam and control groups at the end of the first 15 minutes after intrathecal injection [χ2 (2) = 7.157, P = 0.028], with a mean rank sedation score of 35.58 for dexmedetomidine, 25.00 for midazolam, and 30.93 for control. No significant differences in the side effects were observed during the study period. Midazolam did not lengthen the time of the two segment sensory regression or the time to first request analgesia. Limitation: The study cannot be extrapolated to muscle cutting surgeries under spinal anaesthesia. Conclusions: The addition of dexmedetomidine (5 mcg) to 3 mL of intrathecal hyperbaric bupivacaine (0.5%) significantly prolongs the duration of effective analgesia in comparison to 1 mg midazolam or placebo (0.9% normal saline) with a comparable incidences of side effects. Key words: Dexmedetomidine, midazolam, intrathecal, spinal anaesthesia, subarachnoid block, postoperative pain Pain Physician 20

scholarly journals Comparison between Clinical Efficacies of Levobupivacaine Plain and Levobupivacaine with Fentanyl for Urological Surgeries under Subarachnoid Block

2017 ◽  
Vol 2 (2) ◽  
pp. 34-39
Author(s):  
Aarti Kulkarni ◽  
Paulomi Dey
Keyword(s):  
Side Effects ◽  
Motor Block ◽  
Randomized Study ◽  
Categorical Variables ◽  
Transurethral Resection Of Prostate ◽  
Sensory Level ◽  
Hemodynamic Parameters ◽  
Subarachnoid Block ◽  
Group I ◽  
Group Ii

ABSTRACT Background and aims Spinal anesthesia for urological operations has been frequently used, because symptoms of overhydration, transurethral resection of prostate (TURP) syndrome, and bladder perforation can be recognized. This prospective randomized study was conducted to compare the clinical efficacies of levobupivacaine with and without fentanyl in subarachnoid block with respect to onset and duration of sensory and motor block and duration of analgesia in urological surgeries. Materials and methods This randomized study was conducted in 100 patients of American Society of Anesthesiologists (ASA) physical status grades I and II, posted for urological surgeries. Patients were randomly allocated to two groups and were given the following drugs intrathecally as per group distribution: Group I: 2.5 mL of 0.5% isobaric levobupivacaine and group II: 2.2 mL of 0.5% isobaric levobupivacaine with 15 μg (0.3 mL) fentanyl citrate. Parameters monitored were onset and duration of sensory and motor block, hemodynamic parameters, postoperative analgesia, and side effects. Data were analyzed using Student's t-test for the continuous variables and chi-square test for categorical variables. Results The onset of sensory level of T10 was earlier in group II (4.74 ± 0.723 minutes) than in group I (5.7 ± 0.953 minutes). Duration of sensory block was longer in group I (292.2 ± 8.154 minutes) than in group II (260 ± 11.066 minutes). Motor block regressed earlier in group II (181.2 ± 7.73 minutes) than in group I. Hemodynamic parameters and side effects were similar in both the groups. Conclusion From our study, we concluded that plain levobupivacaine provided a longer duration of sensory and motor subarachnoid blockade. However, addition of fentanyl as a spinal adjuvant had a dose-sparing effect with earlier onset and early regression of motor block and no hemodynamic alterations. How to cite this article Kulkarni A, Dey P. Comparison between Clinical Efficacies of Levobupivacaine Plain and Levobupivacaine with Fentanyl for Urological Surgeries under Subarachnoid Block. Res Inno in Anesth 2017;2(2):34-39.

scholarly journals Positive and Negative Effects of Antipsychotic Medication: An International Online Survey of 832 Recipients

2019 ◽  
Vol 14 (3) ◽  
pp. 173-181 ◽  
Author(s):  
John Read ◽  
James Williams
Keyword(s):  
Side Effects ◽  
Adverse Effects ◽  
Antipsychotic Medication ◽  
Online Survey ◽  
Negative Effects ◽  
Duration Of Treatment ◽  
Direct To Consumer ◽  
Poor Outcomes

Background: Antipsychotic medication is currently the treatment of choice for psychosis, but few studies directly survey the first-hand experience of recipients. Objective: To ascertain the experiences and opinions of an international sample of users of antipsychotic drugs, regarding positive and negative effects. Methods: An online direct-to-consumer questionnaire was completed by 832 users of antipsychotics, from 30 countries – predominantly USA, UK and Australia. This is the largest such sample to date. Results: Over half (56%) thought, the drugs reduced the problems they were prescribed for, but 27% thought they made them worse. Slightly less people found the drugs generally ‘helpful’ (41%) than found them ‘unhelpful’ (43%). While 35% reported that their ‘quality of life’ was ‘improved’, 54% reported that it was made ‘worse’. The average number of adverse effects reported was 11, with an average of five at the ‘severe’ level. Fourteen effects were reported by 57% or more participants, most commonly: ‘Drowsiness, feeling tired, sedation’ (92%), ‘Loss of motivation’ (86%), ‘Slowed thoughts’ (86%), and ‘Emotional numbing’ (85%). Suicidality was reported to be a side effect by 58%. Older people reported particularly poor outcomes and high levels of adverse effects. Duration of treatment was unrelated to positive outcomes but significantly related to negative outcomes. Most respondents (70%) had tried to stop taking the drugs. The most common reasons people wanted to stop were the side effects (64%) and worries about long-term physical health (52%). Most (70%) did not recall being told anything at all about side effects. Conclusion: Clinical implications are discussed, with a particular focus on the principles of informed consent, and involving patients in decision making about their own lives.

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.

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