COMPARISON OF INTRATHECAL BUPIVACAINE WITH OR WITHOUT CLONIDINE FOR PERIOPERATIVE ANALGESIA IN LOWER LIMB ORTHOPEDICS SURGERIES

Background: The newer adjutants for spinal anaesthesia (SA) have seen numerous modifications over the last two decades. Various doses of clonidine have been tried in past but optimal dose which balances the ill effects has to be discovered. Therefore, this study was designed to study the effect of clonidine as an adjuvant in SA in terms of duration and complication. Methods: Two groups I and II ( with 60 patients each) received either 3.0 ml of Bupivacaine 0.5% heavy + 0.5 ml of normal saline and 2.5 ml of bupivacaine 0.5% heavy + 0.5 ml (75µg) of preservative free clonidine respectively. Various haemodynamic parameters and complication were recorded at baseline than 30 min, 1,2,4,6 and 8 hours after SA. Results: Group II shows that addition of clonidine had altered the heart rate and blood pressure significantly for initial two hour duration(p<0.05). No difference in the onset of sensory and motor blockade in both groups. Majority of patients in both group had level of sensory block upto T7 level. Mean VAS score was significantly lower in group II (p<0.001). Group II has prolonged duration of motor blockade (p< 0.00l). The difference in mean duration of analgesia among both the groups was significant indicating that addition of clonidine prolongs the duration of analgesia (p<0.0001). In group II incidence of hypotension and bradycardia is more as compared to group I. Conclusion: Intrathecal clonidine in the dose of 75 µg along with bupivacaine 0.5% heavy prolonged postoperative analgesia and motor blockade. It produces sedation in which patients were asleep and easily arousal and haemodynamic changes which could be easily managed. Keywords: Intrathecal, Bupivacaine, Clonidine, Orthopedics surgeries, VAS score

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A CLINICAL COMPARISON BETWEEN 0.5% BUPIVACAINE AND 0.5% BUPIVACAINE DEXAMETHASONE 8mg COMBINATION IN BRACHIAL PLEXUS BLOCK BY SUPRACLAVICULAR APPROACH

10.36106/ijsr/2903512 ◽

2021 ◽

pp. 18-20

Author(s):

Bonthu Mounica ◽

Palle Krishna Padma Sri ◽

K. Madhusudhan Reddy

Keyword(s):

Brachial Plexus ◽

Upper Limb ◽

Brachial Plexus Block ◽

Single Shot ◽

Motor Blockade ◽

Duration Of Action ◽

Group I ◽

Prolonged Duration ◽

Group Ii ◽

Plexus Block

Aim:To study the onset and duration of sensory and motor blockade Introduction: Brachial plexus block provides a useful alternative to general anaesthesia for upper limb surgeries. Bupivacaine is one of the most frequently used local anaesthetic which has a longer duration of action of 3 to 8 hours but has drawbacks of delayed onset and patchy analgesia. Dexamethasone is a very potent glucocorticoid with very good anti-inammatory and analgesic activity. Materials and methods: A prospective, randomised single-blinded study was undertaken in patients posted for upper limb surgeries under the supraclavicular block. 60 patients with ASA class I and II were randomly grouped into two groups. Group I received 30ml bupivacaine 0.5% and Group II received a combination of 28ml bupivacaine 0.5% and 2ml dexamethasone 8mg. 30ml solution is used for a single shot blockade of supraclavicular brachial plexus. Results: Group II patients had a faster onset of action and prolonged duration of action. Discussion: The addition of dexamethasone 8mg to bupivacaine 0.5% speeds the onset of sensory and motor blockade also prolongs the duration thus provides better analgesia and reduces the requirements of rescue analgesics. Conclusion:Acombination of bupivacaine 0.5% and dexamethasone 8mg has a signicantly faster onset and prolonged duration of action.

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A Comparative Evaluation of Dexamethasone and Tramadol as Adjuvant to Levobupivacaine in Supraclavicular Block

Academia Anesthesiologica International ◽

10.21276/aan.2020.5.1.20 ◽

2020 ◽

Vol 5 (1) ◽

pp. 100-102

Author(s):

Rangit Priyakar Pandey ◽

Richa Chandra

Keyword(s):

Motor Block ◽

Sensory Block ◽

Group I ◽

Significant Difference ◽

The Mean ◽

Group Ii ◽

The Difference ◽

American Society ◽

Supraclavicular Block ◽

Plexus Block

Background: The present study was conducted to evaluate and compare dexamethasone and tramadol as adjuvant to levobupivacaine in supraclavicular block. Subjects and Methods: The present study was conducted on 50 patients of American Society of Anesthesiologists (ASA) grade I and II. Patients were divided in to two groups of 25 each. In group I, 30 ml of 0.5% levobupivacaine hydrochloride plus 2 ml tramadol (100 mg) was used. In group II, 30 ml of 0.5% levobupivacaine hydrochloride plus 2 ml dexamethasone (8 mg) was used. Visual Analogue Scale was used. The onset of sensory and motor block was evaluated.Results: The mean onset of sensory block in group I was 5.41 minutes and in group II was 3.86 minutes, motor onset was 9.12 minutes in group I and 7.25 minutes in group II, duration of sensory block in group I was 12.14 hours and in group II was 15.34 hours, duration of motor block in group I was 14.34 hours and I group II was 16.23 hours, duration of analgesia in group I was 16.1 hour and in group II was 18.4 hours. The difference was significant difference (P<0.05). The mean VAS score in group II was better as compared to group I (P <0.05). Conclusion:Authors found that dexamethasone is a better adjuvant than tramadol when added to levobupivacaine in supraclavicular brachial plexus block.

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Eﬃcacy of Intrathecal Neostigmine with Intrathecal Dexmedetomidine in Postoperative Analgesia

Academia Anesthesiologica International ◽

10.21276/aan.2020.5.2.8 ◽

2020 ◽

Vol 5 (2) ◽

pp. 39-42

Author(s):

Nischala Reddy G ◽

Ajay Babu Ramakrishnan ◽

S. Ankalagowri Sankardevar ◽

Uthkala B Hegde

Keyword(s):

Motor Block ◽

Sensory Block ◽

Sedation Score ◽

Age Group ◽

Group I ◽

The Mean ◽

Group Ii ◽

The Difference ◽

Hyperbaric Solution ◽

Mean Time

Background: The present study was conducted to compare the efficacy of intrathecal neostigmine with intrathecal dexmedetomidine in postop- erative analgesia. Subjects and Methods: The present study was conducted in the department of Anesthesia involving 100 patients belonging to ASA grade I and II, posted for elective Sub umbilical surgeries, under spinal anaesthesia. Group I patients received 3.0ml of hyperbaric solution of 0.5% bupivacaine + 50mcg (0.5ml) of Neostigmine. Group II patients received 3.0ml of hyperbaric solution of 0.5% bupivacaine + 10mcg (0.5ml) of dexmedetomidine. Results: The maximum patients were seen in age group 18-30 years ie 10 in group I and 16 in group II and minimum in 41-50 years ie 6 in group I and 4 in group II. The mean time for onset of sensory block in group I was 1.43 0.53 min and in group II was 2.319 0.44 min. The mean time for onset of peak sensory block in group I was 5.48 0.43 min and Group II was 7.31 0.44 min. Time for two segment regression was significantly higher in dexmedetomidine group as compared to neostigmine group, the mean time for two segment regression in group I was 124.98 21.48 min and group II was 165.24 14.45 min. The mean time for onset of motor block was 3.079 0.44 min in group I and 4.0454 0.38 min in group II. The mean duration of motor block in group I was 191.58 26.81 min and 324 36.8 min in group II. The difference was significant (P< 0.05). The mean sedation score in group I was 1.03 and in group II was 2.07. The difference was significant (P< 0.05). Conclusion: Authors recommend the use of dexmedetomidine as an adjuvant to bupivacaine in subarachnoid block

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Comparison of Dexmedetomidine and Fentanyl as Adjuvants to Intrathecal Levobupivacaine in Lower Segment Cesarean Section

10.53350/pjmhs211582537 ◽

2021 ◽

Vol 15 (8) ◽

pp. 2537-2541

Author(s):

Madiha Zafar ◽

Usman Zeeshan ◽

Shazia Jang Sher ◽

Aesha Sadaf Rizwan ◽

Arooj Fatima

Keyword(s):

Cesarean Section ◽

P Value ◽

Motor Blockade ◽

Group Iii ◽

Lower Segment Cesarean Section ◽

Group I ◽

Prolonged Duration ◽

The Mean ◽

Group Ii ◽

Intrathecal Analgesia

Objective: To determine the effectiveness of dexmedetomidine on the spinal anaesthesia as an adjuvant to the hyperbaric levobupivacaine in patients undergoing cesarean section. Study Design: Comparative/Observational Place & Duration: The study was conducted at Anesthesiology/Obstetrics and Gynaecology departments of Mayo hospital, Lahore for duration of six months i.e from 1st November 2020 to 30th April 2021. Methods: This analysis included a total of 120 cases. After the informed consent the patients had received comprehensive demographics. Three equal classes of patients were divided into groups A, B and C. Group I had 40 patients and received 2.5 ml isobaric levobupivacane, group II with 40 patients and received 2.5 ml isobaric levobupivacaine and 5μg dexmedetomidine, and group III received 2.5 ml isobaric levobupivacaine and 25 μg fentanyl intrathecally. The outcomes of these groups were analysed in which sensory and motor blockage period were measured from the time the intrathecal drugs were administered. The full SPSS 26.0 version was used to analyze the results. Results: The mean age of the patients in group I was 27.44 ± 7.64 years with BMI 23.19±8.44, mean age in group II was 27.22 ±7.42 years with BMI 24.44 ± 6.16 and in group III mean age was 26.99 ±9.61 years with BMI 24.72 ±4.34. Duration of sensory and motor blockade was observed and resulted that it was earlier in group III as compared to group I and II. Prolonged duration of sensory and motor blockade was observed in group II as compared to groups I and III with significantly P value< 0.001. Conclusion: We concluded that for an adjuvant of 0.5 percent isobaric levobupivalacaine, Intrathecal dexmedetomidine induces both prolonged motor blockage and post operative analgesia than fentanyl. Key words: Levobupivacaine; Spinal anesthesia, Fentanyl, Intrathecal analgesia, Cesarean section; Dexmedetomidine.

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Seasonal variations in wool growth and heat tolerance of sheep. I. Wool growth

Australian Journal of Agricultural Research ◽

10.1071/ar9600075 ◽

1960 ◽

Vol 11 (1) ◽

pp. 75 ◽

Cited By ~ 9

Author(s):

M Wodzicka

Keyword(s):

Body Weight ◽

Day Treatment ◽

The Other ◽

Seasonal Rhythm ◽

Group Iii ◽

Wool Growth ◽

Group I ◽

The Mean ◽

Group Ii ◽

The Difference

The monthly wool growth of three groups of rams was studied at Beltsville, Maryland. Group I received natural daylight (at 38° 53' N.) and was shorn monthly. Group II had a 7:17 hours of daylight to hours of darkness rhythm and was shorn every 6 months, once in winter and once in summer. Group III received natural daylight and was likewise shorn every 6 months. The rams of all groups produced more wool in summer than in winter. This difference was significant (P<0.001). The mean body weight and food intake were both greater in the winter months, which indicated that the seasonal rhythm of wool growth was not a consequence of poorer feeding in winter. The rams which were shorn monthly (group I) grew considerably more wool than the other two groups, but the difference was not statistically significant. The short-day treatment of group II did not increase the annual wool production nor decrease the seasonal rhythm of wool growth. The balance of evidence from this and other experiments indicates that temperature rather than light controls the seasonal rhythm of wool growth.

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Aminoglycoside trough levels in neonates

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1002050p ◽

2010 ◽

Vol 138 (1-2) ◽

pp. 50-55 ◽

Cited By ~ 1

Author(s):

Biljana Pejovic ◽

Milica Rankovic-Janevski ◽

Niveska Bozinovic-Prekajski

Keyword(s):

Gestational Age ◽

Trough Level ◽

Inverse Correlation ◽

Risk Groups ◽

Target Range ◽

Group I ◽

Significant Difference ◽

Group Ii ◽

The Difference ◽

Trough Levels

Introduction. Drug safety depends on trough levels. Objective. Objective of the study was to measure gentamicin and amikacin trough levels in neonates and to identify risk groups by gestational and postnatal age. Methods. Gentamicin and amikacin were applied according to the clinical practice guidelines. Trough levels (mg/l) were deter- mined using fluorescence polarization immunoassay methodology. Target trough levels were <2 mg/l for gentamicin, and <10 mg/l for amikacin. Patients were divided in 3 groups by gestational age: I ?32, II 33-36, and III ?37 gestational weeks and, by postnatal age, in 2 groups: ?7 and >7 days. Results. Out of 163 neonates, 111 were receiving gentamicin and 52 amikacin. Mean amikacin trough level was 7.8?4.8 mg/l and, in group I 10.5?4.9 mg/l, which was above the target range and significantly higher than in group II (LSD, p<0.05). In the amikacin group, 26 patients were 7 and less, and 26 more than 7 days old, without significant differences in trough levels between the groups. In the gentamicin group, 52.3% of neonates had trough values within the target range. Gentamicin trough level in group I was above the trough range, 3.7?1.8, 2.3?1.5 in group II and, 1.8?1.4 mg/l in group III. The difference in trough levels among the groups was highly significant (F=9.015, p<0.001, ?2=17. 576, p<0.001). Further analysis revealed that differences between groups I and II (LSD, p=0.002) and between I and III (LSD, p=0.000) were highly significant. Conclusion. Obtained gentamicin and amikacin trough levels are high. Inverse correlation has been confirmed between trough level and gestational age, with highly significant difference, and the risk group has been identified. There is obviously a need to change the dosing regimen in terms of those with extended intervals, particularly for neonates of the lowest gestational age, along with pharmacokinetic measurements.

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Comparison of Ropivacaine-Fentanyl with Bupivacaine-Fentanyl for Labour Epidural Analgesia

The Open Anesthesiology Journal ◽

10.2174/2589645802014010108 ◽

2020 ◽

Vol 14 (1) ◽

pp. 108-114

Author(s):

Kalpana Kulkarni ◽

Rahul Patil

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Epidural Analgesia ◽

Diastolic Blood Pressure ◽

Diastolic Pressure ◽

Vas Score ◽

Group I ◽

Significant Difference ◽

Labour Epidural Analgesia ◽

Group Ii

Background: Bupivacaine with opioid is commonly used for labour epidural analgesia. Ropivacaine is considered as an alternative to bupivacaine due to its lower cardiovascular complications. However, there is a controversy regarding the efficacy of these drugs as some studies suggest equivalent action, whereas others report that ropivacaine produces less motor blockade. The study aimed to compare the effect of ropivacaine-fentanyl and bupivacaine-fentanyl for labour analgesia. Materials and Methods: The prospective randomized study was performed on 60 parturients, divided into two groups of 30 subjects each. Group I received 10ml of bupivacaine 0.1% + fentanyl 2µg/ml and Group II received 10ml of ropivacaine 0.1% + fentanyl 2µg/ml by epidural catheter. Pre-anaesthetic evaluation was performed on all the participants and all were administered metoclopramide 0.25mg/kg and ondansetron 0.08-0.1mg/kg intravenously as premedication. The baseline and post anaesthesia systolic, diastolic blood pressure, heart rate, VAS score, degree of motor block, sedation and APGAR score of the baby were recorded. The data were tabulated and statistically analyzed. Results: When compared, there was no significant difference in systolic/diastolic blood pressure in two groups except at 360 min where diastolic pressure was low in group II. Significantly higher heart rate at 30 min (P=0.0003), 120 min (0.006), and 300 min (P=0.001) was observed in group I subjects. VAS score was significantly less at 180 min (P=0.019) and 300 min (P=0.019) in group II. Adverse effects such as fetal bradycardia, nausea/vomiting and hypotension observed were clinically insignificance when compared in two groups. Conclusion: Bupivacaine and ropivacaine produce an equal degree of analgesia and hemodynamic stability in 0.1% of concentration when added with 2µg/ml fentanyl . However, heart rate was well maintained with lower VAS scores in group II receiving ropivacaine. No significant difference in the side effects between the two groups. Hence, Ropivacaine can be used as a safe alternative to bupivacaine for labour epidural analgesia.

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Comparitive evaluation of different concentrations of alcohol in ultrasound guided coeliac plexus neurolysis for pain relief in upper abdominal malignancies

Indian Journal of Clinical Anaesthesia ◽

10.18231/j.ijca.2021.109 ◽

2021 ◽

Vol 8 (4) ◽

pp. 492-500

Author(s):

Manish Kumar Singh ◽

Pragya Verma ◽

Sarita Singh ◽

Gyan P Singh ◽

Hemlata Verma

Keyword(s):

Quality Of Life ◽

Morphine Consumption ◽

Rescue Analgesia ◽

Vas Score ◽

Group I ◽

Significant Difference ◽

The Mean ◽

Group Ii ◽

Upper Abdominal

Patients suffering from advanced upper abdominal malignancies have pain as predominant symptom affects their quality of life and survival. USG guided coeliac plexus neurolysis become benevolence in these patients on part of their pain management and quality of life improvement. To compare the efficacy of USG guided coeliac plexus neurolysis for pain relief in upper abdominal malignancies by using different concentration of alcohol (50% vs 75%).This Prospective, comparative, randomised double blinded study was conducted during Sep 2019 – Aug 2020 at our tertiary care centre. Total 60 cases were taken as per following inclusion and exclusion criteria and randomly divided into 2 groups i.e. 30 each group, we compare Visual Analogue Scale (VAS) score, quality of life (QOL) and need of rescue analgesia profile between the groups to know the efficacy of USG guided coeliac plexus block. In our study, we observed that the baseline mean VAS score in group I was 8.26±0.78 while in group II was 8.03±0.76. No significant difference was found in mean VAS score at this time between the groups (p=0.24). The baseline mean QOL score in group-I was 77.46±3.40 while for the cases of group II the mean QOL score was 77.36±3.33. No significant difference was found in mean QOL score at baseline between the groups (p=0.90). The baseline mean morphine consumption in group-I was 113.33±39.24 mg while for the cases of group-II the mean morphine consumption was 120.33±38.37mg. No significant difference was found in mean morphine consumption at this time between the groups (p=0.48).Both groups having 50% alcohol and 75% alcohol decreases the VAS score from baseline in patients having upper abdominal malignancies along with QOL and dosages of rescue analgesia whereas no significant difference in VAS score in patients of both groups.

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ADVANTAGES OF INTRATHECAL BUPIVACAINE AND DEXMEDETOMIDINE COMBINATION OVER BUPIVACAINE AND CLONIDINE: A COMPARATIVE ANALYSIS IN GYNAECOLOGICAL INTERVENTIONS

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v4i4.1416 ◽

2020 ◽

Vol 4 (4) ◽

Author(s):

Aruna Mahanta ◽

Keshav Saran Agrawal

Keyword(s):

Regional Anaesthesia ◽

Motor Block ◽

Surgical Intervention ◽

Average Duration ◽

Sensory Block ◽

Lower Side ◽

Regional Analgesia ◽

Surgical Interventions ◽

Group I ◽

Group Ii

Background: most of the gynaecological interventions are generally done under regional anaesthesia. Currently dexmedetomidine came out as a beneficial adjunct for regional analgesia as well as anaesthesia. It is a highly selective α-2 agonist. Aims & objectives: to compare the effects & behavior of dexmedetomidine with clonidine when both are used with bupivacaine for spinal analgesia. Material and Methods: 100 cases of ASA grade 1 & 2 who were undergoing elective gynaecological surgical intervention were studied. They were divided into two groups (50 each). Group I received combination of bupivacaine & clonidine while group II received combination of bupivacaine + dexmedetomidine. Results: Average duration of onset of sensory block was earlier in group II. Arrival of motor block in Group I was slightly on lower side than Group II. Ten cases in Group I and eighteen cases from group II had notable bradycardia and hypotension. Discussion: Our study concludes that dexmedetomidine when used in combination with bupivacaine is very effective in gynaecological surgical interventions that demand longer duration & have comparatively lesser side effects. Keywords: dexmedetomidine, clonidine, Bupivacaine, gynaecological procedures.

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NORMALAND ABNORMAL LIQUOR VOLUME AND ITS CORRELATION WITH PERINATAL OUTCOME

10.36106/ijsr/7938740 ◽

2021 ◽

pp. 4-6

Author(s):

Kumari Nisha ◽

Renu Jha ◽

Kumudini Jha ◽

Debarshi Jana

Keyword(s):

Apgar Score ◽

Perinatal Outcome ◽

Neonatal Intensive Care ◽

Fetal Distress ◽

Special Unit ◽

Group I ◽

Group Ii ◽

The Difference ◽

One Year ◽

Four Quadrant

Aim:To assess and compare the perinatal outcome among mothers with normal and abnormal amniotic uid volume. Method: A prospective comparative study was conducted for a period of one year from January 2020 to December 2020. Group I consist of 50 patients with normal amniotic uid and group II consists of 50 patients with either oligohydramnios or polyhydramnios. Amniotic uid index (AFI) was calculated using Phalen's four quadrant technique using ultrasound. The perinatal outcome was judged by assessing the fetal distress predicted by abnormal fetal heart rate (FHR) or meconium stained liquor, one minute and 5 minute Apgar score, frequency of admission to neonatal intensive care unit (NICU), baby weight of less than 10th percentile for gestation age and perinatal mortality. Results: Induction of labour, caesarean section and meconium stained liquor was found to be most common among the patients in group II (abnormal AFI) in comparison with normal AFI subjects and similarly the perinatal outcome measures like low birth weight, increased frequency of admission to NICU due to respiratory distress and a low APGAR score was more commonly found in abnormal AFI group and the difference was found to be statistically signicant. Conclusion: AFI measurement in antepartum or intrapartum period can help to identify women who need increased antepartum surveillance for pregnancy complications and such women should be managed in a special unit to combat the complications effectively.

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