scholarly journals Low Dose Bupivacaine plus Fentanyl in Subarachnoid Block for Caesarean Section

2016 ◽  
Vol 4 (1) ◽  
pp. 24-30
Author(s):  
Nasir Uddin Ahmed ◽  
Masuda Islam Khan ◽  
Aynul Islam Khan ◽  
AKM Akhtaruzzaman

Background: Spinal anaesthesia induced hypotension, a common problem during caesarean section, is associated with maternal nausea and vomiting and the risk of neonatal acidosis. Low dose local anaesthetic combined with opioids spinal anaesthesia better preserves maternal haemodynamic stability, resulting in equally efficacious anaesthesia.Objectives: To investigate whether this synergistic action could be used to provide effective anaesthesia while preventing hypotension during caesarean operation.Materials and method: This prospective study included 60 pregnant mothers scheduled for caesarean operation who were then divided into two groups (thirty in each). Group-A received a spinal injection of 12.5 mg of standardized 0.5% hyperbaric bupivacaine and group-B received 8 mg of 0.5% hyperbaric bupivacaine with 20 ?gm fentanyl. Hypotension was defined as the systolic blood pressure drops below 90 mm of Hg or a decrease of systolic blood pressure 25% from pre anaesthesia level and hypotension was treated with a bolus of 5 to 10 mg of intravenous ephedrine. The quality of anaesthesia and postoperative analgesia were evaluated.Results: The mean time required to reach peak sensory level was earlier in group-B than group-A and was statistically significant (p<0.05). The decrease in systolic blood pressure in group-A was significantly more than group-B (p<0.05) and vasopressor requirement was also significantly more in group-A compared to group-B (p<0.05). Mean time of two segment regression of sensory analgesia and complete sensory recovery was significantly early in group-B (p<0.05). Duration of motor recovery in group-B was significantly earlier (p<0.05). The duration of effective analgesia was significantly more in group-B (p<0.05).Conclusion: Low dose Bupivacaine with fentanyl provided excellent intraoperative sensory and motor blockade, haemodynamic stability, and effective postoperative analgesia for caesarean delivery.Delta Med Col J. Jan 2016 4(1): 24-30

2021 ◽  
Vol 71 (6) ◽  
pp. 2078-81
Author(s):  
Hina Iftikhar ◽  
Aneel Aslam ◽  
Habib Ur Rehman ◽  
Zulfiqar Ali ◽  
Mohammad Ali Abbass ◽  
...  

Objective: To compare the effect of 0.5% and 0.75% hyperbaric Bupivacaine on haemodynamic stability in terms of mean systolic blood pressure and heart rate recorded at 4 min in patients undergoing caesarian section in spinal anesthesia. Study Design: Quasi experimental study. Place and Duration of Study: Department of Anaesthesiology, Combined Military Hospital, Malir, from Jul to Dec 2018. Methodology: The patients were assigned in two groups (A and B) using lottery method. Group A received 0.5% hyperbaric Bupivacaine solution. Group B received 0.5% hyperbaric Bupivacaine solution. Spinal anaesthesia was given, blood pressure and heart rate were recorded. Data were analyzed in SPSS version 23. Both groups were compared for mean systolic blood pressure and heart rate by using independent sample t-test. Results: The mean age of patients was 29.62 ± 6.21 years in 0.75% Bupivacaine group while 29.31 ± 6.20 years in 0.5% Bupivacaine group. The mean systolic blood pressure of patients was 111.63 ± 5.96 mmHg in 0.75% Bupivacaine group while 117.16 ± 7.12 mmHg in 0.5% Bupivacaine group. The difference was significant in both groups (p-value <0.05). The mean heart rate of patients was 92.27 ± 4.71 beats per min (bpm) in 0.75% Bupivacaine group while 97.68 ± 4.58 bpm in 0.5% Bupivacaine group. The difference was significant in both groups (p-value <0.05). Conclusion: 0.5% hyperbaric Bupivacaine was better than 0.75% hyperbaric Bupivacaine solution in spinal anaesthesia during caesarean section.


2021 ◽  
Vol 29 (01) ◽  
pp. 57-61
Author(s):  
Fozia Mohammad Bakhsh ◽  
Khanda Gul ◽  
Safia Bibi ◽  
Palwasha Gul

Objective: To compare maternal morbidity in planned induction of labour versus expectant management in women with gestational hypertension at term. Study Design: Randomized Clinical Trial. Setting: Department of Obstetrics and Gynecology, Bolan Medical Complex Hospital Quetta. Period: January 2017 to December 2017. Material & Methods: 240 pregnant women with the diagnosis of gestational hypertension with systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg without proteinuria were included. Patients were equally divided into two groups; group A (the intervention group) and group B (the expectant group). In group A, cervical ripening was stimulated with use of intravaginal prostaglandins. In group B, patients were monitored until the onset of spontaneous Labour. In both groups intervention was recommended in case of non-optimal FHR, the diastolic blood pressure ≥110mmHg or the systolic blood pressure ≥170 mmHg and eclampsia. Results: Out of 120 deliveries, 87 (72.5%) delivered by vaginal and 33 (27.5%) by caesarean section in group A. While in group B, out of 120 deliveries, 66 (55%) delivered by vaginal and 54 (45%) by caesarean section. The frequency of maternal outcome like mild preeclampsia present in 15% and 40% of women in group A and in group B respectively. Severe preeclampsia was noted 7.5% and 22.5% in group A and in group B respectively. Seizures were found in 2.5% of women in group A and 10% of women in group B. Conclusion: Complications like mild and severe preeclampsia and eclampsia could be prevented by induction of labour at term and also by widespread use of prenatal care education, prompt diagnosis and treatment of gestational hypertension.


2019 ◽  
Vol 14 (5) ◽  
pp. 376-385 ◽  
Author(s):  
Lin Xu ◽  
Jiangming Huang ◽  
Zhe Zhang ◽  
Jian Qiu ◽  
Yan Guo ◽  
...  

Objective: The purpose of this study was to establish whether Triglycerides (TGs) are related to Blood Pressure (BP) variability and whether controlling TG levels leads to better BP variability management and prevents Cardiovascular Disease (CVD). Methods: In this study, we enrolled 106 hypertensive patients and 80 non-hypertensive patients. Pearson correlation and partial correlation analyses were used to define the relationships between TG levels and BP variability in all subjects. Patients with hypertension were divided into two subgroups according to TG level: Group A (TG<1.7 mmol/L) and Group B (TG>=1.7 mmol/L). The heterogeneity between the two subgroups was compared using t tests and covariance analysis. Results: TG levels and BP variability were significantly different between the hypertensive and non-hypertensive patients. Two-tailed Pearson correlation tests showed that TG levels are positively associated with many BP variability measures in all subjects. After reducing other confounding factors, the partial correlation analysis revealed that TG levels are still related to the Standard Deviation (SD), Coefficient of Variation (CV) of nighttime systolic blood pressure and CV of nighttime diastolic blood pressure, respectively (each p<0.05). In the subgroups, group A had a lower SD of nighttime Systolic Blood Pressure (SBP_night_SD; 11.39±3.80 and 13.39±4.16, p=0.011), CV of nighttime systolic blood pressure (SBP_night_CV; 0.09±0.03 and 0.11±0.03, p=0.014) and average real variability of nighttime systolic blood pressure (SBP_night_ARV; 10.99±3.98 and 12.6±3.95, p=0.024) compared with group B, even after adjusting for age and other lipid indicators. Conclusion: TG levels are significantly associated with BP variability and hypertriglyceridemia, which affects blood pressure variability before causing target organ damage.


Author(s):  
Rishman Tandi ◽  
Tanvi Kumar ◽  
Amritpal Singh Kahlon ◽  
Aaftab Sethi

Introduction: Acute coronary syndrome remains as one of the most important causes for morbidity and mortality in developed countries. Therefore, evidence-based management strategy is required to offset the loss of health during an acute coronary syndrome. An effective approach includes both medical and surgical methods. This study was conducted to evaluate the medical method of management. Objective: To study blood pressure and heart rate variability after administration of Ivabradine or metoprolol in cases with acute coronary syndrome. Materials and methods: The study was a Prospective single center observational study conducted in patients attending Cardiology Intensive Care Unit in Nayyar Heart and Superspecialty Hospital, a tertiary care centre located in an urban area. All patients with Acute coronary syndrome admitted to the emergency or cardiac care unit were analysed with ECG as a preliminary diagnostic test and confirmed with troponin markers. They were either given Ivabradine or Metoprolol. Baseline evaluation and follow up was done and necessary data was collected and analysed.   Results: 100 patients were included in the study out of which 50 were given Metoprolol (Group A) and 50 were given Ivabradine (Group B). Themean age of studied cases was found to be 66.54 years in group A and 68.69 years in group B. It was observed that there was a fall in heart rate by 26.8 beats per minute with beta blocker and 24.4 beats per minute with Ivabradine. In case of blood pressure measurement, in patients with beta blocker administration, there was a fall of 25 mm Hg in systolic blood pressure and 17 mm Hg in diastolic blood pressure However, with Ivabradine there was only a fall of 8mm Hg in systolic Blood pressure and 6 mm Hg in diastolic blood pressure. Conclusion: Although Metoprolol is the drug of choice to decrease heart rate and blood pressure in acute coronary syndrome, Ivabradine is being increasingly used in cases where beta blockers are contraindicated as it has similar efficacy in lowering heart rate without compromising contractility of cardiac muscle, thereby maintaining LVEF and blood pressure. Keywords: Acute coronary syndrome, Beta Blockers, Metoprolol, Ivabradine.


Author(s):  
Prashant Sachan ◽  
Prem Raj Singh ◽  
Sateesh Verma ◽  
Brij Bihari Kushwaha

Introduction: Pain control is an important factor for postoperative recovery. Many drugs have been studied for effectiveness of postoperative analgesia. Fentanyl is a conventional drug and dexmedetomidine is one of the emerging drugs used for analgesia and postoperative pain control. Aim: To compare the effect of fentanyl and dexmedetomidine on pain control and haemodynamic stability. Materials and Methods: A randomised controlled trial was conducted on 60 patients (30 each group) undergoing for abdominal surgery, between January 2019 to January 2020. Group A received fentanyl loading dose 2 μg/kg I.V. followed by 0.5 μg/kg/hr infusion and group B received dexmedetomidine loading 1 μg/kg over 10 minutes followed by maintenance 0.5 μg/kg/hr infusion. Infusion was continued up to four hours during surgery and till eight hours of postoperative in both groups. Haemodynamic parameters {Heart Rate (HR), Mean Arterial Pressure (MAP)} were recorded after start of study drug infusion, after intubation, then every 15 minutes till 1 hour, then every 30 minutes till end of surgery and after extubation. In postoperative period, HR and MAP were recorded at interval of one hour till eight hours after extubation and postoperative analgesia was assessed by Visual Analogue Scale (VAS) at interval of one hour till eight hours. Present study used descriptive statistical analysis for data analysis. Analysis of variance (ANOVA) was used to compare data between two groups. Chi-square test was used to find the significance of difference on categorical scale between two groups. Results: This study showed that group-B had significantly less VAS score most of time in recovery period as compared to group-A (1.97±0.18 vs 2.10±0.31 at eight hours postoperative). HR, MAP was found significantly less all the time during surgery and most of the time postoperatively in group-B (p-value <0.05). Conclusion: Intravenous infusion of dexmedetomidine can be better for controlling postoperative pain and perioperative haemodynamic stability as compared to infusion of fentanyl in patients undergoing abdominal surgeries.


2019 ◽  
Vol 6 (6) ◽  
pp. 1792
Author(s):  
Kiranpreet Kaur ◽  
Sanjay Johar ◽  
Anil Kumar ◽  
Mamta Jain ◽  
Prashant Kumar ◽  
...  

Background: The present study was conducted to compare the effects of 0.5% isobaric levobupivacaine and 0.5% hyperbaric bupivacaine in pregnant females undergoing caesarean section.Methods: Study was conducted on 100 pregnant females undergoing caesarean section. They were randomly divided into two groups B and L receiving 2 ml of 0.5% hyperbaric bupivacaine and 0.5% levobupivacaine respectively. Two groups were compared with regard to sensory block, motor block, haemodynamic stability and complications if any.Results: Time to achieve sensory blockade till T6 dermatome was prolonged in group B (162.52±80.55 sec) as compared to group L (139.40±49.79 seconds) (p value= 0.087). Prolonged duration of motor blockade was observed in group B (160.76±6.56 minutes) as compared to group L (131.48±14.42 minutes) (p<0.001). Less haemodynamic stability was seen in patients of group B with more incidence of hypotension and bradycardia.as compared to group L.Conclusions: Levobupivacaine is nearly equally effective to bupivacaine to produce sensory and motor blockade with comparable onset time and better haemodynamic stability with lesser side effects.


Author(s):  
Suman Chattopadhyay ◽  
Mallika Datta ◽  
Biswanath Biswas

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.


Author(s):  
Preeti Parashar ◽  
Anisha Singh ◽  
Manoj Kumar Sharma ◽  
Dipak L. Raval

 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. 


2017 ◽  
Vol 2 (2) ◽  
pp. 9-14
Author(s):  
Ninik Mas Ulfa

ABSTRAKHipertensi adalah peningkatan tekanan darah sistolik lebih dari 140 mmHg dan tekanan darah diastolik lebih dari 90 mmHg pada dua kali pengukuran dengan selang waktu lima menit dalam keadaan cukup istirahat. Faktor penyebab hipertensi adalah faktor gaya hidup, faktor genetika dan faktor usia. Hipertensi termasuk dalam penyakit degeneratif dimana terjadi penurunan organ tubuh. Tujuan dari penelitian ini adalah untuk mengetahui efektifitas kontrol penurunan teakanan darah dari terapi obat Candersartan, Valsartan dan Kalium Losartan. Pada penelitian ini dilakukan di RS X wilayah Surabaya Selatan dan RS Y wilayah Surabaya Timur. Penelitian ini bersifat retrospektif dengan pengamatan observasioanl. Penelitian ini terbagi dalam 3 kelompok terapi dengan jumlah total populasi adalah 57 pasien. Data tekanan darah sistolik-diastolik diamati selama 5 bulan terapi darimasing-masing kelompok terapi A (Candersartan n = 19), kelompok terapi B (Valsartan n= 19), dan kelompok terapi C (Kalium Losartan n= 19).Hasil penelitian menunjukkan bahwa terjadi penurunan tekanan darah sistolik pada kelompok A sebesar 21,18%, kelompok B = 24,20%, dan kelompok C = 22,51%. Penurunan tekanan darah diastolic pada kelompok A sebesar 12,14%, kelompok B = 14,04% dan kelompok C = 10,98%. Berdasarkan hasil analisa statistik diperoleh hasil p = 0,967 > α = 0,05 yang berarti tidak ada perbedaan yang bermakna dari ketiga kelompok terapi tersebut dalam penurunan tekanan darah sistolik maupun diastolik pada pasien hipertensi. Hal ini berarti bahwa efektifitas ketiga obat tersebut dalam kontrol penurunan tekanan darah pada pasien Hipertensi mempunyai efektifitas yangKata Kunci: Candersartan, Valsartan, Kalium Losartan, HipertensiABSTRACTHypertension is an increase in systolic blood pressure of more than 140 mmHg and diastolic blood pressure of more than 90 mmHg in two measurements with an interval of five minutes in a resting state. Factors causing hypertension are lifestyle factors, genetic factors and age factors. Hypertension is included in degenerative diseases where there is a decrease in body organs. The purpose of this study was to determine the effectiveness of blood pressure control of Candersartan, Valsartan and Potassium Losartan. This research was conducted in RS X of South Surabaya and RS Y of East Surabaya. This study is retrospective with observational. The study was divided into 3 therapeutic groups with a total population of 57 patients. Data on systolic-diastolic blood pressurewere observed for 5 months of therapy from each of the therapy groups A (Candersartan n = 19), therapy group B (Valsartan n = 19), and therapy group C (Potassium Losartan n = 19). That there was a decrease in systolic blood pressure in group A of 21,18%, group B = 24,20%, and group C = 22,51%. Diastolic blood pressure decrease in group A was 12,14%, group B = 14,04% and group C = 10,98%. Based on the results of statistical analysis obtained results p = 0.967> α = 0.05 which means there is no significant difference of the three groups of therapy in the reduction of systolic blood pressure and diastolic in hypertensive patients. This means that the effectiveness of the three drugs in the control of blood pressure reduction in hypertensive patients has the same effectiveness.Key Words: Candersartan, Valsartan, Potasium Losartan, Hypertesion


2010 ◽  
Vol 14 (Number 1) ◽  
pp. 32-35
Author(s):  
N Habib ◽  
Md. R Amin ◽  
US N Begum ◽  
N Akhter ◽  
D Akther ◽  
...  

This descriptive study was done in the Deponment of Physiology. Dhaka Medical College, Dhaka. during the period of January 2008 to December 2008. The objective of the study was to measure pulse and blood pressure in smokers and nonsmoker adult male stroke patients and to find out changes in pulse and blood pressure among the smoker and non-smoker stroke patients. To accomplish this purpose 105 patient of over 20 years of age were selected. They were divided into two groups: Group A consisting of thirty n on-smoker and group B consisting of seven,' five smoker stroke patients. The finding showed that smoking caused no statistical significant difference 1p>0.05) in pulse and systolic blood pressure among she groups. Diastolic blood pressure was significantly higher (p<0.05) fill smokers than non-smokers. The study therefore provides the scope to understand the altered physiology of smoker stroke pollen's.


Sign in / Sign up

Export Citation Format

Share Document