UNILATERAL SPINAL ANESTHESIA FOR LOWER EXTREMITY SURGERY

Objective: To compare the efficacy of unilateral spinal anesthesia by heavy bupivacaine with conventional bilateral anesthesia for lower extremity surgery. Methods: In this prospective randomized study, eighty two patients undergoing elective lower extremity orthopedic surgery were randomly allocated into two groups, unilateral and bilateral. All patients received intrathecally 8 mg of hyperbaric bupivacaine 0.5% over 40 seconds at the L3-4 intervertebral space. A lateral decubitus position after spinal injection was maintained in the unilateral group for 15 min. The onset and recovery of sensory and motor block and perioperative side effects were recorded. Results: Success rate of unilateral anesthesia was 82.9%. In the unilateral group, the sensory block for surgery (above L1) (181.5 ± 18.9 versus 150.0 ± 20.1 min), motor block time (149.3 ± 18.4 versus 121.5 ± 16.4 min) were longer and incidence of hypotension (2.4 versus 29.3%) was lower than those in the bilateral group. Onset of sensory block (3.5 ± 1.1 versus 3.3 ± 0.9 min), succes rate of anesthesia (100% in both groups), incidences of intraoperative nausea, vomiting and agitation and postoperative nausea, vomiting, headache and heart rate, respiratory changes were not significant between two groups. Conclusion: Unilateral spinal anesthesia provided longer sensory and motor block, lower incidence of hypotention in comparison with conventional bilateral anesthesia. This is a suitable technique for lower limb orthopedic procedures. Key words: Unilateral spinal anesthesia, lower extremity surgery

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Comparison of effects of Bupivacaine and Ropivacaine in patients undergoing elective Caesarean section

Birat Journal of Health Sciences ◽

10.3126/bjhs.v4i3.27042 ◽

2020 ◽

Vol 4 (3) ◽

pp. 859-863

Author(s):

Sangeeta Subba ◽

Arjun Arjun Chhetri ◽

Rupak Bhattarai

Keyword(s):

Cesarean Section ◽

Spinal Anesthesia ◽

Motor Block ◽

Elective Caesarean Section ◽

Sensory Block ◽

Elective Cesarean Section ◽

Hyperbaric Bupivacaine ◽

Safe Alternative ◽

Elective Cesarean ◽

Group B

Introduction: Spinal anesthesia is considered a reasonable choice for cesarean section. Bupivacaine and ropivacaine have been used as intrathecal drugs alone or in combination with various opioids. Ropivacaine is considered a valid and safe alternative to bupivacaine for spinal anesthesia. Objectives: To compare the efficacy and safety of hyperbaric ropivacaine with hyperbaric bupivacaine in spinal anesthesia for elective cesarean section. Methodology: Sixty pregnant women undergoing elective cesarean section were allocated into two groups. Group R received 3 ml of 0.5% hyperbaric ropivacaine (2 ml 0.75% plain ropivacaine mixed with 1 ml of 25 %dextrose) and Group B received 2.5 ml of 0.5% hyperbaric bupivacaine. Both the groups were compared in terms of onset of sensory and motor block, regression of sensory and motor block, duration of analgesia and side effects. Results: The onset of sensory block was comparable in both groups but was statistically insignificant. The onset of motor block in Bupivacaine(7.53 ± 1.72) min was faster when compared to Ropivacaine group(14.33 ± 6.19) min. Regression of sensory and motor block both were faster in Ropivacaine group. Duration of analgesia was longer in Bupivacaine group(131.17 ± 32.95)min than Ropivacaine group(125.33 ± 30.54)min. Conclusion: Ropivacaine can be used as an alternative to Bupivacaine for spinal anesthesia in cesarean section but has a shorter duration of sensory and motor block.

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A randomized double blind study to compare 1% 2-chloroprocaine and 0.5% hyperbaric bupivacaine in spinal anesthesia for infra-umbilical surgeries

Anaesthesia, Pain & Intensive Care ◽

10.35975/apic.v23i2.1061 ◽

2019 ◽

pp. 162-167

Author(s):

Arvind Khare ◽

Beena Thada ◽

Devraj Yadav

Keyword(s):

Spinal Anesthesia ◽

Motor Block ◽

Sensory Block ◽

Double Blind Study ◽

Hemodynamic Parameters ◽

Hyperbaric Bupivacaine ◽

Double Blind ◽

Voiding Function ◽

Group A ◽

Group B

Background: Spinal anesthesia is a reliable and safe technique for infra-umbilical surgeries. Preservative-free 2-chloroprocaine has re-emerged for use in spinal anesthesia. 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.Methodology: 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 anesthesia 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.Citation: Khare A, Thada B, Yadav D, Mathur V, Singh M. A randomized double blind study to compare 1% 2-chloroprocaine and 0.5% hyperbaric bupivacaine in spinal anesthesia for infra-umbilical surgeries. Anaesth. pain & intensive care 2019;23(2):162-167

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Haemodynamic Effects and Complications of Unilateral Spinal versus Standard Spinal Anesthesia in Elderly with Low Ejection Fraction Undergone Lower-Limb Surgery

Delta Medical College Journal ◽

10.3329/dmcj.v5i1.31426 ◽

2017 ◽

Vol 5 (1) ◽

pp. 20-24

Author(s):

Md Mushfiqur Rahman ◽

Md Mahbubul Hasan Munir ◽

Raihanuddin ◽

Shafiul Alam Shaheen ◽

Md Abdus Salam Khan ◽

...

Keyword(s):

Spinal Anesthesia ◽

Spinal Anaesthesia ◽

Lower Limb ◽

Motor Block ◽

Sympathetic Block ◽

Hyperbaric Bupivacaine ◽

Unilateral Spinal Anesthesia ◽

Lower Limb Surgery ◽

Group A ◽

Group B

Background: Cardiovascular system may be profoundly affected by spinal anaesthesia due to unavoidable sympathetic blockade which is more prominent in elderly.A restricted sympathetic block during spinal anesthesia may minimize hemodynamic changes.Objective: To assess whether a unilateral spinal anaesthesia using 0.5% hyperbaric bupivacaine will restrict the sympathetic block to avoid the undesired cardio vascular effects.Materials and method: In this prospective study 60 ASA Ill and IV patients aged between 60-90 years undergoing unilateral lower limb surgery were included. Patients were divided into two groups. In group-A, dural puncture was performed with the patient in the lateral decubitus position with 1.5 mL of hyperbaric bupivacaine. In group-B, it was performed with the patient in a seated position using 1.5 mL hyperbaric bupivacaine. Each patient was then placed in supine position. The speed of injection was 1 mL/30s. Patients were placed in the lateral position with operated side down and kept in this position for 10 minutes. Motor and sensory levels were assessed, and haemodynamic alterations were monitored just after block, 5, 10, 15 and 30 minutes of spinal anaesthesia.Results: The demographic data were found similar in both groups. The time to the onset of the sensory and motor block was significantly shorter in group-B. The duration of motor and sensory block was significantly shorter in group-A. Haemodynamically all the parameters revealed better out come in unilateral spinal anesthesia. The incidence of complications (nausea, headache, and hypotension) was also lower in group A.Conclusion: When unilateral spinal anesthesia was performed using a low-dose, low-volume and low-flow injection technique, it provides adequate sensory-motor block and helps to achieve stable hemodynamic parameters during surgery on a lower limb. Furthermore, this technique avoids unnecessary paralysis on the non-operated side.Delta Med Col J. Jan 2017 5(1): 20-24

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Intrathecal Magnesium Sulfate as Analgesic and Anaesthetic Adjunct to Bupivacaine in Patients Undergoing Lower Extremity Orthopaedic Surgery

Journal of Society of Anesthesiologists of Nepal ◽

10.3126/jsan.v4i2.21207 ◽

2018 ◽

Vol 4 (2) ◽

pp. 74-80 ◽

Cited By ~ 1

Author(s):

Prakash Maden Limbu ◽

Sindhu Khatiwada ◽

Birendra Prasad Sah ◽

Satyendra Narayan Singh ◽

Krishna Pokharel ◽

...

Keyword(s):

Adverse Effects ◽

Lower Extremity ◽

Magnesium Sulfate ◽

Spinal Anaesthesia ◽

Orthopaedic Surgery ◽

Motor Block ◽

Sensory Block ◽

P Value ◽

Hyperbaric Bupivacaine ◽

Group B

Background: Subarachnoid block is a popular mode of anesthesia for lower limb surgeries. Studies of Magnesium Sulfate (MgS04 ) as an adjuvant to intrathecal local anaesthetic are limited. The objective was to find out the analgesic and anaesthetic effect of intrathecal MgS04 added to bupivacaine for spinal anaesthesia in patients undergoing lower extremity orthopaedic surgery.Methods: Sixty ASA I or II adult patients undergoing lower extremity orthopaedic surgery were randomly allocated in a double blinded fashion into two groups of thirty each. Group A received 3.0 ml of 0.5% hyperbaric bupivacaine with 0.15 ml of 50% MgSO4. Group B received 3.0 ml of 0.5% hyperbaric bupivacaine with 0.15 ml of NS. Onset of sensory and motor block as well as time to attain highest level of sensory block were recorded. Duration of sensory and motor block along with duration of spinal anaesthesia were also assessed. Any adverse effects were noted and treated.Results: Duration of sensory and motor block along with duration of spinal anaesthesia were prolonged in patients of MgSO4 but were not statistically significant with p-value of 0.33, 0.23 and 0.68 respectively. Onset of anaesthesia, requirement of rescue analgesics, haemodynamic parameters and adverse effects were comparable between two groups.Conclusion: In patients undergoing lower extremity orthopaedic surgery the addition of 75mg of MgSO4 to intrathecal bupivacaine did not prolong the duration of sensory block, spinal anaesthesia nor decreased postoperative analgesic consumption without any additional side effects. Journal of Society of Anesthesiologists of NepalVol. 4, No. 2, 2017, Page: 74-80

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Clinical Comparative Study between Fentanyl and Dexmedetomidine with Bupivacaine for Lower Limb Surgery in Spinal Anaesthesia

Academia Anesthesiologica International ◽

10.21276/aan.2020.5.1.25 ◽

2020 ◽

Vol 5 (1) ◽

pp. 126-130

Author(s):

Tuhin Vashishth ◽

Sangeeta Varun

Keyword(s):

Spinal Anesthesia ◽

Lower Limb ◽

Motor Block ◽

Sensory Block ◽

Double Blind Study ◽

Hyperbaric Bupivacaine ◽

Double Blind ◽

Block Time ◽

Lower Limb Surgery ◽

Group D

Background: Spinal anesthesia is a preferred technique of choice in infraumbilical surgeries. The spinal anesthesia effect can be improved by adding various adjuvant like Fentanyl, clonidine, dexmedetomidine. Dexmedetomidine is a highly selective alpha 2 adrenergic agonists. The aim of study to compare efficacy and safety between Dexmedetomidine and Fentanyl with Bupivacaine.Subjects and Methods:A prospective randomized, double-blind study was conducted on 100 patient by dividing them into two groups. Group D: 2.5ml (12.5mg) of 0.5% hyperbaric bupivacaine with 5mcg (0.5ml) dexmedetomidine and Group F : 2.5ml(12.5mg) of 0.5% hyperbaric bupivacaine with 2 5mcg(0.5ml) fentanyl. The total volume injected intrathecally was 3.0ml in ASA I and II grade patient undergoing lower limb surgery.Results:Patients in dexmedetomidine groupD had a significantly longer sensory and motor block time than patients in fentanyl group F.The mean time of sensory regression to level S1 was 306.00 ± 13 .32 in group D and 206.14± 16.69 in group F(P<0.001). The regression time of motor block to reach modified Bromage 0 was 257.70±14.61 in group D and 178.54±14.23 in group F(P<0.001).Conclusion:Intrathecal Dexmedetomidine is associated with prolonging motor and sensory block as compare to Fentanyl.

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A Prospective, Randomized, Double-Blind Comparison of Unilateral Spinal Anesthesia with Hyperbaric Bupivacaine, Ropivacaine, or Levobupivacaine for Inguinal Herniorrhaphy

Anesthesia & Analgesia ◽

10.1213/01.ane.0000132972.61498.f1 ◽

2004 ◽

pp. 1387-1392 ◽

Cited By ~ 66

Author(s):

Andrea Casati ◽

Elena Moizo ◽

Chiara Marchetti ◽

Federico Vinciguerra

Keyword(s):

Spinal Anesthesia ◽

Hyperbaric Bupivacaine ◽

Double Blind ◽

Inguinal Herniorrhaphy ◽

Unilateral Spinal Anesthesia ◽

Blind Comparison

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

Asian Journal of Medical Sciences ◽

10.3126/ajms.v11i2.26548 ◽

2020 ◽

Vol 11 (2) ◽

pp. 59-63

Author(s):

Hari Poudel ◽

Surinder Nath Bawa ◽

Surendra Mohan Sharma

Keyword(s):

Side Effects ◽

Spinal Anesthesia ◽

Sensory Block ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Maximum Height ◽

Hyperbaric Bupivacaine ◽

Sensory Blockade ◽

Group I ◽

Group Ii

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

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