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

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

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Comparison of effect of intrathecal dexmedetomidine and clonidine as an adjuvant to hyperbaric bupivacaine in patients undergoing surgery for fracture femur and tibia

International Surgery Journal ◽

10.18203/2349-2902.isj20175099 ◽

2017 ◽

Vol 4 (12) ◽

pp. 3833

Author(s):

G. Praveen Chandra ◽

Sampathi Shiva Krishna ◽

Pooja Singh

Keyword(s):

Motor Block ◽

Elective Surgery ◽

Onset Time ◽

Hyperbaric Bupivacaine ◽

Wound Infiltration ◽

Nerve Blocks ◽

Rescue Analgesia ◽

Fracture Femur ◽

Significant Difference ◽

Group D

Background: Spinal anaesthesia with bupivacaine is administered routinely for lower abdominal and lower limb surgeries. The ensuing nerve block is sufficient to ensure patient’s wellbeing, while motor block facilitates the surgeon’s work. Post-operative pain relief can be achieved by various methods namely systemic opioid and non-opioid peripheral nerve blocks and local wound infiltration, each with their own merits and demerits. the present study was undertaken to compare the effect of intrathecal dexmedetomidine and clonidine as an adjuvant to hyperbaric bupivacaine in patients undergoing surgery for fracture femur and tibia.Methods: 80 patients between 20-60 years, undergoing elective surgery for closed fracture shaft of femur and tibia with ASA physical status of 1 and 2 were included in the study. All the subjects were randomly allocated to one of the two groups (Group C and Group D) by a computer-generated randomization chart. Group C received 2.5ml of 0.5% hyperbaric bupivacaine with 50mcg clonidine and group D received 2.5ml of 0.5% hyperbaric bupivacaine with 5mcg dexmedetomidine.Results: 30 of the 40 patients in group C were of ASA I and 10 were ASA II, while in group D, 25 were ASA I and 15 were ASA II. A significant difference was found in the onset time for sensory and motor block, receding time for sensory and motor block and the need of the first rescue analgesia between the two groups, showing that Dexmedetomidine was more potent than clonidine.Conclusions: Dexmedetomidine is a potent, highly selective and specific α2-adrenoreceptor agonist that has both sedative and analgesic effects and is also a valuable adjuvant when regional anaesthesia is incorporated.

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COMPARISON OF INTRATHECAL BUPRENORPHINE VERSUS CLONIDINE AS AN ADJUVANT TO 0.5% HYPERBARIC BUPIVACAINE IN LOWER ABDOMINAL SURGERIES

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v5i1.1691 ◽

2021 ◽

Vol 5 (1) ◽

Author(s):

Jagdish Kumar ◽

Satya Narayan Seervi

Keyword(s):

Postoperative Analgesia ◽

Normal Saline ◽

Side Effect ◽

Motor Block ◽

Onset Time ◽

Sedation Score ◽

Hyperbaric Bupivacaine ◽

Group A ◽

Group B ◽

Intrathecal Clonidine

Introduction: Present study was undertaken to compare the efficacy of intrathecal clonidine or buprenorphine with bupivacaine in lower abdominal surgeries. Methods:90 ASA I and II patients undergoing lower abdominal surgeries were randomly allocated into three groups(n=30). Group A received 3ml of 0.5% hyperbaric bupivacaine with 1ml normal saline, GroupB received 3ml of 0.5% hyperbaric bupivacaine with 60 mcg buprenorphine(1:5 dilution) and Group C received 3ml of 0.5% hyperbaric bupivacaine with 30mcg clonidine(1:5 dilution) respectively (Total volume 4ml). Onset time and duration of sensory and motor block, duration of analgesia, hemodynamics, VAS score, sedation score and side effect were compared. Results: The duration of analgesia was significantly longest in GroupC (354.50±38.48min), followed by Group B (277.10±25.47min) and Group A(131.50±20.15min) (p<0.001) Conclusion: On comparing the two drugs, Clonidine appears to be superior in terms of postoperative analgesia. Keywords: Clonidine, Buprenorphine, Intrathecal

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Comparison between Intrathecal Nalbuphine and Bupivacaine versus Fentanyl and Bupivacaine For Postoperative Analgesia After Lower Abdominal Surgeries

QJM ◽

10.1093/qjmed/hcaa039.051 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

S F Ibrahim ◽

R Y Ataallah ◽

F A Abdelmalek ◽

M M Hamisa

Keyword(s):

Side Effects ◽

Respiratory Depression ◽

Postoperative Analgesia ◽

Motor Block ◽

Intrathecal Injection ◽

Arterial Oxygen ◽

Epidural Administration ◽

Hyperbaric Bupivacaine ◽

Rescue Analgesia ◽

Fentanyl Group

Abstract The use of opioids in intrathecal or epidural anesthesia has become popular to optimize postoperative analgesia. However, opioid-induced side effects, such as respiratory depression, nausea, vomiting, urinary retention and pruritus, limit their use. Several investigations have shown that intrathecal or epidural administration of opioids produces a dose dependent modulation of spinal nociceptive processing in animals and humans and is not associated with sedation. Aim of Study The purpose of this study was to assess the spinally mediated analgesic effects postoperativally of intrathecal Nalbuphine plus bupivacaine after lower abdominal surgeries in comparison to intrathecal bupivacaine plus fentanyl Patients & Methods : 60 patients came to Ain-shams Hospital for lower abdominal surgeries, They were randomly allocated into two equal groups (30 patients each) group F and group N. Group F : Bupivacaine-Fentanyl Patients received an intrathecal injection of 3 ml of 0.5% heavy (hyperbaric) bupivacaine plus 0.5 ml (25 µg) fentanyl. Group N: Bupivacaine-Nalbuphin Patients received an intrathecal injection of 3 ml of 0.5% heavy (hyperbaric) bupivacaine plus 0.5 ml (0.5 mg) Nalbuphine. All patients were assessed and monitored for: Hemodynamics: ECG for heart rate, and non-invasive arterial pressure, respiratory rate and arterial oxygen saturation, onset of sensory block, onset of motor block, duration of analgesia & 1st rescue analgesia, duration of motor block, adverse effects as: hypotension, bradycardia, respiratory depression, pruritus, shivering, nausea and vomiting were recorded. Results & Conclusion Addition of a small dose of nalbuphine or fentanyl to bupivacaine in spinal anesthesia moderately prolonged the time of postoperative analgesia the duration of postoperative analgesia is nearly the same in nalbuphine group & the fentanyl group. There is more rapid onset of motor block in fentanyl group than in nalbuphine group but with no difference in sensory or motor block regression. No respiratory depression or degree of sedation occurs in both groups. Hemodynamic stability & side effects incidence are the same in both groups

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COMPARISON OF INTRATHECAL DEXMEDETOMIDINE AND MAGNESIUM SULPHATE AS AN ADJUVANT TO 0.5% HYPERBARIC BUPIVACAINE IN LOWER LIMB SURGERY

10.36106/ijar/8301507 ◽

2021 ◽

pp. 1-3

Author(s):

Shaheer Ahmed Siddiqui ◽

Kapil Rastogi ◽

Aamir Laique Khan

Keyword(s):

Magnesium Sulfate ◽

Postoperative Analgesia ◽

Lower Limb ◽

Motor Block ◽

Onset Time ◽

Sensory Block ◽

Hyperbaric Bupivacaine ◽

Block Level ◽

Lower Limb Surgery ◽

Group B

Background: Epidural anesthesia is commonly used for perioperative as well as postoperative analgesia in lower limb surgeries. Adjuvant in spinal anesthesia prolongs the duration of anesthesia as well as postoperative analgesia. In this study we evaluate the effects of intrathecal dexmedetomidine and magnesium sulfate as an adjuvant to 0.5% hyperbaric bupivacaine in lower limb surgeries. Methods: Total 60 patients belonging to ASA I or II aged 24 to 57 years of either sex were included in this study and randomly distributed into two groups. Group (B+M) received intrathecal 100mg magnesium sulfate and Group (B+D) received intrathecal 5.0 mcg dexmedetomidine with hyperbaric bupivacaine 15mg (3ml of 0.5%). Onset and duration of sensory and motor block, duration of analgesia, hemodynamic changes and complications were recorded. Results: The mean Onset time of sensory block at T10 (min.), Time to maximum sensory block level (min.), Time in minutes for complete motor block (min.), Time for Motor Emergence from Bromage 3 (min.), Time for Sensory Emergence and Time for first analgesia (min) were significantly different between groups. Conclusion: The dexmedetomidine as an adjuvant with hyperbaric bupivacaine leads to earlier onset and prolonged duration of both sensory and motor block as compared to magnesium sulfate.

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COMPARISON OF INTRATHECAL BUPRENORPHINE VERSUS CLONIDINE AS AN ADJUVANT TO 0.5% HYPERBARIC BUPIVACAINE IN LOWER ABDOMINAL SURGERIES

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v5i8.2106 ◽

2021 ◽

Vol 5 (8) ◽

Author(s):

Mukesh Choudhary ◽

Abhimanyu Singh

Keyword(s):

Postoperative Analgesia ◽

Normal Saline ◽

Motor Block ◽

Onset Time ◽

Sedation Score ◽

Hyperbaric Bupivacaine ◽

Group A ◽

Group B ◽

Intrathecal Clonidine

Introduction: Present study was undertaken to compare the efficacy of intrathecal clonidine or buprenorphine with bupivacaine in lower abdominal surgeries. Methods: 90 ASA I and II patients undergoing lower abdominal surgeries were randomly allocated into three groups(n=30). Group A received 3ml of 0.5% hyperbaric bupivacaine with 1ml normal saline, GroupB received 3ml of 0.5% hyperbaric bupivacaine with 60 mcg buprenorphine(1:5 dilution) and Group C received 3ml of 0.5% hyperbaric bupivacaine with 30mcg clonidine (1:5 dilution) respectively (Total volume 4ml). Onset time and duration of sensory and motor block, duration of analgesia, hemodynamics, VAS score, sedation score and side effect were compared. Results: The duration of analgesia was significantly longest in GroupC (354.50±38.48min), followed by Group B (277.10±25.47min) and Group A(131.50±20.15min) (p<0.001) Conclusion: Clonidine (30mcg) and buprenorphine (60mcg) when used as adjuvants to 0.5% hyperbaric bupivacaine intrathecally produces significantly longer duration and better quality of postoperative analgesia than bupivacaine alone. Keywords: clonidine, buprenorphine, intrathecal, postoperative analgesia.

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A COMPARATIVE STUDY OF INTRATHECAL BUPIVACAINEHEAVY (0.5%) WITH BUPIVACAINE HEAVY (0.5%) PLUS DEXMEDETOMIDINE FOR LOWER ABDOMINAL SURGERIES

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v5i2.1723 ◽

2021 ◽

Vol 5 (2) ◽

Author(s):

Kumar Shailesh ◽

Jitendra Prasad Singh ◽

Arjun Prasad ◽

Veena Horo

Keyword(s):

Side Effects ◽

Normal Saline ◽

Motor Block ◽

Onset Time ◽

Local Anaesthetics ◽

Control Group ◽

Hyperbaric Bupivacaine ◽

Rescue Analgesia ◽

High Doses ◽

Group D

Introduction: Several adjuncts like adrenaline, opioids and alpha-2 adrenergic agonists are being used with local anaesthetics intrathecally for prolongation of intra-operative and post-operative analgesia and to reduce the side-effects of high doses of local anaesthetics. Aim: The present study was done to evaluate the onset and duration of sensory and motor block, hemodynamic effects, post-operative analgesia and adverse effects of Dexmedetomidine given intrathecally with hyperbaric 0.5% Bupivacaine. Materials and methods: Sixty inpatients of ASA class I and II scheduled for various lower abdominal surgeries under Sub-Arachnoid Block were randomly divided into two groups of 30 each namely C (Control), D(Dexmedetomidine) . All received 12.5mg hyperbaric bupivacaine plus 0.5 ml Normal Saline in Group C (Control),10µg Dexmedetomidine (diluted in preservative free Normal saline of 0.5ml) in Group D(Dexmedetomidine) . The onset time to reach peak sensory and motor level, the regression time for sensory and motor block, hemodynamic changes and side-effects were noted. Results: The duration of sensory and motor block, rescue analgesia was significantly prolonged in Dexmedetomidine group when compared to that of Control group. Conclusion: Dexmedetomidine 10 µg seems to be a better neuraxial adjuvant to hyperbaric Bupivacaine. Keywords: Bupivacaine; Dexmedetomidine; intrathecal.

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A comparative study of caudal anesthesia with bupivacaine v/s bupivacaine with dexmedetomidine in lower abdominal surgeries in pediatric age group

Pain medicine ◽

10.31636/pmjua.v6i3.3 ◽

2021 ◽

Vol 6 (3) ◽

pp. 25-29

Author(s):

Kishore Kumar N. ◽

Sandeep Kadam

Keyword(s):

Adverse Effect ◽

Postoperative Analgesia ◽

Rescue Analgesia ◽

Pediatric Age Group ◽

Respiratory Parameters ◽

Caudal Anaesthesia ◽

Significant Difference ◽

Blinded Study ◽

Group B ◽

Double Blinded

Background: caudal anaesthesia has shortterm effect. Alpha2 adenoreceptors when used as adjuvant to local anaesthetic in children prolongs analgesic duration. The study is aimed to assess the efficacy of addition of dexmedetomidine with Bupivacaine in caudal block for extending postoperative analgesia and its safety profile in pediatric infraumbilical surgeries.Method: the prospective interventional longitudinal double blinded study was conducted on 60 patients randomly divided into two groups by simple lottery method: group B who received (0.25 %) bupivacaine 1 ml/kg plus 1 ml normal saline (NS), and those in group BD who received (0.25 %) bupivacaine 1 ml/kg plus 0.5 μg/kg dexmedetomidine in 1 ml NS. Postsurgery, both groups were compared in R studio v1.2.5001. Association between the adverse effect and other variables (age, gender, type of surgery, groups) were assessed by Multiple linear regression.Results: in group BD, duration of analgesia prolonged significantly (P < 0.05). In group BD, FLACC score at initial four hours and at 12th hour was significantly less (P < 0.05). Group B was more likely to receive high number of rescue analgesia (P = 0.0005; OR = 11.769). No significant difference was observed concerning hemodynamics, respiratory parameters and adverse effect between both groups (P > 0.05). Conclusion: in children, dexmedetomidine when used along with bupivacaine prolongs postoperative analgesia duration, without any significant side effects.

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A COMPARATIVE STUDY OF CLONIDINE VERSUS NALBUPHINE AS INTRATHECAL ADJUVANTS TO 0.5% HYPERBARIC BUPIVACAINE DURING LOWER ABDOMINAL SURGERIES – A RANDOMIZED DOUBLE BLIND INTERVENTIONAL STUDY.

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v4i3.1004 ◽

2020 ◽

Vol 4 (3) ◽

Author(s):

Trishala Jain ◽

Jaipal .

Keyword(s):

Motor Block ◽

Sensory Block ◽

Double Blind Study ◽

Hyperbaric Bupivacaine ◽

Double Blind ◽

Rescue Analgesia ◽

Institutional Ethics ◽

Group A ◽

Group B ◽

Intrathecal Clonidine

Background: Regional anesthesia techniques for gynecological procedures are on increasing trends due to their advantage of postoperative analgesia owing to intrathecal adjuvants. The present study was aimed to comparatively evaluate the clinical efficacy of clonidine with nalbuphine when co-administered intrathecally with 0.5% hyperbaric bupivacaine for Lower abdominal surgeries in Gynecology. Methods: With institutional ethics committee clearance No. 193MC/EC/2018, randomized, double blind study was conducted. After obtaining informed written consent total of 84 patients scheduled for lower abdominal surgeries were randomly allocated into two groups: Group A (n=42) - Inj. 3.5 ml Bupivacaine 0.5% + 0.2 ml Clonidine(30µg) intrathecally. Group B (n=42) - Inj.3.5 ml Bupivacaine 0.5%+0.2 ml Nalbuphine(2mg) intrathecally. The characteristics of sensory and motor block, hemodynamic data, side effects were recorded. Results: The onset of sensory block was earlier in Group B than Group A (3.08±0.52 min vs 4.00±0.54 min, p<0.001 ). The onset of motor block was also earlier in Group B than Group A (7.78±0.80 min vs 8.80±0.95min, p<0.001). The time to first rescue analgesia in patients receiving intrathecal clonidine was significantly delayed than patients receiving intrathecal nalbuphine (284.95 ± 12.93 min vs 211.52 ± 15.92 min, p<0.001). Introperative hemodynamic changes were comparable and none of the patient suffered from respiratory depression except very little cases of shivering which are not significant. Conclusions: Intrathecal clonidine as adjuvant to bupivacaine provided was clinically more effective than nalbuphine for prolonging the duration of analgesia for gynecological procedures. Keywords: Bupivacaine, Clonidine, Lower abdominal surgeries in gynecology, Nalbuphine, Subarachnoid block.

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Comparison between isobaric levobupivacaine 0.5% and hyperbaric bupivacaine 0.5% in spinal anesthesia in lower limb surgeries and lower abdominal surgeries in adult patients

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20210417 ◽

2021 ◽

Vol 9 (2) ◽

pp. 418

Author(s):

Preeti Parashar ◽

Anisha Singh ◽

Manoj Kumar Sharma ◽

Dipak L. Raval

Keyword(s):

Blood Pressure ◽

Lower Limb ◽

Motor Block ◽

Total Duration ◽

Sensory Block ◽

Hyperbaric Bupivacaine ◽

Significant Difference ◽

The Mean ◽

Group B ◽

Mean Time

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.

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A COMPARISON BETWEEN INTRATHECAL NALBUPHINE VERSUS FENTANYL AS AN ADJUVANT WITH 0.5% HYPERBARIC BUPIVACAINE FOR POSTOPERATIVE ANALGESIA IN PATIENTS UNDERGOING LOWER SEGMENT CESAREAN SECTION

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v5i8.2081 ◽

2021 ◽

Vol 5 (8) ◽

Author(s):

Mukesh Choudhary ◽

Neeti Mahla

Keyword(s):

Cesarean Section ◽

Postoperative Analgesia ◽

Motor Block ◽

Sensory Block ◽

Hyperbaric Bupivacaine ◽

Double Blind ◽

Lower Segment Cesarean Section ◽

Group A ◽

The Mean ◽

Group B

Background: Subarachnoid block is the preferred anesthesia for cesarean section, being simple to perform and economical with rapid onset. This study aims to compare the postoperative analgesia of intrathecal nalbuphine and fentanyl as adjuvants to bupivacaine in cesarean section. Methods: A prospective, randomized, double?blind, and comparative study was conducted on 120 patients of American Society of Anesthesiologists (ASA) physical status I and II. These patients were randomized into three groups with fifty patients in each group. Group A received 2 ml of 0.5% hyperbaric bupivacaine (10 mg) plus 0.4 ml nalbuphine (0.8 mg), Group B received 2 ml of 0.5% hyperbaric bupivacaine (10 mg) plus 0.4 ml fentanyl (20 ?g), and Group B received 2 ml of 0.5% hyperbaric bupivacaine (10 mg) plus 0.4 ml of normal saline. Results: The mean duration of sensory block was 107.32 ± 5.36 min in Group A, 111.23 ± 4.23 min in Group B, and 85.69 ± 2.31 min in Group C. The mean duration of motor block (time required for motor block to return to Bromage’s Grade 1 from the time of onset of motor block) was 152.02 ± 3.12 min in Group A, 151.69± 2.36 min in Group B, and 122.12 ± 2.32 min in Group C. Conclusion: We concluded that intrathecal nalbuphine prolongs postoperative analgesia maximally and may be used as an alternative to intrathecal fentanyl in cesarean section. Keywords: Nalbuphine, Bupivacaine, Fentanyl.

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