THE STUDY OF DEXMEDETOMIDINE AND FENTANYL FOR EPIDURAL ANALGESIA FOR LOWER LIMB ORTHOPEDIC SURGERY.

Aim:Comparative evaluation of dexmedetomidine and fentanyl for epidural anaesthesia in lower limb orthopedic surgery. Methods: Patients undergoing lower limb orthopaedic surgery aged between 21 to 50 years. For statistical analysis data were entered into a Microsoft excel spreadsheet and then analyzed by SPSS (version 27.0; SPSS Inc., Chicago, IL, USA) and GraphPad Prism version 5. Result: Difference of mean age with both groups was not statistically signicant (p=0.217). Difference of mean duration of surgery with both groups was not statistically signicant (p<0.001).Difference of mean onset time of sensory block (at T10) with both groups was statistically signicant (p<0.001). Difference of mean time of onset of moter block with both groups was statistically signicant (p<0.001). Conclusion: Dexmedetomidine seems to be a better alternative to fentanyl for epidural anaesthesia because of intense analgesia, better quality of motor block and prolong post op analgesia, along with higher sedation scores.

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Clinical Efficacy Of Hyperbaric Bupivacaine With Clonidine In Two Different Doses With Respect To Sensory Characteristics, Motor Characteristics And Recovery Characteristics In Patients Undergoing Lower Limb Orthopaedic Surgeries

10.36106/ijar/1801440 ◽

2020 ◽

pp. 35-37

Author(s):

Preethi HN ◽

Santhosh NV ◽

Ravishankar BM

Keyword(s):

Postoperative Analgesia ◽

Lower Limb ◽

Sensory Block ◽

Local Anaesthetics ◽

Sensory Level ◽

Hyperbaric Bupivacaine ◽

Sedation Scores ◽

The Mean ◽

Mean Time ◽

Effective Analgesia

Background: Intrathecal opiods as adjuvant to local anaesthetics, when administered intrathecally, act synergistically to overcome the property of reduced duration of postoperative analgesia.. Clonidine a selective partial α2 adrenergic agonist administered intrathecally with bupivacaine improved the quality and duration of postoperative analgesia. Methods: In this Randomised comparative study, 60 patients aged between 20 years and 60 years belonging to ASA I and II undergoing lower limb Orthopaedic surgeries were selected. Sample size was calculated by keeping the confidence interval at 95% and power of study at 80%. Results: The mean time of onset of sensory, motor blockade and the time to achieve maximum sensory level and sedation scores was compared in both the groups. The mean duration of effective analgesia in Group BC30 and in Group BC60 was 357.33±6.915 and 425.33±27.131 minutes respectively. Conclusion: In conclusion , the addition of clonidine 60 µg to hypaerbaric bupivacaine intrathecally prolonged both sensory and motor blocked with higher duration of sensory block when compared to motor block of spinal anaesthesia and hence the duration of analgesia when comared to clonidine 30µg .

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Comparison of 0.5% Bupivacaine and 0.5% Ropivacaine epidurally in lower limb orthopaedic surgeries

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20170049 ◽

2017 ◽

Vol 6 (2) ◽

pp. 271

Author(s):

Ushma D. Shah ◽

Krunal N. Dudhwala ◽

Mukesh S. Vakil

Keyword(s):

Epidural Anaesthesia ◽

Lower Limb ◽

Motor Block ◽

Randomized Study ◽

Onset Time ◽

Sensory Block ◽

Pressure Profile ◽

Peak Time ◽

Time Duration ◽

Double Blind

Background: Ropivacaine in equi-potent concentrations with bupivacaine, the degree of motor blockade is less pronounced with ropivacaine, and there is a greater propensity for blocking pain transmitting A-delta and C fibres rather than A-α motor fibres. It appears to have most of the blocking characteristics of bupivacaine. So we have undertaken the study to compare ropivacaine 0.5% (20ml) and bupivacaine 0.5% (20ml) for epidural anaesthesia in patients undergoing lower limb orthopaedic surgeries.Methods: This double-blind, randomized study involves 60 patients who were undergone orthopaedic surgery, having ASA-I or ASA-II physical status. Out of 60, 30 patients received 20 ml of 0.5% ropivacaine and 30 patients received 20 ml of 0.5% bupivacaine at the L3, 4 interspace. Parameters measured were the onset time, duration and spread of sensory block, the onset time, peak time, duration and degree of motor block, the quality of anaesthesia and the heart rate and blood pressure profile during block onset.Results: Epidurally, Ropivacaine in comparison to Bupivacaine provides quicker onset, early peak effect and prolonged duration of sensory block and shorter duration of motor block. Ropivacaine provides prolonged effective analgesia. It reduces requirement of rescue analgesics and related side effects.Conclusions: Ropivacaine 0.5% is safer and effective alternative to Bupivacaine in epidural anaesthesia and post operative pain relief.

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Bupivacaine 0.5% vs. levobupivacaine 0.5% for epidural anaesthesia for caesarean section: a comparative study

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20180110 ◽

2018 ◽

Vol 7 (2) ◽

pp. 343 ◽

Cited By ~ 1

Author(s):

Heena D. Pahuja ◽

Megha P. Tajne ◽

Anjali R. Bhure ◽

Savita M. Chauhan

Keyword(s):

Caesarean Section ◽

Epidural Anaesthesia ◽

Motor Block ◽

Elective Caesarean Section ◽

Sensory Block ◽

Epidural Block ◽

Elective Cesarean Section ◽

Significant Difference ◽

Elective Cesarean ◽

Mean Time

Background: Levobupivacaine has been purported to be as efficacious as Bupivacaine for epidural anaesthesia in recent literature.Methods: With the intent to study the same in caesarean section cases in our set up, we observed various intra- and post-operative variables in two groups (Levobupivacaine and Bupivacaine) of 60 healthy parturients. Sixty parturients for elective caesarean section were allocated randomly to receive epidural block with 10-20 ml of either 0.5% Levobupivacaine with Fentanyl 25µg or 0.5% Bupivacaine with Fentanyl 25µg to reach T6 level.Results: Mean total volume in Bupivacaine group was 15.23ml and in Levobupivacaine group was 12.76 ml. The difference was statistically significant. There was significant difference between the groups in the sensory block. The onset of analgesia was earlier in Levobupivacaine group. Mean time was 6.20 minutes in Bupivacaine group and 4.36 minutes in Levobupivacaine group. The duration of motor block was significantly short in Levobupivacaine group. Mean Time for recovery from motor block in Bupivacaine group was 2.5 hours and in Levobupivacaine group 1.5 hours. Mean time to achieve T6 height was earlier in Levobupivacaine group i.e. 16.46 minutes in Bupivacaine group and 13.26 minutes in Levobupivacaine group. Duration of postoperative analgesia was similar. There was no significant difference in neonatal outcome.Conclusions: Levobupivacaine was found to fare better than Bupivacaine in the studied intra and post-operative parameters and is hence recommended over racemic Bupivacaine for epidural block in patients undergoing elective cesarean section.

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Comparison of 0.5% Ropivacaine and 0.5% Bupivacaine in Lumbar Epidural Anaesthesia for Lower Limb Orthopaedic Surgery

Anaesthesia and Intensive Care ◽

10.1177/0310057x9702500310 ◽

1997 ◽

Vol 25 (3) ◽

pp. 262-266 ◽

Cited By ~ 27

Author(s):

D. P. McGlade ◽

M. V. Kalpokas ◽

P. H. Mooney ◽

M. R. Buckland ◽

S. K. Vallipuram ◽

...

Keyword(s):

Lower Limb ◽

Orthopaedic Surgery ◽

Motor Block ◽

Onset Time ◽

Sensory Block ◽

Pressure Profile ◽

Technical Failure ◽

Time Duration ◽

Double Blind ◽

Multi Centre Study

The purpose of this study was to compare the epidural use of 0.5% ropivacaine and 0.5% bupivacaine in patients undergoing lower limb orthopaedic surgery. In a double-blind, randomized, multi-centre study involving 67 patients, thirty-two patients received 20 ml of 0.5% ropivacaine and 35 patients received 20 ml of 0.5% bupivacaine at the L2,3 or L3,4 interspace. Parameters measured were the onset time, duration and spread of sensory block, the onset time, duration and degree of motor block, the quality of anaesthesia and the heart rate and blood pressure profile during block onset. Four patients (3 ropivacaine, 1 bupivacaine) were excluded from the study due to technical failure of the block. The onset and duration of analgesia at the T10 dermatome (median, interquartile range) was 10 (5-15) minutes and 3.5 (2.7-4.3) hours respectively for ropivacaine, and was 10 (6-15) minutes and 3.4 (2.5-3.8) hours respectively for bupivacaine. Maximum block height (median, range) was T6 (T2-T12) for ropivacaine and T6 (C7-T10) for bupivacaine. Nine patients receiving ropivacaine and eight patients receiving bupivacaine developed no apparent motor block. The incidence of complete motor block (Bromage grade 3) was low in both groups, being 4/27 for ropivacaine and 6/34 for bupivacaine. In the ropivacaine group, motor and sensory block were judged to be satisfactory in 78% of patients. In the bupivacaine group, motor and sensory block were judged to be satisfactory in 71% and 62% of patients respectively. Cardiovascular changes were similar in both groups. No statistical differences were found between the two groups regarding any of the study parameters.

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A comparison of epidural analgesia provided by Bupivacaine plus Pethidine, Bupivacaine plus Morphine, or Bupivacaine plus Morphine plus Midazolam for lower limb Orthopaedic surgery

Journal of Chitwan Medical College ◽

10.3126/jcmc.v4i1.10842 ◽

2014 ◽

Vol 4 (1) ◽

pp. 19-21

Author(s):

NR Sharma ◽

U Rai ◽

S Panthee ◽

P Shrestha

Keyword(s):

Epidural Anaesthesia ◽

Lower Limb ◽

Orthopaedic Surgery ◽

Epidural Morphine ◽

P Value ◽

Medical College ◽

Group A ◽

Group B ◽

Good Patient Satisfaction

Epidural anaesthesia and analgesia in orthopaedic surgeries helps to prevent thromboembolic phenomenon by increasing venodynamics. Adequate post operative analgesia with good patient satisfaction has been observed with this technique. The objective of this study was to assess the duration of postoperative analgesia and complications in patients receiving epidural anesthesia with morphine, midazolam and pethidine in combination with bupivacaine. We prospectively studied 75 Patients who were scheduled for elective lower limb orthopaedic surgery with epidural anaesthesia. This study was conducted from March 2010 to March 2012 at Lumbini Medical College Palpa. They were randomly divided by lottery method into three equal groups. Group ‘A’ (BP) received 50 mg epidural pethidine (3 ml) with 0.5 % bupivacaine 13 ml. Group ‘ B’ (BM) received 5 mg (3 ml) epidural morphine with 13 ml of 0.5% bupivacaine and Group’ C’ (BMM) received 5 mg (1 ml) epidural morphine with 13 ml 0.5% bupivacaine and 2 mg (2 ml) epidural midazolam. All the patients were observed for 24 hours for quality of analgesia and other side effects like nausea vomiting, and pruritus. Data were analysed by SPSS-16.0 software. The result of the study shows the duration of analgesia was prolonged in BMM group than BM, and BP group and was statistically significant (P value <0.001). Incidence of nausea and vomiting in BMM group was lower than that of BP and BM group but was statistically insignificantly (P value 0.489). Pruritus was absent in BP group and was more with BM and BMM group (P value 0.007). In conclusion the use of epidural morphine and midazolam in combination with bupivacaine is the satisfactory method of post operative analgesia. By adding midazolam, duration of analgesia can be increased with decrease in incidence of nausea, vomiting and pruritus. DOI: http://dx.doi.org/10.3126/jcmc.v4i1.10842 Journal of Chitwan Medical College 2014; 4(1): 19-21

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A Comparative Study of Intravenous Clonidine and Dexmedetomidine on Characteristics of Bupivacaine Spinal Anesthesia

Academia Anesthesiologica International ◽

10.21276/aan.2020.5.1.34 ◽

2020 ◽

Vol 5 (1) ◽

pp. 165-167

Author(s):

Shailender Bamel ◽

Nandita Kad ◽

Vinit ◽

Shilpa Popli ◽

Devender Chahal

Keyword(s):

Single Dose ◽

Spinal Anesthesia ◽

Postoperative Analgesia ◽

Orthopedic Surgery ◽

Lower Limb ◽

Motor Block ◽

Sensory Block ◽

Well Being ◽

Control Group ◽

Sensory Blockade

Background: Spinal anesthesia with bupivacaine is administered routinely for lower abdominal and lower limb surgeries. The ensuing nerve block is sufficient to ensure patient’s well being, while motor block facilitates the surgeon’s work. In patients receiving spinal anaesthesia, with local anesthetic agents like bupivacaine, the addition of another drug as adjuvant prolongs the analgesia. The present study is designed to study the effect of dexmedetomidine (D) and Clonidine (C) on the duration of motor and sensory block as well as postoperative analgesia by intrathecal bupivacaine in patients undergoing lower limb orthopedic surgery. Subjects and Methods: This study was carried out on 90 patients in the age group of 18 to 50 years, belonging to the American Society of Anesthesiologists(ASA) physical status I and II presenting for lower limb orthopedic surgery were included in the study. Patients were divided randomly into 3 groups. Group D received 1μg kg-1of dexmedetomidine, group C received 2 μg kg-1 of clonidine and group NS Control group received an equivalent amount of normal saline. Results: From the current study we observed that single dose of 1 μg kg-1 dexmedetomidine over 20 minutes started 20 minutes after spinal block and a single dose of 2 μg kg-1 Clonidine resulted in a significant prolongation of time to two-segment regression, postoperative analgesia, sensory block and motor block with the maintenance of hemodynamic parameters. Intravenous dexmedetomidine was more effective than Clonidine at the prolongation of time to two-segment regression, postoperative analgesia, sensory block and motor block of spinal anesthesia with 0.5% hyperbaric bupivacaine. Conclusion: Dexmedetomidine (1μg kg-1) in comparison to Clonidine (2 μg kg-1) and placebo is far more effective in the motor blockade, sensory blockade and duration of postoperative analgesia.

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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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The Comparison of Plasma Cortisol Levels between 0.125% Bupivacaine and 5 mg Continuous Oxycodone in Lower Extremity Orthopedic Surgery

Journal of Anesthesiology and Clinical Research ◽

10.37275/jacr.v2i2.162 ◽

2022 ◽

Vol 2 (2) ◽

pp. 222-242

Author(s):

Zulkifli ◽

Agustina Br Haloho ◽

Legiran ◽

Pirma I.R.M

Keyword(s):

Cortisol Level ◽

Orthopedic Surgery ◽

Lower Limb ◽

Pain Perception ◽

System Response ◽

Double Blind Study ◽

Double Blind ◽

Significant Difference ◽

Duration Of Surgery ◽

Cortisol Levels

Introduction: Pain is a problem often encountered in postoperative patients. Study has shown after a procedure, 80% patients experience acute pain. This postoperative pain will affect patient’s quality of life therefore necessitating quick and proper treatment. Tissue trauma during surgery will have influence on body system, including endocrine. One of endocrine system response is cortisol secretion. Cortisol levels may be attenuated by bupivacaine and oxycodone. The aim of this study was to determine the efficacy of bupivacaine0,125% and oxycodone 5 mg on pain perception measured by cortisol in patients undergoing orthopedic surgery of the lower limb. Methods: A randomized clinical trial, double-blind study was performed at Mohammad Hoesin General Hospital in Palembang, South Sumatra, from November to May 2021. There were forty samples and divided into two groups (bupivacaine 0,125% and oxycodone 5 mg). Groups were divided by block randomization by computerized random number generator. Blinding were done by making analgesic has the same packages to prevent knowledge of which intervention is being done. Data were analyzed using independent t-test, ANOVA, Mann-Whitney and Chi Square with SPSS version 22.0. Results: There were no statistically significant differences between the two groups on age, gender, body mass index and duration of surgery. In bupivacaine group, cortisol level decreased from 12.94±6.99 µg/dl to 11.32±5.42 µg/dl meanwhile oxycodone group cortisol levels increased from 11.81±8.47 µg/dl to 11.82±7.56 µg/dl. There were no significant difference between two groups relating to cortisol levels. Conclusions: No significant difference was found on administration of bupivacaine 0,125% and oxycodone 5 mg as epidural analgesia on cortisol level in postoperative orthopedic surgery of the lower limb patient.

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A STUDY TO COMPARE THE EFFECT OF DEXMEDETOMIDINE AND CLONIDINE AS AN ADJUVANT TO ROPIVACAINE FOR EPIDURAL ANESTHESIA IN INFRAUMBILICAL SUGERIES

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v3i3.150 ◽

2019 ◽

Vol 3 (3) ◽

Author(s):

Pinki Meena ◽

Maya Damor ◽

Trishala Jain ◽

Anupama Gupta

Keyword(s):

Epidural Anaesthesia ◽

Sensory Block ◽

Research Review ◽

Sensory Level ◽

Adrenergic Agonists ◽

Double Blind ◽

Significant Difference ◽

Group A ◽

Group B ◽

Mean Time

Background: Alpha-2 adrenergic agonists have both analgesic and sedative properties and can be used as an effective adjuvant in epidural anaesthesia. The aim of our study to compare the efficacy and clinical profile of α-2 adrenergic agonists dexmedetomidine and clonidine, when used as adjuvants in epidural anaesthesia in patients undergoing infraumbilical surgeries with special emphasis on their sedative properties and ability to provide smooth intra-operative and post- operative analgesia. Methods: This Hospital Based, double blind, randomized, comparative, interventional Study was carried out in 60 patients undergoing infra umbilical surgeries. After obtaining permission from Institutional Ethics Committee and Research Review Board. All patients randomly allocated in two groups of 30 patients in each group. Group A patient received 15 ml 0.75 % ropivacaine + 1 microgram/kg dexmedetomidine, Group B received 15 ml 0.75 % ropivacaine + 1 microgram/kg clonidine. Results: The time of onset of sensory block with dexmedetomidine was earlier compared to clonidine (8.3+1.26 min versus 11.6+1.81min). Mean time to attain highest sensory level was 13.3± 1.4 minutes in group A and 17.6± 1.9 minutes in group B. Mean duration of sensory block was 306.1 ± 8.32 minutes in group A and 285.2 ± 17.4 minutes in group B. Mean time to motor onset was 17.7±3.3 minutes in group A and 18.8±2.9 minutes in group B. Mean duration of motor block was 241.1 ± 4.81 minutes in group A and 216.9± 7.17minutes in group B. There was no significant difference in VAS score till half an hour and after one hour we got significant difference in both groups. Conclusion: We concluded that when used with ropivacaine (0.75%) as an adjuvant dexmedetomidine (1microgram/kg) and clonidine (1microgram/kg) shortens the onset of sensory block, prolongs the duration of sensory and motor blockade and provides the effective and prolonged post operative analgesia with adequate sedation and without major adverse effects and hemodynamic changes. Keywords: Clonidine, dexmedetomidine, epidural, ropivacaine.

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