"COMPARATIVE CLINICAL EVALUATION OF INTRATHECAL ISOBARIC LEVOBUPIVACAINE (0.5%) WITH MORPHINE AND ISOBARIC ROPIVACAINE (0.5%) WITH MORPHINE IN INFRAUMBILICAL SURGERIES -A CLINICAL STUDY”

2021 ◽  
pp. 5-7
Author(s):  
Bhawna Dubey ◽  
Surendra Raikwar ◽  
Vinita Lipton
Keyword(s):  
Clinical Study ◽  
Motor Block ◽  
Intrathecal Morphine ◽  
Sensory Block ◽  
Morphine Group ◽  
Early Recovery ◽  
Rescue Analgesia ◽  
Subarachnoid Block ◽  
Anesthetic Agents ◽  
Duration Of Surgery

Background: Subarachnoid block is a simple technique that provides a deep and fast surgical block through the injection of small doses of local anaesthetic drug in Subarachnoid space. Various local anesthetic agents have been used in subarachnoid block since their introduction, isobaric drugs along with opioids provide excellent combination of shorter motor and longer sensory block which is useful for short duration infraumbilical surgeries. Methods: The present study is a prospective, comparative and clinical study between age group 18-45 years of either sex belonging to ASA grade I and II undergoing elective infra-umbilical surgeries. 40,40 patients were taken into each group. Mean duration of surgery in each group was around 90 minutes. Perioperative vitals like heart rate, blood pressure, oxygen saturation, ECG were recorded. Motor block was assessed through modied Bromage scale and post operative pain was assessed through VAS visual analogue scale , also need for rescue analgesia was monitored postoperatively. Results: We found that 150 microgram intrathecal morphine added as an adjuvant to 0.5% isobaric ropivacaine provided prolonged duration of analgesia and early recovery as compared to 150 microgram intra thecal morphine added with 0.5% isobaric levobupivacaine in patients undergoing infra-umbilical surgeries without causing signicant hemodynamic variation and adverse effects. Conclusion: In present study, we conclude that time of onset of sensory block was more and duration of sensory and motor block was less in isobaric ropivacaine with morphine as compared to isobaric levobupivacaine with morphine. Which revealed that ropivacaine group provides good postoperative analgesia and shorter motor block, that leads to early recovery and better patient satisfaction So, ropivacaine with morphine seems to be better as compared to levobupivacaine with morphine group.

A COMPARATIVE STUDY OF 0.5 % BUPIVACAINE WITH FENTANYL VERSUS 0.75% ROPIVACAINE WITH FENTANYL IN EPIDURALANESTHESIA FOR ABDOMINAL HYSTERECTOMY

2021 ◽  
pp. 71-73
Author(s):  
Pravin Vijayan ◽  
Debarshi Jana
Keyword(s):  
Motor Block ◽  
Sensory Block ◽  
Local Anaesthetics ◽  
Abdominal Hysterectomy ◽  
Controlled Study ◽  
Rescue Analgesia ◽  
Study Results ◽  
Duration Of Surgery ◽  
Group B ◽  
Time To Onset

INTRODUCTION Abdominal hysterectomy (AH) is a quite common gynaecological surgical procedure and electively done under central neuraxial blockade. AH is performed for malignant as well as benign indications such as uterine leiomyoma, persistent vaginal bleeding, or pelvic organ prolapse. AIMS AND OBJECTIVES Compare the onset of motor and sensory block. Find out the duration of the sensory and motor blockade. Observe intraoperative hemodynamic changes and assess post-operative analgesia requirements in 24 hour. Duration of analgesia assessed by requirement of rst rescue analgesic. Observe any untoward incident during intraoperative and post-operative period and managed accordingly MATERIALS AND METHODS Study Area: Department of Anesthesiology & critical care, DARBHANGAMEDICALCOLLEGE AND HOSPITAL. Study Population: Adult patients (30- 65 years) undergoing elective abdominal hysterectomy with regional anaesthesia were included for this study. Study Period:January 2019 to March 2020 Sample Design: Subjects were divided into two groups (n=35) equal in numbers and they sampled as per computerized randomization chart. These patients were divided into two groups, group B (with epidural 0.5% bupivacaine and 100g fentanyl) and group R (with epidural 0.75% ropivavaine and 100g fentanyl). Study Design: Prospective, open, randomized, controlled study. RESULTS: In Our study showed that 3.38kg/m2 and 24.86 3.60 kg/m2in group B and R respectively. The duration of surgery was 100.86 9.35minutes and 98.86 8.32 minutes and the duration of stay, was4.86 0.81days and 4.60 0.914 days in group B and group R respectively. Now with comparison of both groups, time to onset of sensory block (uptoT6) has signicant variation. But the other parameters namely, time to onset of motor block, two segment regression or duration of sensory block, rescue analgesia timing and complete motor recovery time were comparable and not signicant statistically in both groups. SUMMARY & CONCLUSIONS To conclude that in the present study using 0.5% bupivacaine with fentanyl and 0.75% ropivacaine with fentanyl epidurally, ropivacaine produced an earlier onset but similar duration of sensory block. The onset, quality and duration of motor block werecomparable in both the groups. It is important that new local anaesthetics with lower cardiotoxic property are adopted to ensure that regional techniques using large amounts of local anaesthetics remain safe with minimal complications. The recovery prole of ropivacaine may be useful where prompt mobilization is require

scholarly journals Comparison between Morphine and Hyaluronidase Added to Local Anesthetic in Sonar Guided Supraclavicular Brachial Plexus Block; Randomized Double Blinded Controlled Study

2021 ◽  
pp. 155-165
Author(s):  
Ahmed A. E. Elmaghraby ◽  
Amany F. Omara ◽  
Rabab M. Mohammed ◽  
Ashraf E. Alzeftawy
Keyword(s):  
Brachial Plexus ◽  
Normal Saline ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
Sensory Block ◽  
Control Group ◽  
Morphine Group ◽  
Rescue Analgesia ◽  
Supraclavicular Brachial Plexus Block ◽  
Plexus Block

Background: Huge volumes of local anaesthetics used in conventional blocks may be associated with complications. Hyaluronidase is an enzyme that hydrolyses hyaluronic acid in the tissue. It has been shown to aid the spread of local anaesthetics (LA) through tissue. The aim of this study was to compare between the addition of morphine or hyaluronidase to local anaesthetic in sonar guided supraclavicular brachial plexus block regarding the onset and duration of the block, postoperative analgesia and the total analgesic requirements in the first 24 hours. Patient and methods: Seventy-five patients of American Society of Anaesthesiologists (ASA) physical status I & II, aged 18-60 years, scheduled to acute or elective elbow, forearm or hand surgery under sonar guided supraclavicular brachial plexus block at Tanta University Hospital were randomly allocated into three equal groups; Group I (Control group) received 20 ml containing 9 ml bupivacaine 0.5% and 9 ml lidocaine 2% plus 2 ml normal saline, group II (Morphine group) received 20 ml containing 9 ml bupivacaine 0.5% and 9 ml lidocaine 2% plus 5 mg morphine in 2 ml normal saline and group III (Hyaluronidase group) received 20 ml containing 9 ml bupivacaine 0.5% and 9 ml lidocaine 2% plus 1500 units of hyaluronidase in 2 ml normal saline. The onset of sensory and motor block, duration of sensory and motor block, postoperative VAS, time to first rescue analgesia, total morphine consumption and possible side effects were recorded. Results: Onset of the sensory block and motor block was significantly shorter in the hyaluronidase group than control group and morphine group. Duration of the sensory block and motor block was significantly prolonged in morphine group than hyaluronidase group & control group. VAS started to increase at 6 hours in the control group, at 10 hours in morphine group and at 8 hours in hyaluronidase group. Time to first rescue analgesia was significantly prolonged in morphine group than control group and hyaluronidase group. Total analgesic consumption of morphine was significantly lower in morphine group than control group and hyaluronidase group. Conclusion: Morphine was superior to hyaluronidase as regarding to improving the post-operative pain. The incidence of complications was nil and self-limited in the three groups.

scholarly journals The efficacy and safety of intrathecal bupivacaine alone versus bupivacaine combined with magnesium sulfate in adults using spinal anesthesia: a meta-analysis of randomized controlled trials

2020 ◽  
Author(s):  
Mi-Zhou Wang ◽  
Rui Dong ◽  
Li-Na Jia ◽  
Deng-Bin Ai ◽  
Jian-Hua Zhang
Keyword(s):  
Adverse Events ◽  
Randomized Controlled Trials ◽  
Magnesium Sulfate ◽  
Motor Block ◽  
Meta Analysis ◽  
Sensory Block ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Rescue Analgesia ◽  
Randomized Controlled

Abstract Background: Several studies have investigated the effects of intrathecal magnesium sulfate as an adjuvant for bupivacaine; however, their conclusions are inconsistent. Therefore, it is necessary to conduct a meta-analysis on this topic.Methods We searched Pubmed, EMBASE (OvidSP) and Cochrane Central Register of Controlled Trials (CENTRAL) for randomized controlled trials (RCTs) comparing the effect of intrathecal bupivacaine combined with magnesium sulfate versus bupivacaine alone in adults using spinal anesthesia.Results Eighteen studies that met our inclusion criteria were included in our analysis. We found that the addition of intrathecal magnesium sulfate to bupivacaine provided a longer duration of analgesia (SMD 0.99; 95% CI [0.45, 1.52], P = 0.0003, I2 = 93%), prolonged the duration of sensory block (MD=106.69; 95% CI, 60.93-152.45; P<0.00001), delayed the onset of sensory block (SMD 1.20; 95% CI [0.65, 1.75], P =<0.0001, I2 = 91%) and motor block (SMD 1.46; 95% CI [0.23, 2.69], P =0.02, I2 = 96%), decreased the requirement for rescue analgesia (SMD -0.81; 95% CI [-1.06, -0.56], P < 0.00001, I2 = 11%). For duration of motor block, and incidence of postoperative adverse events (such as nausea and vomiting, hypotension, bradycardia, pruritus, shivering and neurological deficit), no statistically differences were observed between the 2 groups.Conclusions Our meta-analysis demonstrated that intrathecal magnesium sulfate combined with bupivacaine prolongs the dusration of analgesia, without an impact on the adverse events. However, the quality of evidence was very low when using GRADE to assess it. Given adverse effects before use, more high-quality trials with large samples are required before magnesium sulfate is routinely used as a intrathecal adjunct.

scholarly journals 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.

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.

Effect of intrathecal morphine before and after laminectomy on intraoperative surgical stress response and post-operative pain: A prospective randomized study

2020 ◽  
Vol 16 (1) ◽  
pp. 15-22
Author(s):  
Amany Faheem Abd El Salam Omara, MD ◽  
Asmaa Fawzy Amer, MD
Keyword(s):  
General Anesthesia ◽  
Surgical Stress ◽  
Intrathecal Morphine ◽  
Morphine Group ◽  
Rescue Analgesia ◽  
Group Iii ◽  
General Anesthesia Group ◽  
Group I ◽  
Anesthesia Group ◽  
Group Ii

Study objective: Intrathecal administration of morphine.Design: A prospective, randomized, controlled study.Setting: Operating room.Patients: Ninety patients of American Society of Anesthesiologists physical statuses I and II undergoing lumbar laminectomy.Interventions: Pre-emptive versus post-operative intrathecal morphine injection, compared to a control group.Main outcome: The visual analog score at the time of discharge and 2, 4, 6, 8, 10, 12, 18, and 24 h later, serum cortisol level, the number of patients needing post-operative rescue analgesia, its duration, and the total amount required. Main results: Morphine sulfate consumption as rescue analgesia over 24-h postoperatively was significantly higher in general anesthesia group (Group I) than in pre-emptive intrathecal morphine groups (Group II) [p = 0.001] and then postoperative intrathecal morphine group (Group III) [p = 0.001], and it was higher in Group III than Group II [p = 0.001]. There was a greater need for post-operative rescue morphine in general anesthesia group (Group I) than in the other two groups, and it was greater in post-operative intrathecal morphine group (Group III) than in pre-emptive intrathecal morphine group (Group II). At 30 min after surgical incisions and at 1 and 24 h after surgery, serum cortisol levels were significantly higher in general anesthesia group (Group I) [p = 0.001] and in post-operative intrathecal morphine group (Group III) [p = 0.001] than in pre-emptive intrathecal morphine groups (Group II), with no significant difference between general anesthesia group (Group I) and post-operative intrathecal morphine group (Group III) [p = 0.704, 0.263, and 0.943, respectively].Conclusion: Pre-emptive intrathecal morphine analgesia is an effective technique for controlling surgical stress response and post-lumbar laminectomy pain.

scholarly journals A Prospective Study of Dexmedetomidine as an Adjuvant to Local Anaesthetic Used in Supraclavicular Block

2021 ◽  
Vol 8 (07) ◽  
pp. 345-349
Author(s):  
Paidikondala L.R.N.N. ◽  
Kommula Gopala Krishna ◽  
Subhamani P ◽  
Sudhir Sirkar P
Keyword(s):  
Brachial Plexus ◽  
Local Anaesthetic ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
Sensory Block ◽  
Postoperative Pain Management ◽  
Control Group ◽  
Rescue Analgesia ◽  
Supraclavicular Brachial Plexus Block ◽  
Plexus Block

BACKGROUND To improve the quality of block (sensory and motor characteristics), postoperative pain management and reduce large doses of local anaesthetics, various adjuvants are used with local anaesthetic agents. We have evaluated dexmedetomidine as an adjuvant to 0.5 % ropivacaine in supraclavicular brachial plexus block in terms of onset and duration of sensory and motor block & duration of postoperative analgesia. METHODS This is a prospective randomised comparative study. 60 patients who were admitted for elective surgeries of the lower arm, at the level of elbow, forearm & hand were enrolled. They were divided in to two groups of 30 patients each as follows - group RD: supraclavicular brachial plexus block given with 30 mL of 0.5 % ropivacaine + 1 mL (100 μg) of dexmedetomidine. Group RC: supraclavicular brachial plexus block given with 30 mL of 0.5 % ropivacaine + 1 mL of normal saline. Various parameters like onset times and durations of sensory and motor block, duration of analgesia, total analgesic needed, and side-effects were recorded for each patient. RESULTS The time of onset of sensory and motor block was significantly early in dexmedetomidine group than in control group. The duration of sensory and motor block was significantly prolonged in group RD as compared to group RC. The duration of sensory block was 724.18 + 73.26 min in group RD (GD) and 582.16 + 93.12 min. in group RC (GC). The duration of analgesia was significantly prolonged in group RD. CONCLUSIONS Addition of dexmedetomidine as an adjuvant to ropivacaine is associated with early onset of sensory and motor block. The duration of sensory and motor block was prolonged. The duration of analgesia was prolonged and patients required less rescue analgesia. The use of dexmedetomidine was associated with reversible bradycardia and sedation score was less KEYWORDS Ropivacaine, Dexmedetomidine, Adjuvant, Supraclavicular Brachial Plexus Block

scholarly journals Effect of 3 Different Doses of Intrathecal Dexmedetomidine (2.5µg, 5µg, and 10 µg) on Subarachnoid Block Characteristics: A Prospective Randomized Double Blind DoseResponse Trial

2016 ◽  
Vol 3;19 (3;3) ◽  
pp. E411-E420 ◽  
Author(s):  
Dr Mayank Gupta
Keyword(s):  
Adverse Effects ◽  
Motor Block ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
College Teaching ◽  
Sensory Block ◽  
Motor Blockade ◽  
Analgesic Requirement ◽  
Double Blind ◽  
Subarachnoid Block

Background: The extended analgesic efficacy of intrathecal dexmedetomidine (ITD) has been investigated in a few clinical trials; however, there is a lack of conclusive evidence upon its ideal dosage. Objectives: To elucidate the dose-response relationship between ITD and subarachnoid block characteristics, particularly the duration of analgesia and differential analgesia (DA: defined as time difference from the offset of motor blockade to the first analgesic requirement on numerical rating scale ≥ 4.0). Study Design: Prospective, randomized double blind active control trial. Setting: Medical college teaching hospital. Methods: Ninety adult (18 – 60 years) patients undergoing elective lower abdominal and lower limb surgeries were randomized into 3 groups to receive intrathecal 0.5% bupivacaine 3 mL with 2.5 µg (group BD2.5), 5µg (group BD5), or 10 µg (group BD10) dexmedetomidine in 0.5 mL normal saline. The 2 segment sensory regression times (TSSRT), duration of motor blockade analgesia, DA, and perioperative adverse effects were assessed. The primary outcome was duration of analgesia and DA. Statistics: ANOVA, Kruskal Wallis test, Chi-square (χ2), and Fisher’s exact test, significance: P < 0.05. Results: The onset of sensory block was significantly earlier in group BD10 compared with group BD5 (P = 0.035) and BD2.5 (P = 0.010) while the onset of motor block was significantly earlier in group BD10 compared with BD2.5 (P = 0.020). There was a significant and dose-dependent prolongation of the duration of sensory block (127.50, 149.17, and 187.50 minutes; P < 0.001), motor block (258.50, 331, and 365 minutes; P < 0.001), analgesia (306.17, 396.50, and 512 minutes; P < 0.001), and DA (47.67, 65.50, and147 minutes; P < 0.001) with escalating doses of ITD, respectively. Group BD10 required significantly fewer rescue analgesics compared with other 2 groups (P = 0.001). Except for mild sedation which was significantly higher in group BD10; all the groups were comparable with respect to hemodynamic and other adverse effects. Limitations: Lack of placebo group, exclusion of higher doses (15µg) of ITD, and short duration of postoperative follow-up. Conclusions: The addition of 10 µg compared with 2.5 µg or 5µg ITD to 0.5% hyperbaric bupivacaine is associated with significantly earlier onset of sensory and motor block as well as prolonged duration of sensory block, motor block, analgesia, and DA with a comparable adverse effect profile. Key words: Analgesia, bupivacaine, dexmedetomidine, differential analgesia, intrathecal, pain, spinal anaesthesia

Early Analgesic Efficacy of Morphine, Butorphanol, Lidocaine, Bupivacaine or Carprofen After Periodontal Treatment in Dogs

2021 ◽  
pp. 089875642098692
Author(s):  
Petr Raušer ◽  
Tomáš Fichtel
Keyword(s):  
Clinical Study ◽  
Analgesic Efficacy ◽  
Serum Cortisol ◽  
Saline Group ◽  
Periodontal Treatment ◽  
Analog Scale ◽  
Morphine Group ◽  
Nerve Blocks ◽  
Rescue Analgesia ◽  
Lidocaine Group

The early effectiveness of 5 analgesics was investigated after periodontal treatment. Dogs were assigned to 6 groups (n = 14 each). A prospective, randomized and blinded clinical study was performed. Before anesthesia was induced, butorphanol, morphine, carprofen and saline were administered. After induction, a maxillary and mandibular block was performed with lidocaine or bupivacaine. Painful periodontal therapies were performed. Two hours after the administration of analgesics and after anesthesia reversal, pain was scored using the Visual Analog Scale for pain (VAS) and the modified University of Melbourne Pain Score (UMPS). Blood glucose and cortisol levels were measured prior to analgesic administration and again 2 hours later. Rescue analgesia was provided when the VAS exceeded 50 mm or the UMPS exceeded 14 points. Rescue analgesia was required in one patient in the morphine group and one in the carprofen group. The VAS values were significantly lower in the butorphanol group compared to those of the saline group and in the bupivacaine group vs. those in the saline and lidocaine groups. Significantly lower UMPS values were obtained in the bupivacaine group compared to those in the saline, butorphanol and lidocaine groups and in the carprofen group vs. those in the saline and lidocaine groups. Significantly higher serum cortisol values were found in the lidocaine group compared to those in the saline, bupivacaine and carprofen groups. Administration of carprofen or the use of nerve blocks with bupivacaine improved analgesia after periodontal treatment more than did butorphanol, morphine or nerve blocks using lidocaine.

scholarly journals Comparison of two different doses of dexmedetomidine (0.25 mcg/kg and 0.5 mcg/kg) in prolonging duration of spinal anaesthesia and postoperative analgesia in patients undergoing trans urethral resection of prostate: a prospective randomized double blinded study

2021 ◽  
Author(s):  
Anil K. Bhiwal ◽  
Karuna Sharma ◽  
Vikram S. Rathore ◽  
Chintan M. K. Patel ◽  
Alka Chhabra ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Spinal Anaesthesia ◽  
Postoperative Analgesia ◽  
Motor Block ◽  
Statistical Significance ◽  
Sensory Block ◽  
Mean Value ◽  
Spinal Block ◽  
Rescue Analgesia ◽  
Different Doses

Background: Trans urethral resection of prostate (TURP) under spinal anaesthesia (SAB) in elderly with associated cardio-pulmonary, endocrine or other co-morbidities induces detrimental physiological and psychological stress response to surgery and anaesthesia. Proper sedation during spinal anaesthesia can reduces this response. Aim of this study was to compare the characteristics of spinal block, hemodynamic changes, and postoperative analgesia, following administration of intravenous DMT (0.25 mcg/kg and 0.5 mcg/kg) in elderly patients undergoing TURP under SAB.Methods: Sixty-eight patients were randomly allocated to two groups of 34 patients each. After giving spinal anaesthesia patients received two different doses of dexmedetomidine intravenously; 0.25 mcg/kg (Group D25) and 0.50 mcg/kg (Group D50) respectively. Drugs were given slowly in dilution of 10ml normal saline. Patients were monitored for intraoperative haemodynamics, sensory and motor block characteristics and postoperative analgesia in terms of VAS (visual analogue scale) and first and total dose of rescue analgesic.Results: Mean value of lowest HR in Group D50 and D 25 was comparable (p=0.11) and time taken to achieve lowest HR was also comparable (p=0.13). Mean value of lowest SBP, DBP and MAP were lower in Group D50 than in Group D25 but the difference did not reach statistical significance (p=0.52,0.95 and 0.41 respectively). Onset of sensory block was comparable between the two groups, p=0.62. Maximum sensory block was achieved significantly earlier in Group D50 (10.64±2.75 min versus 12.94±3.04 min in Group D25), p=0.0012. Group D50 patients achieved Bromage score 3 earlier (10.735±1.797 min) than group D25 (12.794±2.52 min) (p=0.00). Recovery from motor block was found earlier in Group D25 group (141.325±4.97 mins) compared to Group D50 (154.41±8.143 mins). Group D50 reported significantly higher sedation than group D25 (p=0.00). Group D25 reported more pain at 4 hours compared to Group D50 (VAS -4.705±0.462 versus 2.588±1.478). Time of requirement of first rescue analgesia was delayed in Group D50 (270.59±50.78 mins) than in Group D25 (172.50±10.46 mins), p=0.000.Conclusions: Dexmedetomidine is effective in relieving anxiety in elderly patients undergoing TURP under spinal anaesthesia. Dose of 0.50 mcg/kg is more effective than 0.25 mcg/kg without increasing the risk of adverse effect. 

COMPARISON BETWEEN PERINEURAL DEXAMETHASONE AND INTRAVENOUS MAGNESIUM SULPHATE AS ADJUVANT IN SUPRACLAVICULAR BLOCK

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ahmed Nagah El-Shaer ◽  
Ahmed Kamal Mohamed Ali ◽  
Farouk Kamal Eldeen Abd El-Aziz ◽  
Mostafa Samir El-Sayed
Keyword(s):  
Upper Extremity ◽  
Magnesium Sulphate ◽  
Regional Anaesthesia ◽  
Motor Block ◽  
Sensory Block ◽  
University Hospital ◽  
Study Patient ◽  
Rescue Analgesia ◽  
Group A ◽  
Group B

Abstract   Background: Upper extremity surgeries are commonly performed under regional anaesthesia. Regional anaesthesia of the upper extremity has several advantages over general anaesthesia such as improved postoperative pain management, decreased postoperative narcotic consumption, and reduced recovery time. Objectives: The aim of the study was to compare between dexamethasone and magnesium sulphate as adjuvants in supraclavicular brachial plexus block as regards the onset and duration of sensory and motor block as well as side effects. Patients and Methods: This prospective double-blinded comparative study was carried out in Faculty of Medicine, Ain-Shams University Hospital on 120 adult patients between 21-50 years of both sexes with ASA classification 1&2 who were scheduled for elective upper limb orthopaedic surgeries. A written informed consent was obtained from all patients. Every patient received an explanation about the purpose of the study. Procedures had been approved by the institutional and the regional ethical committee. Total 120 patients are enrolled in the study and divided into 3 groups A and B and C (40 for each one). Results From aspect of increasing the duration of sensory &motor block magnesium sulphate group (group A) showed higher prolongation of sensory & motor block with recovery of pin prick sensation in median time 313 mins ± when compared with group B &C even with longer time taken for patient to request rescue analgesia after 5 hours. In group (B) by adding dexamethasone with bupivacaine the blood pressure rate are increased after 20 min of injection and return normal after 240 min, heart rate are normal, but in case of sensory and motor block about 77.5% of study patient in this group have full motor and sensory block, in case of increasing time of motor and sensory block the dexamethasone success increasing time for motor and sensory block to reach 278 min sensory and 314 min in motor block, first call of Analgesic are after 4 hr. Conclusion: Group A (Magnesium sulphate with bupivacaine) were more effective and increasing affected time in motor and sensory block than Group B (Dexamethasone with Bupivacaine) and Group C (Control).

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