A COMPARATIVE STUDY OF DEXMEDETOMIDINE AND FENTANYL AS AN ADJUVANT TO EPIDURAL BUPIVACAINE IN LOWER LIMB SURGERIES

2021 ◽  
pp. 59-61
Author(s):  
Anant Prakash ◽  
Rahul Kumar ◽  
Chandeshwar Choudhary ◽  
Debarshi Jana
Keyword(s):  
Lower Limb ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Maximum Level ◽  
Saline Group ◽  
Sensory Level ◽  
Motor Blockade ◽  
Sensory Blockade ◽  
Bupivacaine Hydrochloride ◽  
Epidural Bupivacaine

Background: Epidural anesthesia is the most commonly used technique for inducing surgical anesthesia and postoperative analgesia in patients undergoing lower limb surgeries. Fentanyl as an adjuvant to epidural local anesthetic has been used for a long time. Dexmedetomidine is a potent and highly selective á-2-adrenoceptor agonist with analgesic potency. Aim: The aim of the present study was to compare the effect of dexmedetomidine and fentanyl as an adjuvant to epidural bupivacaine in lower limb surgeries. Materials And Methods: Sixty patients belonging to the American Society of Anesthesiologists' Grade I or II who were undergoing lower limb surgery were randomly divided into two groups. Group BD: received epidural study solution of 38 ml of 0.25% bupivacaine hydrochloride + 1 ml of 100 ìg dexmedetomidine + 1 ml of normal saline. Group BF: received epidural study solution of 38 ml of 0.25% bupivacaine hydrochloride + 2 ml of 100 ìg fentanyl. Onset and maximum level of sensory blockade, time to attain maximum sensory level, time to complete motor blockade, time for two-segment regression, duration of analgesia and motor block, heart rate, and blood pressure were observed. Pain and sedation were assessed by numerical rating scale and Ramsay Sedation Scale, respectively. Data were recorded and statistically analyzed. Results: The onset of sensory blockade and time to attain maximum sensory level in Group BD were earlier than that of Group BF (P < 0.001). Duration of analgesia and motor blockade in Group BD were signicantly more than that of Group BF (P < 0.001). Postoperative visual analog scale was reduced statistically signicantly in Group BD (P < 0.001). Conclusion: Dexmedetomidine as an adjuvant to epidural bupivacaine is a better alternative to fentanyl with higher analgesic property

scholarly journals Comparing the Analgesic Efficacy of Intrathecal Bupivacaine Alone with Intrathecal Bupivacaine Midazolam or Magnesium Sulphate Combination in Patients Undergoing Elective Infraumbilical Surgery

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Josef Attia ◽  
Amany Abo Elhussien ◽  
Mostafa Zaki
Keyword(s):  
Side Effects ◽  
Magnesium Sulphate ◽  
Lower Limb ◽  
Analgesic Efficacy ◽  
Motor Blockade ◽  
Sensory Blockade ◽  
Lower Limb Surgery ◽  
Group A ◽  
Group B ◽  
Limited Duration

Background. Spinal anaesthesia, which is one of the techniques for infraumbilical surgeries, is most commonly criticized for limited duration of postoperative analgesia. Aim of the Work. The aim of this study was to decrease bupivacaine dose used in spinal anesthesia in patients undergoing orthopedic lower limb surgery and reduce its possible side effects. Patient and Methods. Sixty adult patients of both sexes, divided into three. Group C received 2.5 mL bupivacaine and 0.5 mL saline 0.9%. Group A received 2.5 mL bupivacaine and 0.5 mL midazolam. Group B received 2.5 mL bupivacaine and 0.5 mL magnesium sulphate. Results. As regards onset of both motor and sensory blockade, there are a significant decrease in group A and a significant increase in group B as compared to group C, with a significant decrease in duration of motor blockade and significant increase in duration of sensory blockade in both group A and group B, respectively, as compared to group C, with a significant decrease in the duration of sensory blockade in group B as compared to group C. Conclusions. These results suggested that intrathecal midazolam as an adjuvant for bupivacaine increases the duration of both sensory and motor blockade more than that of magnesium sulphate.

INTRATHECALLY ADMINISTERED ADJUVANTS MIDAZOLAM AND CLONIDINE WITH BUPIVACAINE ON HEMODYNAMIC STABILITY- A PROSPECTIVE STUDY

2021 ◽  
pp. 12-14
Author(s):  
Ganga Nagalakshmi ◽  
Subha . J
Keyword(s):  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Respiratory Rate ◽  
Pulse Rate ◽  
Normal Saline ◽  
Sensory Block ◽  
Sensory Level ◽  
Motor Blockade ◽  
Hemodynamic Stability ◽  
Sensory Blockade

We conducted a double blinded randomized control study in 60 patients belonging to ASA I and II undergoing elective lower abdominal surgeries. Patients of both sexes ranging between 22 to 65 years of age were included. Our aim was to evaluate the effects of intrathecal midazolam 2mg and clonidine 30 mcg as adjuvant to bupivacaine for hemodynamic stability and postoperative analgesia. Patients were divided randomly using closed cover technique into two groups of 25 each.Group BM received 3ml of 0.5% heavy bupivacaine 0.4ml midazolam (preservative free) and 0.1ml of normal saline. Group BC received 3ml of 0.5% heavy bupivacaine, 0.2ml clonidine and 0.3 ml of normal saline. The total volume of the injected solution was 3.5ml in both groups. The onset of sensory and motor blockade, the duration of sensory and motor blockade, peak sensory level, time to achieve maximum sensory level, changes in pulse rate, changes in mean arterial pressure, duration of analgesia, respiratory rate, o saturation, 2 sedation score and adverse effects were noted in both groups. The data collected were analyzed by Chi square test and students't' tests. We found that onset of sensory and motor blockade, time to achieve maximum sensory level, and duration of complete motor recovery was earlier in BM group than BC group. Duration of Sensory block and duration of analgesia were prolonged in BM group than BC group. In both groups, no signicant changes were observed in respiratory rate, O saturation and sedation in our study. Intrathecal Midazolam as an adjuvant to bupivacaine 2 comparing to Clonidine resulted Rapid onset of sensory and motor blockade, Achieves maximum sensory level at a shorter interval, Increased duration of sensory blockade and decreased duration of Motor blockadeIt gives stable mean arterial pressure and pulse rate.

Effect of Adding Magnesium Sulphate to Epidural Bupivacaine Compared to Addition of Fentanyl in Patients undergoing Lower Limb Orthopedic Surgery under Combined Spinal Epidural Anathesia

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohamed Ibrahim El-Desoukey Mohamed ◽  
Sahar Mohammed Kamal Mahmoud ◽  
Kareem Youssef Kamal
Keyword(s):  
Orthopedic Surgery ◽  
Magnesium Sulphate ◽  
Lower Limb ◽  
The Other ◽  
Sulphate Group ◽  
Sensory Blockade ◽  
Combined Spinal Epidural ◽  
Epidural Bupivacaine ◽  
Spinal Epidural ◽  
Fentanyl Group

Abstract Background 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. Objectives The purpose of this study was to assess the postoperative analgesic requirements and the analgesic effect of adding magnesium sulphate to epidural bupivacaine compared to addition of fentanyl in patients undergoing lower limb orthopedic surgery under combined spinal epidural anathesia. Patients and Methods After approval of ethical committee in our study and obtaining written informed consent from eligible patients the study was conducted on 60 patients classified to ASA I and II scheduled for lower limb orthopedic surgery. The study presents double armed randomized interventional prospective study including patients allocated into two equal groups each consists of 30 patients. Group (A): patients received magnesium sulphate added to bupivacaine in epidural, Group (B): patients received fentanyl added to bupivacaine in epidural Results The results of their study showed that the maximum level of sensory blockade was significantly higher in the combined fentanyl with magnesium group as compared with fentanyl group alone and magnesium sulphate group alone. The duration of sensory blockade of the combined fentanyl and magnesium group was significantly prolonged as compared to the other two groups as for the other two group the difference in the blockade duration was insignificant Conclusion We concluded that either magnesium sulfate (75 mg) combined with (10 ml) 0.25% Bupivacaine or fentanyl (1 µg/kg) combined with (10 ml) 0.25% Bupivacaine in combined spinal epidural improves intraoperative analgesia and prolongs early postoperative analgesia in lower limb orthopedic surgeries. The duration of analgesia was more prolonged in magnesium sulphate group than in the fentanyl group and this difference was statistically significant.

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

scholarly journals Polish Cross-Cultural Adaptation of the Lower Limb Functional Index (LLFI) Demonstrates a Valid Outcome Measure for the Lower Limb Region and Joints

2021 ◽  
Vol 18 (18) ◽  
pp. 9894
Author(s):  
Agnieszka Bejer ◽  
Agnieszka Bieś ◽  
Sylwia Kyc ◽  
Magdalena Lorenc ◽  
Piotr Mataczyński ◽  
...  
Keyword(s):  
Lower Limb ◽  
Cultural Adaptation ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Cross Sectional Study ◽  
Cross Cultural ◽  
Functional Index ◽  
Cross Sectional ◽  
Cross Cultural Adaptation ◽  
Polish Version

This study aimed to perform linguistic and cross-cultural adaptation to establish a Polish version of the Lower Limb Functional Index (LLFI) as well as an evaluation of the psychometric properties. This was a two-stage, cross-sectional study. The first stage—linguistic and cultural adaptation, complied with the International Society for Pharmacoeconomics and Outcomes Research guidelines to produce the Lower Limb Functional Index, Polish version (LLFI-PL). The subjects were recruited to the second stage of the study from a sample of convenience (n = 125, age x- = 52.86 ± 19.53 years, 56% female, symptoms duration x- = 17.69 ± 18.39 weeks). Baseline reliability was performed on the LLFI-PL with retest period at 3–7 days. The Western Ontario and McMaster University Osteoarthritis Index (WOMAC), EuroQol Health Questionnaire 5-Dimensions 5-Level (EQ-5D-5L), and an 11-point Pain Numerical Rating Scale (P-NRS) were completed to assess the validity of the LLFI-PL. Statistical analysis showed high internal consistency (α = 0.94), and excellent test–retest reliability (ICC2.1 = 0.96). The measurement error was SEM = 1.69% with MDC90 = 3.93%. Construct validity demonstrated strong correlations between the LLFI-PL and WOMAC (r = 0.81) and moderate correlations with the EQ-5D-5L (r = −0.63) and P-NRS (r = −0.39). Exploratory factor analysis confirmed a single-factor structure. The LLFI-PL is a psychometrically sound questionnaire for Polish-speaking patients with lower limb musculoskeletal conditions. The results support findings from the previous original English, Spanish, and Turkish versions.

The Epidural “Top-up”

2002 ◽  
Vol 96 (6) ◽  
pp. 1310-1314 ◽  
Author(s):  
Michal Leeda ◽  
Rudolf Stienstra ◽  
M. Sesmu Arbous ◽  
Maarten J. M. Verschure ◽  
Albert Dahan ◽  
...  
Keyword(s):  
Maximum Level ◽  
Female Gender ◽  
Sensory Block ◽  
Saline Group ◽  
Volume Effect ◽  
Loading Dose ◽  
Sensory Blockade ◽  
Dural Sac ◽  
Group 2 ◽  
Number Of Segments

Background Extension of sensory blockade after an epidural top-up in combined spinal epidural (CSE) anesthesia is partly attributed to compression of the dural sac by the injected volume. This study investigated whether a volume effect plays a significant role when administering an epidural top-up after an initial epidural loading dose and assessed the predictive value of different factors with respect to the increase in sensory blockade. Methods After an epidural loading dose of 75 mg ropivacaine, 0.75%, 30 patients were randomly assigned to one of three groups. After the maximum level of sensory blockade (MLSB) had been established, patients received either an epidural top-up with 10 ml ropivacaine, 0.75% (group 1, n = 10) or saline (group 2, n = 10), or no epidural top-up (group 3, n = 10). Subsequently, sensory blockade was assessed at 5-min intervals for a further 30 min by a blinded observer. Results The MLSB increased significantly in the patients receiving an epidural top-up with ropivacaine but not in the patients receiving normal saline. Sensory block extension was inversely related to the number of segments blocked at the time of the epidural top-up, and female gender was associated with a smaller increase in MLSB. Conclusions When using epidural ropivacaine, the extension of sensory blockade after administering an epidural top-up is caused by a local anesthetic effect and not by a volume effect. Under the conditions of this study, predictors of the increase in sensory blockade are the presence of ropivacaine in the top-up injectate, the number of segments blocked at the time of epidural top-up, and gender.

scholarly journals OnabotulinumtoxinA Reduces Temporal Pain Processing at Spinal Level in Patients with Lower Limb Spasticity

Toxins ◽  
2019 ◽  
Vol 11 (6) ◽  
pp. 359
Author(s):  
Roberto De Icco ◽  
Armando Perrotta ◽  
Eliana Berra ◽  
Marta Allena ◽  
Enrico Alfonsi ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Lower Limb ◽  
Temporal Summation ◽  
Rating Scale ◽  
Muscle Tone ◽  
Numerical Rating Scale ◽  
Therapeutic Option ◽  
Lower Limbs ◽  
Open Label ◽  
Cord Injury

Spasticity is a muscle tone disorder associated with different neurological conditions. Spasticity could be associated with pain, high disability, poor functional recovery, and reduced quality of life. Botulinum neurotoxin type A (BoNT-A) is considered a first-line treatment for spasticity and, more recently, it also represents a therapeutic option for various chronic pain conditions. In this open label study, we aim to evaluate the effect of the BoNT-A on the spinal nociception in patients affected by spasticity of the lower limbs with associated pain with predominantly neuropathic features. Ten patients with stroke, 10 with multiple sclerosis and 5 with spinal cord injury were enrolled in the study. They were tested with clinical scales (neuropathic pain scale inventory (NPSI), numerical rating scale (NRS), modified Ashworth scale (MAS) and with the nociceptive withdrawal reflex at lower limbs to explore the spinal temporal summation threshold at baseline and 30 day after BoNT-A injection. OnabotulinumtoxinA (50 to 200 units per site) was injected in the lower limb muscles according to the distribution of spasticity. No significant differences were found at baseline for neurophysiological features across groups. After the BoNT-A injection, we recorded a significant reduction in MAS and NRS scores. Regarding the neurophysiological parameters, we described a significant increase in the temporal summation threshold after the BoNT-A injection. Our data supports the hypothesis that peripherally injected OnabotulinumtoxinA modulates the excitability of spinal cord nociceptive pathways. This activity may take place irrespective of the effect of the drug on spasticity.

Evaluation of Femoral Nerve Blockade for Postoperative Analgesia in Dogs Undergoing Stifle Arthrotomy

1997 ◽  
Vol 10 (01) ◽  
pp. 37-44 ◽  
Author(s):  
D. Riedesel ◽  
K. R. Cox
Keyword(s):  
Postoperative Pain ◽  
Nerve Block ◽  
Rating Scale ◽  
Femoral Nerve Block ◽  
Numerical Rating Scale ◽  
Femoral Nerve ◽  
Systolic Pressure ◽  
Saline Group ◽  
Perineural Injection ◽  
Significant Difference

SummaryThe efficacy of the femoral nerve block (FNB) in alleviating postoperative pain was evaluated in dogs undergoing stifle arthrotomy. The pre- and postoperative nerve blocks were compared to intraarticular administration of a local anaesthetic. Forty-eight dogs with a ruptured cranial cruciate ligament were randomly assigned to the following groups: Group A (n = 16) received a femoral perineural injection prior to surgery; eight dogs within this group were given 0.5% bupivacaine and eight dogs received 0.9% saline. Group B (n = 16) had a femoral perineural injection immediately after surgery; eight dogs received 0.5% bupivacaine and eight received 0.9% saline. Group C (n = 16) dogs were given 0.5% bupivacaine (n = 8) or 0.9% saline (n = 8) intraarticularly. Postoperative pain was evaluated using a visual analog scale and a numerical rating scale, including measurement of heart rate, respiratory rate and systolic pressure. The dogs were scored preoperatively and at zero to six and at 24 hours after the operation. A significant difference was not noted between groups during the time until the first dose of supplemental analgesia nor in the total dose of supplemental analgesia required. The duration of the operation was found to be negatively correlated with the duration of postoperative analgesic effect. There was not any significant difference between the groups in pain scores at any time.Femoral nerve block (FNB) was evaluated for the control of postoperative pain in dogs undergoing stifle arthrotomy. FNB, using bupivacaine, was performed preoperatively and was compared to a postoperative FNB, and to saline controls. In addition, the efficacy of the FNB was compared to intra-articularly administered bupivacaine. Differences were not found between any groups in the alleviation of postoperative pain.

scholarly journals Comparative Study of Ketamine and Fentanyl When Added to Intrathecal Bupivacaine on Sensory and Motor Blockade in Patients Undergoing Total Abdominal Hysterectomy

2021 ◽  
Vol 8 (8) ◽  
pp. 420-426
Author(s):  
Saba Wani ◽  
Sadia Ali Wani ◽  
Salma Mariyam
Keyword(s):  
Comparative Study ◽  
Onset Time ◽  
Control Group ◽  
Sensory Level ◽  
Motor Blockade ◽  
Hyperbaric Bupivacaine ◽  
Double Blind ◽  
Sensory Blockade ◽  
Group I ◽  
Patient Consent

Introduction:- Ketamine and Fentanyl used intrathecally as adjuvant to 0.5% hyperbaric bupivacaine for patients undergoing TAH to shorten the onset of sensory and motor blockade and prolonging the duration of block. Aims and Objective:-We evaluated onset and duration of sensory and motor blockade and timing of regression of sensory blockade to T 12 and motor blockade to Bromage scale 3. Material and Methods:-This analytical Comparative Study was conducted in Department of Anaesthesiology, Era’s Lucknow Medical College and Hospital, Era University, Lucknow over a period of eighteen months from 2016 -2018 following approval from institutional ethical committee and written informed patient consent. The sample size of 162 female patient aged 40 to 60 years, belonging to ASA physical status 1 and 2 undergoing TAH were randomly allocated to three groups in double blind manner. Group I Received Inj. Bupivacaine (0.5% Heavy) 3.0ml + Inj. Ketamine (25 mg), Group II Received Inj. Bupivacaine (0.5% Heavy) 3.0 ml + Inj. Fentanyl (25 µgm), Group III (Control Group): Received Inj. Bupivacaine (0.5% Heavy) 3.0 ml + Normal saline 0.5 ml. Onset and Duration of Sensory and Motor Blockade and time taken for regression of sensory level to T12 and motor level to Bromage scale 3 noted. Results:- The present study showed that both Ketamine as well as Fentanyl shortened the onset time and prolonged the block duration. However, with respect to onset time, ketamine has shorter onset of blockade than fentanyl. Conclusion:- Both the modalities independently assured quicker onset and prolonged duration of block, thus suggesting that adjuvant use of either of two could be beneficial. Keywords: TAH, Ketamine, Fentanyl, Bupivacaine.

scholarly journals Epidural Fentanyl and Fentanyl Plus Magnesium for Post-Operative Analgesia in Lower Extremity Surgery

2020 ◽  
Vol 5 (2) ◽  
pp. 35-38
Author(s):  
Ajay Babu Ramakrishnan ◽  
S. Ankalagowri Sankardevar ◽  
Nischala Reddy G ◽  
Uthkala B Hegde
Keyword(s):  
Lower Extremity ◽  
Normal Saline ◽  
Lower Limb ◽  
Saline Group ◽  
Epidural Fentanyl ◽  
Sensory Level ◽  
Group I ◽  
Duration Of Surgery ◽  
Group Ii ◽  
The Difference

Background: The present study was conducted to assess the efficacy of epidural fentanyl with a combination of epidural fentanyl and magnesium in lower extremity surgery. Subjects and Methods : This study was conducted on 100 ASA I/II patients scheduled to undergo elective lower limb orthopedic surgeries. Group I patients received epidural fentanyl 50 µg (1cc) diluted and made up to 6cc with normal saline. Group II patients received epidural fentanyl 50 µg (1cc)+ Magnesium sulphate 50mg (4 units in insulin syringe of 50% solution) diluted and made up to 6cc with normal saline. Patient data such as indication for surgery, the anesthetic details, intraoperative monitoring, post-operative follow-up, etc was recorded. Results: Each group had 36 males and 14 females. Time is taken for the highest sensory level in group I was 13.92 4.50 minutes and 12.24  3.43 minutes in groups I and II respectively. The mean duration of surgery was 99.00  13.31 minutes in group I and 92.20   15.21   in group II. Time for Regression to L1 was 118.80 13.41 and 119.60 17.85 minutes in group I and II respectively. The duration of analgesia (min) was 107.00 25.82 and 143.40 39.57 minutes in group I and II respectively. Common adverse events were nausea/ vomiting seen 2 in group I and 4 in group II and urinary retention seen 0 in group I and 2 in group II. The difference was non- significant (P> 0.05). Conclusion: Authors found that the addition of magnesium sulfate to epidural fentanyl for elective lower limb orthopedic surgeries has prolonged the duration of fentanyl analgesia without any significant side effects.

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