COMPARISONS OF EFFECTS OF DIFFERENT DOSES OF DEXMEDETOMIDINE AS ADDITIVE IN INTRATHECAL BLOCKADE WITH 0.5% HYPERBARIC BUPIVACAINE IN LOWER LIMB ORTHOPEDIC SURGERIES

2021 ◽  
pp. 21-23
Author(s):  
Shantanu Hazra ◽  
Debabanhi Barua ◽  
Sudeshna Mondal ◽  
Arpita Laha
Keyword(s):  
Lower Limb ◽  
Controlled Study ◽  
Sensory Level ◽  
Hyperbaric Bupivacaine ◽  
Duration Of Action ◽  
Stable Conditions ◽  
Study Results ◽  
The Mean ◽  
Group D

INTRODUCTION Lower limb surgeries may be performed under local, regional (spinal or epidural) or general anaesthesia, but neuraxial blockade is the preferred mode of anaesthesia. Spinal block is still therst choice because of its rapid onset, superior blockade, low risk of infection as from catheter in situ, 1 less failure rates and cost-effectiveness. Intrathecal local anaesthesia alone is associated with relatively short duration of action and thus early analgesic intervention is needed in post-operative period. AIMS AND OBJECTIVES With use of dexmedetomidine in 3 different graded doses with hyperbaric bupivacaine intrathecally as regional anaesthesia for lower limb surgeries. MATERIALS AND METHODOLOGY This Prospective double blinded randomized controlled study. The study will be conducted in adult patients aged between 18-50 years undergoing lower limb surgeries under spinal anaesthesia in orthopedic OT, dept. of Anaethesiology, Medical college & hospital, Kolkata. Duration of the study One year (9 months for data collection & 3 months for data analysis, review& report writing). Total 63 patients in our study. RESULTS We found the mean of two segment regression time from highest sensory level in Group B was 130.56min; in group C was 171.34min; ingroup D was 217.85min So, block regression was signicantly slower with the addition of intrathecal dexmedetomidine (Group D) as compared to group C & B ( P < 0.0001) The mean regression time to S1 from highest sensory level for Group Bwas 289.43 min ( SD- 12.43) For Group C, the mean regression time to S1 from highest sensory level was 402.71 min ( SD- 28.60) For Group D, the mean regression time to S1 from highest sensory level was 584.43min ( SD- 38.92) Overall the mean regression time to S1 from highest sensory level was 425.52 min ( SD- 125.71) The sensory regression time to S1 from highest sensory level was signicantly higher with increasing dose of dexmedetomidine i. e. D>C>B . (P< 0.0001). CONCLUSION We recommend the use of 10mcg of intrathecal dexmedetomidine as an adjuvant to bupivacaine as it seems to be a good alternative to other additives for long duration surgical procedures due to its profound intrathecal anesthetic and analgesic properties. It provides good quality of intraoperative analgesia, thermodynamically stable conditions, minimal side effects, and excellent quality of postoperative analgesia.

scholarly journals Dexamethasone Blunts Post-Spinal Hypotension in Geriatric Patients Undergoing Orthopedic Surgery: A Double Blind, Placebo-Controlled Study

2020 ◽  
Author(s):  
Tarek Ashoor ◽  
Noha S. Hussien ◽  
Sherif G. Anis ◽  
Ibrahim M. Esmat
Keyword(s):  
Heart Rate ◽  
Spinal Anesthesia ◽  
Demographic Data ◽  
Volume Overload ◽  
Controlled Study ◽  
Hyperbaric Bupivacaine ◽  
Double Blind ◽  
Spinal Hypotension ◽  
Group D

Abstract Background. Post-spinal hypotension in elderly is challenging, correction by fluids either colloids or crystalloids or by vasoconstrictors pose the risk of volume overload or compromising cardiac conditions. Dexamethasone is used to treat conditions manifested by decrease of peripheral vascular resistance; we were the first to test the hypothesis of its role in preventing or decreasing the incidence of post-spinal hypotension.Methods. 110 patients aged 60 years or more were recruited in the study, 55 in the Dexamethasone group (D group) were given 8 mg Dexamethasone 2 hours preoperatively, and 55 were given placebo (C group).Variations in blood pressure and heart rate and need of vasoconstrictors and/or atropine following spinal anesthesia (SA) was done. SA was done by subarachnoid injection of 3 ml of hyperbaric bupivacaine.Results. Demographic data and the quality of sensory and motor block were comparable between groups. At 5, 10 minutes; systolic, diastolic and, mean arterial pressures were significantly higher in group D. At 20 minutes readings were non significant between groups. Heart rate changes didn’t show any significance. Need for ephedrine was less in group D, side effects were less in the D group. Conclusion. Dexamethasone may attenuate post-spinal hypotension in elderly, with a favorable response against nausea, vomiting and shivering that associate spinal anesthesia.

scholarly journals 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

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 .

scholarly journals A comparison of intrathecal 0.5% hyperbaric ropivacaine with 0.5% hyperbaric bupivacaine for elective surgery: a prospective, randomized, double-blind, controlled study

2021 ◽  
Vol 9 (2) ◽  
pp. 471
Author(s):  
Pallavi Amol Kharat ◽  
Rajshree Chandrashekhar Deopujari
Keyword(s):  
Lower Limb ◽  
Motor Block ◽  
Elective Surgery ◽  
Sensory Block ◽  
Controlled Study ◽  
Complete Regression ◽  
Hyperbaric Bupivacaine ◽  
Duration Of Action ◽  
Significant Difference ◽  
Group B

Background: To compare the onset of action, intensity and duration of motor block of 0.5% hyperbaric ropivacaine with 0.5% hyperbaric bupivacaine for elective lower abdominal, perineal and lower-limb surgeries.Methods: 70 patients undergoing elective lower abdominal, perineal and lower limb surgery receiving spinal anesthesia were divided randomly into two groups, Group B, (bupivacaine 5 mg/ml with glucose 80 mg/ml;4 ml, and Group R, (ropivacaine 5 mg/ml with glucose 80 mg/ml; 4 ml).Results: The results were analyzed and compared using Chi-square test, student ‘s t-test and Fisher’s exact tests. The onset of sensory block was more rapid with bupivacaine (p<0.05). The maximum cephalad spread was similar in both groups. However, the time required to maximum extent of cephalic spread was less in Group B (p<0.05). Motor block 3 according to modified bromage scale was obtained in both groups and the time to achieve the same was not significant. The duration of motor blockade i.e., time to complete regression of motor block was significantly greater with Group B than with Group R (0.0001). We found that there was no significant difference in the time taken to achieve grade 3 motor block but ropivacaine gave a lesser degree of motor block which regressed faster than bupivacaine (118 min versus 156 min; p<0.0001). There was no significant difference in hemodynamic parameters except that diastolic and mean pressures remained on lower side in group B (p<0.05).Conclusions: We conclude that 0.5% hyperbaric ropivacaine provides a sensory block of similar onset and extent, shorter duration of action and less frequency of hypotension as compared to 0.5% hyperbaric bupivacaine.

Comparative study of postoperative analgesia intrathecal addition of fentanyl versus clonidine in lower limb surgeries

2021 ◽  
Vol 18 (2) ◽  
pp. 83-87
Author(s):  
Palak Gupta ◽  
Keyword(s):  
Spinal Anaesthesia ◽  
Lower Limb ◽  
Hyperbaric Bupivacaine ◽  
Duration Of Action ◽  
Medical College ◽  
Anesthetic Drugs ◽  
Prolonged Duration ◽  
The Difference ◽  
Intrathecal Clonidine

Background: Local anesthetic drugs like bupivacaine are commonly used in spinal anesthesia for lower limb surgeries but the duration of spinal anaesthesia is very short. However, the duration of action of bupivacaine in spinal anaesthesia can be prolonged by using adjuvants such as midazolam, opioids, neostigmine, dexmedetomidine and clonidine. The present study is being undertaken to evaluate and compare the effects of clonidine and fentanyl as intrathecal adjuvants to hyperbaric bupivacaine in patients undergoing lower limb orthopaedic surgery. Material and Methods: Present study was conducted in the Department of Anaesthesiology and Intensive Care, Government Medical College, Jammu in patients of either sex ranging in age from 20-60 years belonging to ASA I/ II scheduled for lower limb orthopaedic surgeries. 90 patients were randomly allocated in three groups of 30 each in order to compare the duration and quality of analgesia of clonidine and fentanyl used as adjuvants to intrathecal bupivacaine. Results: All the three groups were comparable in age, gender, height, weight, ASA grade distribution and the difference between them was not statistically significant. The difference between the time to reach the T10 block, mean time taken for first request for analgesia and duration of motor block in all three groups were found out to be statistically significant (p<0.0001). It was found that group with clonidine had better results than fentanyl and bupivacaine alone. In our study 1 patient in bupivacaine (15mg) with fentanyl (25µg) group and 2 patients in clonidine(37.5ugm) group had hypotension but the difference was statistically insignificant. Only 1 patient in each fentanyl and clonidine group had 1 episode of bradycardia but no patient in bupivacaine alone group had bradycardia and the difference was also insignificant. Postoperative vomiting was experienced by 3.33% of patients receiving Bupivacaine (15mg) with fentanyl (25µg) and it was treated by giving injection Ondansetron 4 mg i/v whereas no case was reported in clonidine group. This difference was statistically insignificant. 2 patients in bupivacaine (15mg) with fentanyl (25µg) group had itching but no such case was reported in clonidine group and the difference was also statistically insignificant. No respiratory depression, nausea was noted in study patients. Conclusion: It can be concluded that intrathecal clonidine (37.5ugm) provides quicker onset and prolonged duration of sensory and motor blocks simultaneously increasing the duration of analgesia when compared to fentanyl (25ugm).

scholarly journals EFFECT OF INTRAVENOUS VERSUS INTRATHECAL DEXMEDETOMIDINE ON CHARACTERISTICS OF HYPERBARIC BUPIVACAINE SPINAL ANESTHESIA IN LOWER LIMB SURGERY

2018 ◽  
Vol 11 (7) ◽  
pp. 427
Author(s):  
Laxman K Senapati ◽  
Priyadarsini Samanta
Keyword(s):  
Side Effects ◽  
Spinal Anesthesia ◽  
Lower Limb ◽  
Motor Block ◽  
Infusion Pump ◽  
Controlled Study ◽  
Sensory Level ◽  
Hyperbaric Bupivacaine ◽  
Rescue Analgesia ◽  
Lower Limb Surgery

Objectives: Dexmedetomidine was shown to prolong the duration of spinal anesthesia and enhance post-operative analgesia. The aim of the study was to compare the effect of intravenous (IV) versus intrathecal (IT) administration of dexmedetomidine on bupivacaine spinal anesthesia in patients undergoing lower limb surgery.Methods: A prospective randomized controlled study was conducted during the year 2014–15. 60 American Society of Anesthesiologists physical status I–II aged 18–60 years scheduled for lower limb surgery under spinal anesthesia were assigned randomly to two groups: (1) IT group (IT group) (n=30) patients received 3 ml of 0.5% hyperbaric bupivacaine and 5 μg of dexmedetomidine intrathecally (100 μg/1 ml ampoule drawn in 40 IU/ml insulin syringe making 5 μg=2 IU=0.05 ml) and (2) IV group (IV group) (n=30) received 3 ml of 0.5% hyperbaric bupivacaine and 0.05 ml of normal saline intrathecally followed 5 min later by IV dexmedetomidine 0.5 μg/kg by infusion pump over 10 min as a single dose.Results: The IT group had a statistically significantly earlier sensory onset to T10 and shorter time from injection to highest sensory level (p<0.001). The regression times of two dermatomes, regression time to S1 dermatome and time to reach Bromage 3 motor block were significantly less in the IT group, whereas regression time to Bromage 0 was prolonged (p<0.001). The IT group showed a significantly longer time to the use of rescue analgesia and less analgesic consumption in first 24 h than the IV group (p<0.001). Furthermore, the intensity of pain was significantly less in the IT group as compared to IV group (p<0.001). Compared with IV group, the IT group had low sedation score, fewer overall side effects, which was statistically not significant (p>0.05).Conclusion: In bupivacaine spinal anesthesia for limb surgeries, dexmedetomidine, when administered intrathecally, has greater augmentation to sensory and motor block, more hemodynamic stability, better analgesic properties, and fewer overall side effects compared to the IV route of administration.

scholarly journals The Quality of Statistical Reporting and Data Presentation in Predatory Dental Journals Was Lower Than in Non-Predatory Journals

Entropy ◽  
2021 ◽  
Vol 23 (4) ◽  
pp. 468
Author(s):  
Pentti Nieminen ◽  
Sergio E. Uribe
Keyword(s):  
Open Access ◽  
Peer Review ◽  
Scientific Journals ◽  
Mean Values ◽  
Data Presentation ◽  
Predatory Journals ◽  
Study Results ◽  
The Mean ◽  
Highly Cited

Proper peer review and quality of published articles are often regarded as signs of reliable scientific journals. The aim of this study was to compare whether the quality of statistical reporting and data presentation differs among articles published in ‘predatory dental journals’ and in other dental journals. We evaluated 50 articles published in ‘predatory open access (OA) journals’ and 100 clinical trials published in legitimate dental journals between 2019 and 2020. The quality of statistical reporting and data presentation of each paper was assessed on a scale from 0 (poor) to 10 (high). The mean (SD) quality score of the statistical reporting and data presentation was 2.5 (1.4) for the predatory OA journals, 4.8 (1.8) for the legitimate OA journals, and 5.6 (1.8) for the more visible dental journals. The mean values differed significantly (p < 0.001). The quality of statistical reporting of clinical studies published in predatory journals was found to be lower than in open access and highly cited journals. This difference in quality is a wake-up call to consume study results critically. Poor statistical reporting indicates wider general lower quality in publications where the authors and journals are less likely to be critiqued by peer review.

scholarly journals Impact of a Smart-Ring-Based Feedback System on the Quality of Chest Compressions in Adult Cardiac Arrest: A Randomized Preliminary Study

2021 ◽  
Vol 18 (10) ◽  
pp. 5408
Author(s):  
Chiwon Ahn ◽  
Seungjae Lee ◽  
Jongshill Lee ◽  
Jaehoon Oh ◽  
Yeongtak Song ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Feedback System ◽  
Controlled Study ◽  
Feedback Group ◽  
Compression Depth ◽  
System Usability Scale ◽  
The Mean ◽  
Preliminary Study ◽  
The Ideal

This study aimed to assess the effectiveness of a novel chest compression (CC) smart-ring-based feedback system in a manikin simulation. In this randomized, crossover, controlled study, we evaluated the effect of smart-ring CC feedback on cardiopulmonary resuscitation (CPR). The learnability and usability of the tool were evaluated with the System Usability Scale (SUS). Participants were divided into two groups and each performed CCs with and without feedback 2 weeks apart, using different orders. The primary outcome was compression depth; the proportion of accurate-depth (5–6 cm) CCs, CC rate, and the proportion of complete CCs (≤1 cm of residual leaning) were assessed additionally. The feedback group and the non-feedback group showed significant differences in compression depth (52.1 (46.3–54.8) vs. 47.1 (40.5–49.9) mm, p = 0.021). The proportion of accurate-depth CCs was significantly higher in the interventional than in the control condition (88.7 (30.0–99.1) vs. 22.6 (0.0–58.5%), p = 0.033). The mean SUS score was 83.9 ± 8.7 points. The acceptability ranges were ‘acceptable’, and the adjective rating was ‘excellent’. CCs with smart-ring feedback could help achieve the ideal range of depth during CPR. The smart-ring may be a valuable source of CPR feedback.

Burden of Care and Its Relationship with Sleep Quality of Cancer Patients’ Caregivers

2021 ◽  
Author(s):  
Mohammadreza Boostaneh ◽  
Mohammad Zirak ◽  
Ramezan Fallah
Keyword(s):  
Sleep Quality ◽  
Cancer Patients ◽  
Poor Sleep ◽  
Burden Of Care ◽  
Quality Of Sleep ◽  
Study Results ◽  
Northwest Of Iran ◽  
The Mean ◽  
Convenience Sampling

Abstract Purpose: This study aimed to assess the burden of care and its relationship with sleep quality of cancer patients’ caregivers.Methods: This descriptive-correlational study was conducted in a referral center of cancer in Zanjan, northwest of Iran. 135 caregivers of cancer patients were recruited through convenience sampling method. The data were collected using a demographic characteristics questionnaire, Novak and Guest’s caregiver burden inventory and Pittsburgh sleep quality index (PSQI). The collected data was analyzed using descriptive and inferential statistics.Results: The mean (± SD) age of the participants was 39.71 (± 10.74) years. The mean (± SD) burden of care and sleep quality of the participants was 45.22 (± 17.75) and 8.88 (± 4.21), respectively. It was found that there is a significant positive relationship between burden of care and quality of sleep scores (r = 0.65, P < 0.001).Conclusion: cancer patients’ caregivers endure a remarkable burden of care and their sleep quality is undesirable. Results indicated that an increase in the burden of care reduces the caregiver’s quality of sleep. High burden of care and poor sleep quality may reduce the quality of the provided care that increase the costs and weakens the disease prognosis. According to the study results, reducing burden of care is an effective strategy regarding improving the caregivers’ quality of sleep that can improve the quality of provided cares by caregivers.

scholarly journals A comparative study of low doses of intrathecal ketamine and midazolam with bupivacaine for postoperative analgesia in infraumbilical surgeries

2019 ◽  
Vol 6 (2) ◽  
pp. 197
Author(s):  
Rajabhushanam M. ◽  
Sunil Kumar K. ◽  
Syed Ali Aasim ◽  
Venkatesh S.
Keyword(s):  
Postoperative Analgesia ◽  
Cost Effective ◽  
Rapid Onset ◽  
Spinal Block ◽  
P Value ◽  
Sensory Level ◽  
Hyperbaric Bupivacaine ◽  
First Choice ◽  
Mean Time

Background: Infra-umbilical surgeries may be performed under local, regional (spinal or epidural) or general anaesthesia, spinal block is still a first choice, because of its rapid onset, high quality of blockade, lack of catheter related infection, less failure rate and also cost effective but the duration of block and postoperative analgesia is limited. The purpose of study was to compare the efficacy of adding ketamine to 0.5% hyperbaric bupivacaine with midazolam to 0.5% hyperbaric bupivacaine in elective infraumbilical procedures.Methods: A randomized, single blinded, clinical study. 60 subjects were enrolled from the patients presenting for elective infraumbilical surgeries after following the inclusion and exclusion criteria laid down for the study. Sixty ASA Grade I and II patients undergoing infra umbilical surgeries were randomly divided into one of the two equal groups (n=30).Results: Total 60 patients were included in this study. The mean time to achieve T10 sensory level and modified bromage scale III was prolonged in group M (4.33±1.09, 6.66±1.26 min) as compared to group K (3.3±0.7, 4.96±1.21 min) which was statistically significant (P value <0.05).Conclusions: The present study concludes that addition of intrathecal midazolam to hyperbaric bupivacaine provide very good and prolonged post-operative analgesia without significant intra-operative and post-operative side effects compared to intrathecal ketamine.

scholarly journals Epidural butorphanol for post operative analgesia in lower limb surgeries: A comparative study with epidural tramadol

2017 ◽  
Vol 6 (3) ◽  
pp. 26-32
Author(s):  
G P Deo ◽  
S K Shrestha ◽  
I N Shrestha
Keyword(s):  
Patient Satisfaction ◽  
Side Effects ◽  
Lower Limb ◽  
Analgesic Efficacy ◽  
Epidural Injection ◽  
Double Blind ◽  
Duration Of Action ◽  
Number Of Patients ◽  
Group B

To compare the efficacy of epidural butorphanol and tramadol for post operative analgesia in lower limb surgeries. Randomized, controlled, double blind, prospective study conducted at Department of Anaesthesia and Critical Care, Chitwan Medical College from September 1st 2015 to August 31st 2016. 60 patients of ASA Grade I and II of either sex, aged between 18-65 years willing for epidural analgesia for post operative analgesia were included in the study. They were divided into two groups: Group B- Butorphanol group and Group T- Tramadol group. Subjects of Group B received 2mg of Butorphanol and 0.25% Bupivacaine making a total volume of 10 ml and that of Group T received 100mg of Tramadol and 0.25% Bupivacaine also making a total volume of 10 ml. Analgesic efficacy was assessed by Visual Analogue Scale (VAS). The onset and duration of analgesia along with side effects were also assessed. The quality of analgesia was studied using time to independent mobilization and overall patient satisfaction. Total number of patients was 60, of ASA Grade I and II, aged between 18-65 years. The mean age of patients in Group B was 42.6±11.7 years and 46.1±11.2 years in Group T. Time of onset of analgesia after epidural injection was 7.4±0.9 minutes in Group B and 12.7±1.5 minutes in Group T and the difference was found to be statistically significant. Duration of analgesia was 317.1±99.1 minutes and 438.8±136.6 minutes in Butorphanol and Tramadol groups respectively which was also statistically significant. Sedation was significantly higher in butorphanol group whereas nausea and vomiting was higher in tramadol group. Quality of analgesia in terms of patient satisfaction was better with epidural butorphanol. Both epidural tramadol and butorphanol were effective in relieving post operative pain however butorphanol had lesser side effects and greater patient satisfaction compared to tramadol but the duration of action was relatively short.

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