scholarly journals Comparison of Efficacy of Different Doses of Clonidine with 0.5% Bupivacaine for Spinal Anesthesia in Lower Limb Orthopedic Surgeries

2017 ◽  
Vol 3 (2) ◽  
pp. 45-49
Author(s):  
KT Venkatesh Murthy ◽  
Maya D Nadkarni ◽  
N Amaranath
Keyword(s):  
Postoperative Complications ◽  
Spinal Anesthesia ◽  
Lower Limb ◽  
Saline Group ◽  
Controlled Study ◽  
Hyperbaric Bupivacaine ◽  
Hemodynamic Stability ◽  
Group Iii ◽  
Group I ◽  
Different Doses

ABSTRACT Clonidine, a centrally acting α2 adrenergic agonist has been under use as an adjuvant with hyperbaric bupivacaine for prolonging analgesia and maintaining hemodynamic stability during lower limb orthopedic and lower abdominal surgeries. The purpose of our study was to compare the efficacy and safety of intrathecal Clonidine 50 and 75 μg as adjuvant to hyperbaric Bupivacaine 15 mg (3 mL), and hyperbaric Bupivacaine 3 mL with saline 0.5 mL for onset and duration of anesthesia, hemodynamic stability, and side effects if any. This prospective randomized controlled study was conducted on 120 patients scheduled for lower limb orthopedic surgeries under spinal anesthesia. The study population was divided into three groups with 40 patients in each group. Group I (controlled group) received 3 mL (15 mg) of 0.5% Bupivacaine heavy and 0.5 mL of normal saline. Group II received 50 μg of clonidine followed by Bupivacaine 0.5% 3 mL (15 mg) and group III received 75 μg of clonidine followed by Bupivacaine 0.5% 3 mL (15 mg) intrathecally. Time taken for onset of sensory and motor blockade, duration of anesthesia, and any perioperative and postoperative complications was noted. We found that clonidine 75 μg given prior to bupivacaine, 3 mL, significantly prolongs the duration of anesthesia with minimal changes in hemodynamic parameters and postoperative complications. How to cite this article Murthy KTV, Nadkarni MD, Amaranath N. Comparison of Efficacy of Different Doses of Clonidine with 0.5% Bupivacaine for Spinal Anesthesia in Lower Limb Orthopedic Surgeries. J Med Sci 2017;3(2):45-49.

scholarly journals COMPARATIVE STUDY OF DIFFERENT DOSES OF DEXMEDETOMIDINE AS AN ADJUVANT TO INTRATHECAL HYPERBARIC BUPIVACAINE IN LOWER LIMB ORTHOPAEDIC SURGERIES

2021 ◽  
Vol 5 (8) ◽  
Author(s):  
Mukesh Choudhary ◽  
Neeti Mahla
Keyword(s):  
Lower Limb ◽  
Motor Block ◽  
Double Blind Study ◽  
Hyperbaric Bupivacaine ◽  
Analgesic Requirement ◽  
Double Blind ◽  
Group Iii ◽  
Group I ◽  
Dose Dependent ◽  
Different Doses

Background: This study is aimed to different doses of Dexmedetomidine as an adjuvant to Intrathecal hyperbaric bupivacaine in lower limb orthopaedic surgeries Methods: A prospective randomized double blind study was conducted with 90 consenting patients of ASA grade I and II, scheduled for lower limb Orthopaedic surgeries. Using the lottery method, the patients were randomly allotted into 3 groups, 30 patients in each group. Group I , Group II & Group III.  Results: Post-operative VAS and total analgesic requirement in 24 hours were minimal in group C as compare to B group. All the patients achieved Bromage scale 3 motor block and there was dose dependent prolongation of motor block in B and C groups. Conclusion: Supplementation of spinal Bupivacaine with Dexmedetomidine significantly prolonged both sensory and motor block compared with intrathecal Bupivacaine alone. Keywords: Bupivacaine, Dexmedetomidine, Motor block.

Comparison between Nalbuphine and Ketamine as an adjuvant to Heavy Bupivacaine on Post Dural Puncture Headache

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohammad A El Gendy ◽  
Gamal M Elewa ◽  
Mina Z Wadea ◽  
Ashraf M Hazem
Keyword(s):  
Spinal Anesthesia ◽  
Normal Saline ◽  
Dural Puncture ◽  
Sensory Block ◽  
Saline Group ◽  
Controlled Study ◽  
Normal Saline Group ◽  
Hyperbaric Bupivacaine ◽  
Post Dural Puncture Headache ◽  
Significant Difference

Abstract Background Incidence of post dural puncture headache (PDPH) is relatively high, and many methods have been tried to prevent or treat it, but results are not satisfactory. Both Nalbuphine and Ketamine have analgesic effects, and have been used intrathecally with local anesthetics, but their effects on PDPH were not studied. Objective To study the incidence and severity of PDPH when nalbuphine or ketamine was added as an adjuvant to hyperbaric bupivacaine in spinal anesthesia (primary outcome). Secondary outcomes were the effects of adding nalbuphine or ketamine as an adjuvant to hyperbaric bupivacaine on motor and sensory effects, duration of analgesia, hemodynamics and side effects of both of them. Patients and Methods This prospective double-blind, randomized controlled study was conducted on 320 patients, aged 21–60 years of both sexes, ASA physical status I and II, and allocated for lower abdominal, pelvic, or lower limb surgeries under spinal anesthesia, after approval from ethical committee (Assurance No. FWA 000017585) of Faculty of Medicine, Ain, Shams University, Cairo, Egypt. Contact with 17 patients was lost. So, 303 patients completed the study. Patients were divided into 3 equal groups (101 each) according to drugs injected intrayhecally. Group (N): 3 ml of 0.5% hyperbaric bupivacaine with 0.5 mg nalbuphine hydrochloride diluted in 0.5 ml normal saline. Group (K): 3 ml of 0.5% hyperbaric bupivacaine with 25 mg ketamine hydrochloride diluted in 0.5 ml normal saline. Group (C): 3 ml of 0.5% hyperbaric bupivacaine with 0.5 ml normal saline. Results Incidence of PDPH was statistically significantly less in group N in comparison to Groups K and C, in the first day. But, no statistically significant difference was found between the three groups at 2nd and 3rd days. There was no statistically significant difference between groups according to severity of PDPH by visual analog score (VAS). Group N has the most rapid onset and long duration of sensory block in comparison with groups K and C. There was no statistically significant difference between groups according to onset and duration of motor block and hemodynamic changes. Conclusion Adding nalbuphine, and not ketamine, with hyperbaric bupivacaine in spinal anesthesia decreased incidence of post dural puncture headache, and prolonged the duration of sensory block. Both groups provided adequate anesthesia and analgesia with good hemodynamic stability.

scholarly journals Effect of IV Infusion of Magnesium Sulfate on Postoperative Pain after Spinal Anesthesia: A Prospective Randomized Trial

2021 ◽  
Author(s):  
Shubhi Singhal ◽  
Devang Bharti ◽  
Sangeeta Yadav ◽  
Nitin Hayaran
Keyword(s):  
Postoperative Pain ◽  
Magnesium Sulfate ◽  
Spinal Anesthesia ◽  
Lower Limb ◽  
Controlled Study ◽  
Control Group ◽  
Analgesic Requirement ◽  
Group I ◽  
Significant Difference ◽  
Vas Scores

Background: The current study attempts to evaluate the effect of intravenous (IV) infusion of magnesium sulfate during spinal anesthesia on postoperative pain and postoperative analgesic requirements in lower limb surgeries. Methods: In this double blind, randomized controlled study, 60 patients undergoing elective lower limb surgeries, were selected and randomly divided into two groups. Group I received isotonic saline and group II was administered magnesium sulfate 50 mg Kg-1 IV for 15 min and then 15 mg Kg-1 h-1 by continuous IV infusion till the end of surgery or 2 hours, whichever was earlier. Ramsay sedation scores, VAS scores for pain, time of first administration of rescue analgesic and total analgesic requirement were noted in both the groups. Results: Statistically significant difference was observed in the VAS score between the two groups at 1st, 2nd, 3rd, 6th, 9th and 12th hour intervals; with VAS scores being lower in the magnesium group (p<0.05). The mean time of first rescue analgesic requirement in control group was 144.00 mins, while in magnesium group was 246.00 mins (p<0.05). The total rescue analgesic requirement was found to be 251.67 mg and 181.67 mg at the end of 24 hours, in control and magnesium groups, respectively (p<0.05). Conclusion: This study demonstrates statistically significant lowering of postoperative VAS scores, delayed need of postoperative analgesia and reduced total postoperative analgesic requirement in patients receiving intraoperative IV magnesium sulfate compared to the control group. Magnesium sulfate did not cause sedation or any other significant adverse effect in the doses used in the study.

scholarly journals Comparative evaluation of pre-infusion at caesar section performed under spinal anesthesia. Results of multicenter trial

Pain medicine ◽  
2020 ◽  
Vol 5 (1) ◽  
pp. 37-42
Author(s):  
Kim Yong Din ◽  
K Mikirtichev ◽  
O Matkurbanov ◽  
E Allamov ◽  
V Kim ◽  
...  
Keyword(s):  
Spinal Anesthesia ◽  
Hemodynamic Instability ◽  
Multicenter Trial ◽  
Hyperbaric Bupivacaine ◽  
Group Iii ◽  
Group I ◽  
Severe Hypotension ◽  
Duration Of Surgery ◽  
Tract Infections ◽  
Narrow Pelvis

Abstact. Study of the effect of preinfusion, various infusion solutions on the state of hemodynamics, in patients undergoing a cesarean section performed under spinal anesthesia with 0.5 % solution of Longocain Heavy (0.5 % hyperbaric bupivacaine).Materials and methods. Spinal anesthesia (SAN) was performed in 2 190 women, aged 21 to 39 years, with a gestational age of 39 to 40 weeks. The structure of extragenital pathology was dominated by chronic anemia of varying severity – 1 650 (75.3 %), urinary tract infections – 756 (34.5 %), mild preeclampsia – 245 (11.2 %), chronic nonspecific lung diseases – 125 (5.7 %). 1 786 (81.5 %) patients underwent surgery in a planned manner, according to emergency indications – 404 (18.4 %). A combination of the two pathologies was observed in 852 (38.9 %) women. Indications for surgery were: disease of the operated uterus, insolvency of the scar on the uterus, clinically narrow pelvis, high-grade myopia, secondary labor weakness. The duration of surgery is ranged from 40 to 52 minutes.Results. In group I, the expressed hypotension, requiring sympathomimetic support with mezaton was observed in 192 (34.8 %) patients. In group II, severe hypotension requiring sympathomimetic support with mezaton was observed in 114 (20.8 %) patients. And in group III, hypotension requiring sympathomimetic support with mezaton was observed in 127 (23.2 %) patients. At that time, in patients of group IV severe hypotension, requiring sympathomimetic support with mezaton was observed in only 91 (18 %) cases.Conclusions. Neuraxial anesthesia is accompanied by the development of hypotension, which can be prevented by preinfusion with crystalloid solutions. Aggressive preinfusion of large volumes of isoosmolar crystalloids at a dose of 10–14 ml/kg was associated with an increase in the frequency of hemodynamic instability requiring sympathomimetic support.

scholarly journals Comparative Study of Hyperbaric Bupivacaine and Isobaric Ropivacaine for Lower Limb Surgery under Spinal Anesthesia

2019 ◽  
Vol 2 (2) ◽  
pp. 22-27
Author(s):  
Gunjan Regmi ◽  
Rejina Shahi ◽  
Kanak Khanal ◽  
Kumud Pyakurel ◽  
Chetan Bohora ◽  
...  
Keyword(s):  
Heart Rate ◽  
Comparative Study ◽  
Spinal Anesthesia ◽  
Lower Limb ◽  
Motor Block ◽  
Hyperbaric Bupivacaine ◽  
Subarachnoid Block ◽  
Arterial Blood ◽  
Group I ◽  
Lower Limb Surgery

Introduction: Subarachnoid block is commonly employed technique for lower abdominal and lower limb procedures. Bupivacaine and ropivacaine are commonly used local anesthetics for subarachnoid block. The aim of this study is to compare the efficacy and safety of isobaric Ropivacaine over hyperbaric Bupivacaine. Methods: This was a prospective comparative study for a duration of six months. 60 ASA grade I-II adult patients between 16-60 years undergoing lower limb surgery under spinal anesthesia were randomized into two groups. Group I including patients who received 15 mg of hyperbaric bupivacaine 0.5% and group II including patients who received 22.5 mg of isobaric ropivacaine 0.75%. The onset and duration of sensory and motor block and hemodynamics including heart rate (HR), non invasive mean arterial blood pressure (MAP) and respiratory depression were recorded. Data were entered in Microsoft excel and statistical analysis was done by chi square test and T test using SPSS (version 23.0). Results: Both the groups were demographically statistically insignificant. Successful block was attained in all patients in both groups. The sensory onset and motor onset were significantly delayed in the Ropivacaine Group compared to the Bupivacaine Group P<0.001. There was no significant difference in the hemodynamics (heart rate and mean arterial pressure ). Conclusions: Though isobaric ropivacaine provided lesser degree of sensory and motor block with delayed onset compared to hyperbaric bupivacaine, it can effectively and safely used in subarachnoid block in lower limb surgeries without any major hemodynamic changes and adverse effects.

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 Effect of Intravenous Dexamethasone on Propofol Injection Pain: A Randomized Placebo Controlled Study

2020 ◽  
Vol 25 (1) ◽  
pp. 28-33
Author(s):  
Muhammad Sazzad Hossain ◽  
Md Afzalur Rahman ◽  
Mamunur Rashid ◽  
Monirul Islam ◽  
Anisur Rahman Babu ◽  
...  
Keyword(s):  
Normal Saline ◽  
Saline Group ◽  
Controlled Study ◽  
Injection Pain ◽  
Moderate Pain ◽  
Dexamethasone Group ◽  
Group I ◽  
Elective Surgical Procedure ◽  
American Society ◽  
American Society Of Anesthesiologists

Background and aim of study: Pain on propofol injection (POPI) is a common problem. None of the commonly used methods completely attenuate the pain. Inflammatory response to propofol contributes to the pain. This study was conducted to compare the efficacy of dexamethasone in attenuation of pain following intravenous injection of propofol. Materials and methods: A total of 80 adult patients were scheduled in this study with either sex, ASA (American Society of Anesthesiologists) grade I and II, for routine elective surgical procedure under general anesthesia. The patients enrolled were divided randomly into two groups of 40 patients each. Group I received 0.15 mg/kg of intravenous dexamethasone in 5 ml normal saline and Group II (placebo group) received 5 ml of 0.9% intravenous normal saline, following exsanguination and occlusion of the vein of the arm. This was followed by 0.5 mg/kg of propofol intravenously.The patients were asked to report their pain during injection of propofol according to the McCririck and Hunter scale. Results: The incidence of pain experienced in dexamethasone group was 45% patients and in saline group was 70% patients (p<0.05). The severity of POPI was also lower in dexamethasone group than the saline group (p<0.05). The incidence of mild and moderate pain in dexamethasone groups versus saline group was 30% versus 45% and 15% versus 25% respectively p<0.05. There was no severe pain recorded in any groups. Conclusion: Pretreatment with intravenous dexamethasone (0.15 mg/kg) before injection of propofol is effective and safe in reducing the incidence and severity of pain on propofol injection (POPI). Bangladesh J Otorhinolaryngol; April 2019; 25(1): 28-33

scholarly journals A comparative clinical study of intrathecal hyperbaric bupivacaine with and without fentanyl for hysterectomy

2020 ◽  
Vol 11 (2) ◽  
pp. 59-63
Author(s):  
Hari Poudel ◽  
Surinder Nath Bawa ◽  
Surendra Mohan Sharma
Keyword(s):  
Side Effects ◽  
Spinal Anesthesia ◽  
Sensory Block ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Maximum Height ◽  
Hyperbaric Bupivacaine ◽  
Sensory Blockade ◽  
Group I ◽  
Group Ii

Background: Spinal anaesthesia has been widely used for lower abdominal surgeries like hysterectomy.Hyperbaric bupivacaine is the most extensively used local anesthetic. Addition of fentanyl can allow the reduction in the dose of bupivacaine, increase the height and duration of sensory blockade, and reduces complications of spinal anesthesia. Aims and Objective: The aim of the study was to examine whether adding fentanyl to hyperbaric bupivacaine would increase the height of sensory blockade, accelerate the onset of sensory blockade and increase the duration of the sensory blockade. Material and Methods: This study was done in Manipal Teaching Hospital, Pokhara, Nepal that included hundred patients who underwent total abdominal hysterectomy. The patients were randomly allocated in two groups; Group I: received 0.5% hyperbaric bupivacaine 2.5 ml (12.5 mg) plus normal saline 0.5 ml. Group II: received 0.5% hyperbaric bupivacaine 2.5 ml (12.5 mg) plus 0.5 ml fentanyl (25 μg). Hemodynamic variables, onset of motor and sensory blockade, duration of sensory and motor blockade and any side effects were observed and recorded. Results: The highest and lowest sensory block in Group I was T-7 and T-9 whereas in Group II was T-5 and T-9 respectively. In group I, the mean onset till maximum height of sensory blockade was 7.04 min whereas in group II it was 5.96 min (P<0.00).There was no significant statistical difference in the incidence of side effects in both the groups. Conclusion: Intrathecal fentanyl with hyperbaric bupivacaine for spinal anesthesia significantly accelerated the onset of sensory blockade and increased its maximum height and duration.

scholarly journals The Effects of 2 μG and 4 μG Doses of Dexmedetomidine in Combination with Intrathecal Hyperbaric Bupivacaine on Spinal Anesthesia and its Postoperative Analgesic Characteristics

2014 ◽  
Vol 19 (2) ◽  
pp. 75-81 ◽  
Author(s):  
Abdulkadir Yektaş ◽  
Enver Belli
Keyword(s):  
Side Effects ◽  
Spinal Anesthesia ◽  
Intrathecal Injection ◽  
Military Hospital ◽  
Hyperbaric Bupivacaine ◽  
Analgesic Effects ◽  
Group 3 ◽  
First Pain ◽  
Different Doses ◽  
Group 1

OBJECTIVE: To compare the postoperative analgesic characteristics and side effects of two different doses of intrathecal dexmedetomidine in combination with hyperbaric bupivacaine, and to evaluate the effects of these combinations on spinal anesthesia.METHODS: After obtaining approval from the local ethics committee, 60 male patients who were undergoing inguinal surgery and were classified as American Society of Anesthesiologists physical status class I were included in the study. The present study was conducted in 2003 in a military hospital with a capacity of 100 beds. The patients were randomly assigned to three groups of 20 patients: group 1, 0.5 mL saline added to 3 mL (15 mg) hyperbaric bupivacaine; and groups 2 and 3, 2 μg dexme-detomidine and 4 μg dexmedetomidine added to 3 mL (15 mg) hyperbaric bupivacaine, respectively. Medications were administered by intrathecal injection in a total volume of 3.5 mL. The postoperative analgesic characteristics, effects on spinal anesthesia and side effects were recorded.RESULTS: Demographic characteristics were similar among the groups. The mean (± SD) time to onset of pain was 220.75±112.7 min in group 1, 371.5±223.5 min in group 2 and 1042.50±366.78 min in group 3. Time to first pain sensation in group 3 was significantly longer than that in groups 1 and 2 (P<0.001).CONCLUSION: Two different doses of dexmedetomidine, an α2-adrenoceptor agonist with analgesic effects, resulted in an increased duration of analgesia and efficacy, decreased postoperative analgesic use and was associated with no notable adverse effects.

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