scholarly journals Comparison of Effect of Intrathecal Fentanyl-bupivacaine and Tramadol-bupivacaine Combination on Postoperative Analgesia in Lower Abdominal Surgeries

2016 ◽  
Vol 1 (2) ◽  
pp. 35-40 ◽  
Author(s):  
Naina P Dalvi ◽  
Narendra Patil
Keyword(s):  
Blood Pressure ◽  
Postoperative Analgesia ◽  
Total Duration ◽  
Double Blind Study ◽  
Motor Blockade ◽  
Hyperbaric Bupivacaine ◽  
Double Blind ◽  
Sensory Blockade ◽  
Prolonged Duration ◽  
American Society

ABSTRACT Introduction This single-center, prospective, randomized, double-blind study compares the effect of intrathecal fentanylbupivacaine and tramadol-bupivacaine on the onset and duration of sensory and motor blockade, as well as postoperative analgesia in lower abdominal surgeries. Materials and methods Patients of either sex, aged 18 to 60 years, American Society of Anesthesiologists (ASA) grade I/II undergoing lower abdominal surgeries like appendicectomy, inguinal hernia repair surgery, and hydrocele surgery were administered either 2.5 mL of 0.5% bupivacaine + 0.5 mL (25 μg) of fentanyl citrate (group F) or 2.5 mL of 0.5% bupivacaine + 0.5 mL (25 mg) of tramadol (group T) intrathecally. Monitoring of the vital parameters, onset and duration of sensory and motor block, duration of postoperative analgesia, visual analog scale (VAS) score, sedation score, and any adverse drug reactions was done at predetermined intervals. Results Sixty patients were randomized to the group F (n = 30) and group T (n = 30). The duration of sensory blockade was significantly prolonged in group F (314.66 ± 49.25 minutes) as compared to group T (261.66 ± 27.92 minutes). Similarly, duration of motor blockade was longer in group F (263.66 ± 40.97 minutes) compared to group T (214.66 ± 26.61 minutes). The total duration of analgesia was significantly prolonged (p < 0.001) in group F (412 ± 97.888 minutes) compared to group T (301 ± 38.75 minutes). Hemodynamic parameters, such as pulse, systolic blood pressure, diastolic blood pressure and oxygen saturation were comparable in both the groups. Visual analog scores were significantly lower in the group F patients as compared to the group T patients. The group F patients had got significantly higher sedation scores as compared to Group T patients. Discussion Fentanyl 25 μg, when added to 2.5 mL of 0.5% hyperbaric bupivacaine, confers prolonged duration of sensory and motor blockade than 25 mg tramadol added to 2.5 mL of 0.5% hyperbaric bupivacaine. The bupivacaine-fentanyl combination prolonged duration of sensory and motor blockade, improved analgesia, as manifested by lower pain scores, and prolonged duration of postoperative analgesia. How to cite this article Dalvi NP, Patil N. Comparison of Effect of Intrathecal Fentanyl-bupivacaine and Tramadol-bupivacaine Combination on Postoperative Analgesia in Lower Abdominal Surgeries. Res Inno in Anesth 2016;1(2):35-40.

scholarly journals Comparision of dexmedetomidine and clonidine with hyperbaric bupivacain in spinal anaesthesia

2021 ◽  
Vol 8 (12) ◽  
pp. 3563
Author(s):  
Anshul Agrawal ◽  
Sunita Jain ◽  
Ashish Goyal
Keyword(s):  
Spinal Anaesthesia ◽  
Onset Time ◽  
Peak Level ◽  
Sensory Block ◽  
Double Blind Study ◽  
Motor Blockade ◽  
Hyperbaric Bupivacaine ◽  
Double Blind ◽  
Sensory Blockade ◽  
Lower Limb Surgery

Background: Alpha-2 adrenergic agonists used as adjuvant to spinal anaesthesia produce substantial sensory and motor blockade of bupivacaine. This study was planned to compare the sensory and motor blockade characteristics of intrathecal combinations of adjuvants dexmedetomidine and clonidine with hyperbaric bupivacaine in the cases who underwent lower limb surgery under spinal anaesthesia.Methods: This was prospective, randomized, double blind study. 90 patients of age group between 18-60 years, ASA grade I and II were allotted into 3 equal groups. Group B received 15 mg bupivacaine plain, group BD and BC received dexmedetomidine (5mcg) and clonidine (50mcg) as adjuvants to bupivacaine respectively.Results: The duration of 2 dermatome regression time, sensory blockade and motor blockade were longest in dexmedetomidine group (129.37±4.87; 386±58.43; 353±48.87) in compared to clonidine (109.77±5.95; 296.53±57.19; 269.7±51.2) and bupivacaine group (81.03±6.83; 211.1± 30.47;181.03±20.8). Both drugs do not affect the peak level of sensory blockade, sensory block onset and motor block onset time. Dexmedetomidine and clonidine do not cause sedation in intraoperative and postoperative period.Conclusions: We conclude that addition of dexmedetomidine and clonidine in spinal anesthesia with hyperbaric bupivacaine increase the duration of ‘2 dermatome regression’ time, sensory and motor blockade and both are more with dexmedetomidine than with clonidine.

Phenylephrine Added to Prophylactic Ephedrine Infusion during Spinal Anesthesia for Elective Cesarean Section

2001 ◽  
Vol 95 (3) ◽  
pp. 668-674 ◽  
Author(s):  
Frédéric J. Mercier ◽  
Edward T. Riley ◽  
Willard L. Frederickson ◽  
Sandrine Roger-Christoph ◽  
Dan Benhamou ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Spinal Anesthesia ◽  
Cesarean Delivery ◽  
Elective Cesarean Section ◽  
Hyperbaric Bupivacaine ◽  
Double Blind ◽  
Elective Cesarean ◽  
American Society ◽  
Spinal Hypotension

Background Because ephedrine infusion (2 mg/min) does not adequately prevent spinal hypotension during cesarean delivery, the authors investigated whether adding phenylephrine would improve its efficacy. Methods Thirty-nine parturients with American Society of Anesthesiologists physical status I-II who were scheduled for cesarean delivery received a crystalloid preload of 15 ml/kg. Spinal anesthesia was performed using 11 mg hyperbaric bupivacaine, 2.5 microg sufentanil, and 0.1 mg morphine. Maternal heart rate and systolic blood pressure were measured at frequent intervals. A vasopressor infusion was started immediately after spinal injection of either 2 mg/min ephedrine plus 10 microg/min phenylephrine or 2 mg/min ephedrine alone. Treatments were assigned randomly in a double-blind fashion. The infusion rate was adjusted according to systolic blood pressure using a predefined algorithm. Hypotension, defined as systolic blood pressure less than 100 mmHg and less than 80% of baseline, was treated with 6 mg ephedrine bolus doses. Results Hypotension occurred less frequently in the ephedrine-phenylephrine group than in the ephedrine-alone group: 37% versus 75% (P = 0.02). Ephedrine (36+/-16 mg, mean +/- SD) plus 178+/-81 microg phenylephrine was infused in former group, whereas 54+/-18 mg ephedrine was infused in the latter. Median supplemental ephedrine requirements and nausea scores (0-3) were less in the ephedrine-phenylephrine group (0 vs. 12 mg, P = 0.02; and 0 vs. 1.5, P = 0.01, respectively). Umbilical artery pH values were significantly higher in the ephedrine-phenylephrine group than in the group that received ephedrine alone (7.24 vs. 7.19). Apgar scores were similarly good in both groups. Conclusion Phenylephrine added to an infusion of ephedrine halved the incidence of hypotension and increased umbilical cord pH.

scholarly journals Effect of Lateral Posture on Epidural Blockade for Surgery

1983 ◽  
Vol 11 (2) ◽  
pp. 97-102 ◽  
Author(s):  
L. T. Seow ◽  
F. J. Lips ◽  
M. J. Cousins
Keyword(s):  
Lateral Position ◽  
Double Blind Study ◽  
Motor Blockade ◽  
Volume Data ◽  
Time Intervals ◽  
Double Blind ◽  
Sensory Blockade ◽  
Epidural Blockade ◽  
Initial Onset ◽  
Lateral Posture

In a prospective double-blind study, single-dose lumbar epidural blockade was administered to 60 healthy patients undergoing lower abdominal surgery, the patients lying in the lateral position only during the time of injection of the local anaesthetic. Solutions used were bupivacaine HCl 0.5%, lignocaine HCl 2% and lignocaine-bupivacaine mixtures in the ratios of 1:3, 1:1 and 3:1 by volume. Data were pooled and analysed for the effects of posture on epidural blockade. Using skin temperature as a criterion of sympathetic blockade, onset of blockade was more rapid and there was more prolonged blockade on the dependent side. Initial onset of sensory blockade was faster on the dependent side by I minute and 3.1 minutes for partial and complete blockade, respectively. Mean duration of sensory blockade was longer in the dependent dermatomes for partial (14, SD 7, minutes, T6-L4) and complete blockade (20, SD 6, minutes, T8-L3) respectively. Initial onset of complete motor blockade was 5 minutes more rapid on the dependent side, with mean myotome score consistently greater at all time intervals on the dependent side. Our study therefore suggests that a more efficacious sensory and motor blockade could be achieved by lying the patient on the operative side during the administration of the epidural and injection of the local anaesthestic solution close to the operative dermatomes.

scholarly journals Comparison between intrathecal bupivacaine and combination of bupivacaine and midazolam for postoperative pain relief after infraumbilical elective surgeries

2020 ◽  
Vol 8 (11) ◽  
pp. 4031
Author(s):  
Neha Sharma ◽  
Chetan Shukla
Keyword(s):  
Postoperative Analgesia ◽  
Motor Block ◽  
Demographic Data ◽  
Sample Size Calculation ◽  
Sensory Block ◽  
Double Blind Study ◽  
Hemodynamic Changes ◽  
Hyperbaric Bupivacaine ◽  
Sensory Blockade ◽  
To Receive

Background: Objective of the study was to identify the efficacy of midazolam as an adjuvant to intrathecal hyperbaric bupivacaine 0.5%, a prospective, randomized, double blind study was conducted to compare the onset, duration of sensory and motor block, postoperative analgesia, hemodynamic changes and complications.Methods: Sixty patients, ASA I/II, Age 18-60 year, scheduled for infraumbilical surgeries, were randomly allocated to group BNS(n=30) to receive intrathecally 2.5 ml of 0.5% hyperbaric bupivacaine with 0.4 ml normal saline; and group BM (n=30) to receive 2.5 ml of 0.5% hyperbaric bupivacaine +2 mg preservative free midazolam 0.4 ml (5mg/ml). We observed onset, duration and regression of sensory and motor block, degree of sedation and pain scores, hemodynamic changes and adverse effects. (PS) version 3.0.0.34 was used for power and sample size calculation. Statistical analysis was performed using Microsoft (MS) office excel software with the student’s t-test and chi-square test (P=0.05)Results: Highest level of sensory blockade (p<.05), motor block duration (179.67±14.94 vs 151.83±10.96 min), sensory block duration (222±16.5 vs 174±12.53 min) and time to first requirement of i.v. analgesia were significantly higher in group BM. Postoperative VAS score was significantly less in group BM. Both groups were comparable in demographic data and hemodynamic changes.Conclusions: Intrathecal 2 mg midazolam found as an attractive adjuvant to 0.5% hyperbaric bupivacaine in spinal anesthesia in infraumbilical surgeries by producing significantly longer duration of motor and sensory block, good quality of intraoperative and postoperative analgesia with less incidence of nausea vomiting as compared to bupivacaine alone. 

scholarly journals Comparison of dexmedetomidine and buprenorphine as an adjuvant to bupivacaine during spinal anaesthesia for tibial interlocking nailing surgeries

2017 ◽  
Vol 4 (6) ◽  
pp. 1653
Author(s):  
Amitha S. ◽  
Pradeep R.
Keyword(s):  
Spinal Anesthesia ◽  
Spinal Anaesthesia ◽  
Motor Blockade ◽  
Hyperbaric Bupivacaine ◽  
Chi Square ◽  
Double Blind ◽  
Sensory Blockade ◽  
Exact Test ◽  
Interlocking Nailing ◽  
Group 3

Background: Buprenorphine is being used as an adjuvant to local anaesthetic for spinal anaesthesia since long. Dexmedetomidine is a new drug which has got alpha 2 agonistic property, and is being tried for spinal anesthesia along with bupivacaine in recent times. Settings and Design: This study was conducted in a prospective, randomized, controlled and double-blind manner. The study included ninety American Society of Anaesthesiologists class I and II patients undergoing tibial interlocking nailing surgeries under spinal anaesthesia.Methods: The patients were randomly divided into three groups (n=30 each) by closed envelope technique. Patients in group 1 received 15 mg of 0.5% hyperbaric bupivacaine, group 2 received 15 mg of 0.5% hyperbaric bupivacaine with 30μg of buprenorphine, and group 3 received 15 mg of 0.5% hyperbaric bupivacaine with 5μg dexmedetomidine for spinal anesthesia. The duration of motor and sensory blockade and any adverse events were recorded. Data were analysed using Chi-square test or Fisher’s exact test for categorical data and analysis of variance for continuous data. A value of P<0.05 was considered as statistically significant.Results: In our study the subjects in group 3 (dexmedetomidine) group had significantly longer period of motor blockade (240±20min) and sensory blockade (180±22.2min) compared to other groups, which is statistically significant (P=0.0001 and P= 0.006 respectively). The time to first request of analgesic in the post-operative period was also longer (240±30.2min) in dexmedetomidine group when compared with other groups (P=0.0001). There were no untoward complications (hypotension, sedation) in any groups.Conclusions: We concluded that dexmedetomidine (5μg) with bupivacaine for spinal anesthesia gives significantly longer duration of sensory and motor blockade, than buprenorphine (30μg) with bupivacaine for spinal anaesthesia.

scholarly journals Comparison between intrathecal nalbuphine and butorphanol as adjuvants to isobaric ropivacaine in elective lower limb orthopedic surgeries: A prospective, randomized, double blind study

2020 ◽  
Author(s):  
Akash Nirmal ◽  
Yashpal Singh ◽  
Sharad Kumar Mathur ◽  
Satish Patel
Keyword(s):  
Postoperative Analgesia ◽  
Lower Limb ◽  
Primary Outcome Measure ◽  
Blind Study ◽  
Double Blind Study ◽  
Motor Blockade ◽  
Chi Square ◽  
Double Blind ◽  
Lower Limb Surgery ◽  
To Receive

Background: Intrathecal ropivacaine is now routinely used for lower limb surgery. Adjuvants e.g. fentanyl, dexmedetomidine or morphine etc. are commonly used to prolong the intraoperative anesthesia or postoperative analgesia. The available literature lacks information on use of butorphanol and nalbuphine as adjuvants with 0.75% isobaric ropivacaine. We aimed to compare nalbuphine and butorphanol as adjuvant with isobaric ropivacaine in lower limb orthopedic surgeries. Methodology: After institutional ethical committee approval and informed written consent, a total of 108 patients of ages between 18 to 65 y, of either sex, American Society of Anesthesiologists (ASA) grade ӏ & ӏӏ, scheduled for elective lower limb orthopedic surgeries, were enrolled and  randomly allocated into two groups: Group RN; to receive isobaric ropivacaine (0.75%, 7.5 mg/ml) 2.5 ml plus nalbuphine 500 µg (0.5 ml), and Group RB; to receive isobaric ropivacaine 2.5 ml plus butorphanol 100 µg (0.5 ml) intrathecally. Primary outcome measure was the duration of sensory‑motor blockade from the time of intrathecal drug administration. Statistical analysis was performed by using t-test and chi-square test as applicable. A p < 0.05 was considered as significant. Results: Duration of sensory (p < 0.001) and motor blockade (p = 0.02) was significantly prolonged in nalbuphine group than butorphanol group. Onset of blockade was earlier in nalbuphine group. Duration of motor block and sensory analgesia was prolonged in group RN (p < 0.001). Perioperative hemodynamic parameters and the observed side effects including bradycardia, hypotension, nausea and vomiting, sedation and shivering were comparable between the two groups (p = 0.77). Conclusion: Intrathecal nalbuphine produces prolonged motor blockade as well as postoperative analgesia than intrathecal butorphanol when used as adjuvants to isobaric 0.75% ropivacaine. Citation: Nirmal A, Singh Y, Mathur SK, Patel S. Comparison between intrathecal nalbuphine and butorphanol as adjuvants to isobaric ropivacaine in elective lower limb orthopedic surgeries: A prospective, randomized, double blind study. Anaesth pain & intensive care 2019;23(4)__ Received: 22 August 2019; Reviewed: 8, 9 October 2019; 6, 7 November 2019; Revised: 18 November 2019; Reviewed: 19 November 2019; Accepted: 20 November 2019

Epidural dexamethasone for postoperative analgesia in patients of carcinoma rectum undergoing lower anterior resection (LAR)

JMS SKIMS ◽  
2019 ◽  
Vol 22 (1) ◽  
Author(s):  
Sheikh Irshad Ahmad ◽  
Gowhar Hameed ◽  
Tanveera Gani ◽  
Tantry Tariq Gani ◽  
Wasim Mohammad Bhat ◽  
...  
Keyword(s):  
Postoperative Analgesia ◽  
Anterior Resection ◽  
Double Blind Study ◽  
Double Blind ◽  
Rescue Analgesia ◽  
Carcinoma Rectum ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
To Receive ◽  
Lower Anterior Resection

Background and Aims: This prospective, randomized, double blind study was undertaken to establish the effect of addition of dexamethasone as an adjunct to epidural ropivacaine in patients of carcinoma rectum undergoing lower anteriorresection. Materials and Methods: Sixty ASA (American Society of Anesthesiologists) class I and II patients undergoing lower anterior resection were enrolled to receive either 6mg or 8mg or 10mg of dexamethasone along with epidural ropivacaine to a total of 10ml test solution in each group for epidural analgesia. Hemodynamic parameters, postoperative analgesia, total requirement of rescue analgesia and adverse events were monitored. Results: Analgesia in the postoperative period was better in Group receiving 10mg of dexamethasone associated with less postoperative rescue analgesic consumption Conclusion: Hence, addition of dexamethasone 10mg to epidural ropivacaine can be advantageous with respect to better postoperative analgesia.

scholarly journals Clinical efficacy of clonidine versus nalbuphine as intrathecal adjuvants to 0.5% hyperbaric bupivacaine for subarachnoid block during gynaecological procedures: a double blind study

2017 ◽  
Vol 5 (6) ◽  
pp. 2540 ◽  
Author(s):  
Manoranjan Bansal ◽  
Shikha Agarwal ◽  
Kumkum Gupta ◽  
Prashant K. Gupta ◽  
Salony Agarwal ◽  
...  
Keyword(s):  
Regional Anesthesia ◽  
Clinical Efficacy ◽  
Postoperative Analgesia ◽  
Sensory Block ◽  
Double Blind Study ◽  
Hyperbaric Bupivacaine ◽  
Double Blind ◽  
Rescue Analgesia ◽  
Intrathecal Clonidine ◽  
Increasing Trends

Background: Regional anesthesia techniques for gynaecological 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 gynaecological procedures.Methods: Regional anesthesia techniques for gynaecological 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 gynaecological procedures.Results: The onset of sensory block was earlier in patients of Group BN (3.91±2.25 min vs 4.30±0.87 min, p=0.039). The onset of motor block was also earlier in patients of Group BN (p=0.042). The time to first rescue analgesia in patients receiving intrathecal clonidine was significantly delayed (283±14.18 min vs 231.50±26.18 min, p=0.001). Intraoperative hemodynamic changes were comparable and none of the patient suffered from respiratory depression, shivering, nausea or vomiting.Conclusions: Intrathecal clonidine as adjuvant to bupivacaine provided was clinically more effective than nalbuphine for prolonging the duration of analgesia for gynaecological procedures.

scholarly journals COMPARISON OF INTRATHECAL HYPERBARIC ROPIVACAINE 0.5% WITH AND WITHOUT 75 MG MAGNESIUM SULFATE AS AN ADJUVANT FOR INFRA UMBILICAL SURGERIES: A DOUBLE-BLIND RANDOMIZED CLINICAL TRIAL

2021 ◽  
pp. 117-121
Author(s):  
SRINIDHI SRIKANTH ◽  
ANTONY JOHN CHARLES S ◽  
YASHA KAMAESHAR ◽  
GAYATRI MISHRA
Keyword(s):  
Clinical Trial ◽  
Adverse Effects ◽  
Magnesium Sulfate ◽  
Statistical Tests ◽  
Total Duration ◽  
Motor Blockade ◽  
Double Blind ◽  
Sensory Blockade ◽  
Free Interval ◽  
Post Operative Pain

Objective: Intrathecal magnesium as an adjuvant to hyperbaric ropivacaine could extend duration of sensory blockade and improve the quality of post-operative analgesia; thereby reducing opioid requirements and its adverse effects. Hence, we conducted this prospective, randomized, double-blind clinical trial to observe its effects for day care surgeries. Methods: After obtaining institutional ethical committee approval and registration of trial, patients’ informed consent was taken and eighty adult patients of either gender, ASA 1 and 2, posted for infra umbilical surgeries were divided into two groups: Group RM received 3 ml hyperbaric Ropivacaine with 0.75 ml magnesium sulfate (75 mg) and Group R received 3 ml hyperbaric Ropivacaine with 0.75 ml sterile water. Sensory and motor blockade parameters, hemodynamic variables, and adverse effects were monitored, analyzed using appropriate statistical tests. Results: Total duration of sensory blockade was significantly prolonged in Group RM compared to Group R (242.8 ± 9.9 versus 186.6 ± 8.4 min) (***p<0.001). Complete motor regression was observed significantly earlier in Group RM than in Group R (151.3 ± 7.8 versus 184.7 ± 5.6 min) (*p<0.05). Post-operative pain free interval was significantly prolonged in group RM compared to group R (725.2 ± 18.6 vs. 515.2 ± 17.8 min) (***p<0.001). Conclusion: We concluded that intrathecal magnesium as an adjuvant to hyperbaric Ropivacaine significantly prolonged both sensory blockade duration, post-operative pain-free interval without increasing motor blockade duration and the incidence of adverse effects.

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.

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