Comparison of the Effects of Pre-Anesthetic Administration of Normal Saline, Ringer and Voluven on the Spread of Sensory Block With Hyperbaric Bupivacaine Spinal Anesthesia

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.

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

Asian Journal of Medical Sciences ◽

10.3126/ajms.v11i2.26548 ◽

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.

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INTRATHECAL 1% 2 CHLOROPROCAINE V/S 0.5% HYPERBARIC BUPIVACAINE IN AMBULATORY SURGERY

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v5i8.2103 ◽

2021 ◽

Vol 5 (8) ◽

Author(s):

Mukesh Choudhary ◽

Abhimanyu Singh

Keyword(s):

Spinal Anesthesia ◽

Hospital Discharge ◽

Ambulatory Surgery ◽

Sensory Block ◽

Ambulatory Setting ◽

Interventional Study ◽

Hyperbaric Bupivacaine ◽

Double Blind ◽

Subarachnoid Block

Background: Aims of the study to compare 2-CP with bupivacaine for spinal anesthesia in an elective ambulatory setting. Methods: Hospital based Randomized, Double Blind, Interventional study conducted on patients undergoing for ambulatory surgery under subarachnoid block. Results: The finding that shows the most significant advantage is the time for regression of the sensory block to S2, as 2-CP was faster than bupivacaine. Conclusion: 2-chloroprocaine provides adequate duration and depth of surgical anesthesia for short procedures with the advantages of faster block resolution and earlier hospital discharge compared with spinal bupivacaine Keywords: 2-chloroprocaine, Bupivacaine, Ambulatory surgery

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Comparison of effects of Bupivacaine and Ropivacaine in patients undergoing elective Caesarean section

Birat Journal of Health Sciences ◽

10.3126/bjhs.v4i3.27042 ◽

2020 ◽

Vol 4 (3) ◽

pp. 859-863

Author(s):

Sangeeta Subba ◽

Arjun Arjun Chhetri ◽

Rupak Bhattarai

Keyword(s):

Cesarean Section ◽

Spinal Anesthesia ◽

Motor Block ◽

Elective Caesarean Section ◽

Sensory Block ◽

Elective Cesarean Section ◽

Hyperbaric Bupivacaine ◽

Safe Alternative ◽

Elective Cesarean ◽

Group B

Introduction: Spinal anesthesia is considered a reasonable choice for cesarean section. Bupivacaine and ropivacaine have been used as intrathecal drugs alone or in combination with various opioids. Ropivacaine is considered a valid and safe alternative to bupivacaine for spinal anesthesia. Objectives: To compare the efficacy and safety of hyperbaric ropivacaine with hyperbaric bupivacaine in spinal anesthesia for elective cesarean section. Methodology: Sixty pregnant women undergoing elective cesarean section were allocated into two groups. Group R received 3 ml of 0.5% hyperbaric ropivacaine (2 ml 0.75% plain ropivacaine mixed with 1 ml of 25 %dextrose) and Group B received 2.5 ml of 0.5% hyperbaric bupivacaine. Both the groups were compared in terms of onset of sensory and motor block, regression of sensory and motor block, duration of analgesia and side effects. Results: The onset of sensory block was comparable in both groups but was statistically insignificant. The onset of motor block in Bupivacaine(7.53 ± 1.72) min was faster when compared to Ropivacaine group(14.33 ± 6.19) min. Regression of sensory and motor block both were faster in Ropivacaine group. Duration of analgesia was longer in Bupivacaine group(131.17 ± 32.95)min than Ropivacaine group(125.33 ± 30.54)min. Conclusion: Ropivacaine can be used as an alternative to Bupivacaine for spinal anesthesia in cesarean section but has a shorter duration of sensory and motor block.

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CLONIDINE AS AN ADJUVANT TO HYPERBARIC BUPIVACAINE FOR SPINAL ANESTHESIA IN ELDERLY PATIENTS UNDERGOING INFRAUMBLICAL SURGERIES

10.36106/ijsr/3217567 ◽

2021 ◽

pp. 72-74

Author(s):

Purushottam Singhal ◽

Suresh Pandey ◽

. S. P. Chittora

Keyword(s):

Blood Pressure ◽

Elderly Patients ◽

Systolic Blood Pressure ◽

Spinal Anesthesia ◽

Sensory Block ◽

Primary Study ◽

Control Group ◽

Sensory Level ◽

Hyperbaric Bupivacaine ◽

Small Doses

Background: Use of adjuvant with small doses of local anesthetics is a preferred technique for spinal anesthesia for lower limb surgeries. This study tested the hypothesis that addition of small doses of clonidine augments the spinal block levels produced by hyperbaric bupivacaine in patients without affecting the side-effects. Materials and Methods: This was a prospective, randomized, double-blind study. Above 60 years patients were allocated to three equal groups. Group C received 10 mg hyperbaric bupivacaine without clonidine while Group C and Group C received 15 μg and 30 μg clonidine with 15 30 hyperbaric bupivacaine respectively for spinal anesthesia. Effect of clonidine on sensory block levels was the primary study outcome measure. Motor blockade and hemodynamic parameters were also studied. Results:Asignicantly higher median block levels were achieved in Group C (P < 0.05) and Group C (P <0.05) than Group C. Highest median 15 30 sensory block level, the mean times for sensory regression to T12 level and motor block regression were statistically signicant between Groups C15 and C and between Groups C and C. On comparison of fall in systolic blood pressure trends, there was no signicant difference in the clonidine 30 groups as compared with the control group. Conclusions: In elderly patients, clonidine when used intrathecally in doses of 15 μg or 30 μg with bupivacaine, signicantly potentiated the sensory block levels and duration of analgesia without affecting the trend of systolic blood pressure as compared to bupivacaine alone. Clonidine in doses of 30 μg however facilitated the ascent of sensory level block to unexpectedly higher dermatomes for a longer time.

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Correlation between anthropometric measurements and sensory block level of spinal anesthesia for cesarean section

Anesthesiology and Pain Medicine ◽

10.5812/aapm.118627 ◽

2021 ◽

Vol In Press (In Press) ◽

Author(s):

Hyojoong Kim ◽

Sung Hyun Shin ◽

Myoung Jin Ko ◽

Yei Heum Park ◽

Ki Hwa Lee ◽

...

Keyword(s):

Cesarean Section ◽

Spinal Anesthesia ◽

Sensory Block ◽

Anthropometric Measurements ◽

Abdominal Circumference ◽

Hip Circumference ◽

Height Ratio ◽

Hyperbaric Bupivacaine ◽

Spinal Anesthetic ◽

Block Level

Background: When performing spinal anesthesia for cesarean section, it is important to determine the appropriate anesthetic dose as well as to predict the level of spinal anesthesia. In this study, it was hypothesized that some anthropometric measurements may be related to maximum sensory block and hemodynamic changes. Objectives: The aim of this study are to find maternal anthropometric values that are correlate with the level of spinal anesthesia. Methods: Maternal anthropometric measurements, including height, weight, supine and standing abdominal circumference (AC), and hip circumference, were recorded before spinal anesthesia for cesarean section. Spinal anesthesia was induced by administering 8 mg of 0.5% hyperbaric bupivacaine and 20 μg of fentanyl at the L3-L4 interspace. The level of sensory block was determined using pin-prick at 1, 5, 10, and 15 minutes after spinal anesthesia. The sensory block level and hemodynamic adverse events were analyzed in relationship to anthropometric measurements. Results: The supine AC/height ratios significantly correlate with the maximal sensory block level at 5, 10, and 15 minutes after the injection of spinal anesthetic (p = 0.001, p < 0.001 and p < 0.001, respectively). Further, there were significant correlations between body mass index (BMI) and sensory block level at every assessment (p = 0.041, p = 0.002, p = 0.001 and p < 0.001, respectively). When comparing the groups with and without hypotension, BMI, weight, and supine AC/height ratio were found to be significantly higher in the group with hypotension (p = 0.002, p = 0.004 and p = 0.006, respectively). Conclusions: We conclude that BMI and AC/height ratio correlate with the sensory block level of spinal anesthesia for cesarean section.

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UNILATERAL SPINAL ANESTHESIA FOR LOWER EXTREMITY SURGERY

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2014.2.5 ◽

2014 ◽

pp. 29-34

Author(s):

Van Long Le ◽

Van Minh Nguyen ◽

Kha Canh Ho

Keyword(s):

Lower Extremity ◽

Spinal Anesthesia ◽

Motor Block ◽

Randomized Study ◽

Sensory Block ◽

Orthopedic Procedures ◽

Hyperbaric Bupivacaine ◽

Bilateral Group ◽

Unilateral Spinal Anesthesia ◽

Unilateral Group

Objective: To compare the efficacy of unilateral spinal anesthesia by heavy bupivacaine with conventional bilateral anesthesia for lower extremity surgery. Methods: In this prospective randomized study, eighty two patients undergoing elective lower extremity orthopedic surgery were randomly allocated into two groups, unilateral and bilateral. All patients received intrathecally 8 mg of hyperbaric bupivacaine 0.5% over 40 seconds at the L3-4 intervertebral space. A lateral decubitus position after spinal injection was maintained in the unilateral group for 15 min. The onset and recovery of sensory and motor block and perioperative side effects were recorded. Results: Success rate of unilateral anesthesia was 82.9%. In the unilateral group, the sensory block for surgery (above L1) (181.5 ± 18.9 versus 150.0 ± 20.1 min), motor block time (149.3 ± 18.4 versus 121.5 ± 16.4 min) were longer and incidence of hypotension (2.4 versus 29.3%) was lower than those in the bilateral group. Onset of sensory block (3.5 ± 1.1 versus 3.3 ± 0.9 min), succes rate of anesthesia (100% in both groups), incidences of intraoperative nausea, vomiting and agitation and postoperative nausea, vomiting, headache and heart rate, respiratory changes were not significant between two groups. Conclusion: Unilateral spinal anesthesia provided longer sensory and motor block, lower incidence of hypotention in comparison with conventional bilateral anesthesia. This is a suitable technique for lower limb orthopedic procedures. Key words: Unilateral spinal anesthesia, lower extremity surgery

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Effect of Intrathecal Dexmedetomidine in Preventing Intra-operative Shivering after Spinal Anesthesia

Journal of Advances in Medicine and Medical Research ◽

10.9734/jammr/2021/v33i630858 ◽

2021 ◽

pp. 17-26

Author(s):

Hossam Ibrahim Ibrahim ◽

Hesham Elsayed Elashry ◽

Reda Sobhy Abdel Rahman ◽

Osama Mahmoud Shalaby

Keyword(s):

Relative Risk ◽

Confidence Interval ◽

Spinal Anesthesia ◽

Normal Saline ◽

Lower Limb ◽

Randomized Study ◽

Hyperbaric Bupivacaine ◽

Double Blind ◽

Equal Group ◽

Group B

Background: Dexmedetomidine (DEX) has sedative, analgesic, sympatholytic, anesthetic-sparing and hemodynamic-stabilizing properties. This study aims to evaluate the effects of intrathecal DEX as an adjuvant to hyperbaric bupivacaine in the prevention of shivering in patients who underwent surgeries under Intrathecal anesthesia. Methods: A prospective double-blind, controlled, randomized study was conducted on 100 patients aged above 21 years old, ASA I & II undergoing lower limb orthopedic surgeries under intrathecal anesthesia. Patients were subdivided randomly into 2 equal group; Group Bupivacaine-Dexmedetomidine (BD): 5 µg dexmedetomidine diluted in 0.5 ml 0.9% normal saline was added to 12.5 mg heavy bupivacaine 0.5% and Group Bupivacaine (B): 0.5 ml 0.9% normal saline was added to 12.5mg heavy bupivacaine 0.5% (3ml volume). Results: Shivering occurred in 9 patients (18%) in group BD and 23 patients (46%) in group B with a significant decrease in group BD compared to group B (P = 0.003). The relative risk of developing shivering was decreased 53% (95% Confidence Interval: 74 – 16%) with group BD compared to group B. Tsai and Chu score was significantly better in group BD (P = 0.013). Conclusion: The use of intrathecal DEX (5μg) in conjugation with heavy bupivacaine help decrease the incidence and intensity of shivering when compared with heavy bupivacaine alone in surgeries under spinal anesthesia.

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A randomized double blind study to compare 1% 2-chloroprocaine and 0.5% hyperbaric bupivacaine in spinal anesthesia for infra-umbilical surgeries

Anaesthesia, Pain & Intensive Care ◽

10.35975/apic.v23i2.1061 ◽

2019 ◽

pp. 162-167

Author(s):

Arvind Khare ◽

Beena Thada ◽

Devraj Yadav

Keyword(s):

Spinal Anesthesia ◽

Motor Block ◽

Sensory Block ◽

Double Blind Study ◽

Hemodynamic Parameters ◽

Hyperbaric Bupivacaine ◽

Double Blind ◽

Voiding Function ◽

Group A ◽

Group B

Background: Spinal anesthesia is a reliable and safe technique for infra-umbilical surgeries. Preservative-free 2-chloroprocaine has re-emerged for use in spinal anesthesia. We compared onset and duration of sensory block with intrathecal use of 1% 2-chloroprocaine (30 mg) or 0.5% Hyperbaric Bupivacaine (15 mg) as primary objective. Secondary objectives being onset and duration of motor block, duration of analgesia, time to return of voiding function, hemodynamic parameters and side effects.Methodology: 90 patients of age group 18-60 years, either sex, belonging to ASA physical status I/II undergoing infra-umbilical surgeries were randomly divided into two groups, 1% 2-chloroprocaine Group A (n=45) and 0.5% hyperbaric bupivacaine Group B (n=45). Each group received intrathecally either 30 mg of 2-chloroprocaine or 15 mg of hyperbaric bupivacaine 15 mg. For statistical analysis unpaired-t-test and chi-square test were used.Results: Earlier onset and shorter duration of sensory block were observed in Group A as compared to Group B respectively (p < 0.001). Similarly, onset was earlier and duration of motor block, duration of analgesia and time to return of voiding function were shorter in Group A as compared to Group B respectively (p < 0.001). Hemodynamic parameters (HR, MAP) were comparable in both groups.Conclusion: Intrathecal 1% 2-chloroprocaine 30 mg provides spinal anesthesia of adequate duration for infra-umbilical surgeries with the advantage of earlier onset and faster regression of spinal block resulting in earlier voiding with stable hemodynamics as compared to 0.5% hyperbaric bupivacaine 15 mg.Citation: Khare A, Thada B, Yadav D, Mathur V, Singh M. A randomized double blind study to compare 1% 2-chloroprocaine and 0.5% hyperbaric bupivacaine in spinal anesthesia for infra-umbilical surgeries. Anaesth. pain & intensive care 2019;23(2):162-167

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Evaluation of adjunctive analgesia with intrathecal fentanyl along with hyperbaric bupivacaine in spinal anesthesia for elective cesarean section

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20203439 ◽

2020 ◽

Vol 8 (8) ◽

pp. 2924

Author(s):

Ranu Neelamchand Surana ◽

Trishala Jain

Keyword(s):

Side Effects ◽

Cesarean Section ◽

Spinal Anesthesia ◽

Analgesic Efficacy ◽

Sensory Block ◽

Elective Cesarean Section ◽

P Value ◽

Hyperbaric Bupivacaine ◽

Analgesic Requirement ◽

Elective Cesarean

Background: Cesarean section (CS) is one of the most common surgical procedures in female patients. Authors aimed to evaluate the postoperative analgesic efficacy of adding intrathecal fentanyl to bupivacaine, and its effect on the onset and duration of spinal anesthesia along with its effect on mother and neonate.Methods: Study was performed on 60 cesarean section parturients divided into two groups. Group F received 2 ml of 0.5% hyperbaric bupivacaine (10 mg) plus 0.4 ml fentanyl (20 µg), and Group B received 2 ml of 0.5% hyperbaric bupivacaine (10 mg) plus 0.4 ml of normal saline. The parameters taken into consideration were pain scores, analgesic requirement, hemodynamic stability and side effects.Results: It was found that duration of sensory block was prolonged in fentanyl group (111 minutes vs 86 minutes, p<0.001). Duration of effective analgesia (174.36 minutes vs 127.81; p value <0.001) were also found to be prolonged in Group F with requirement of fewer postoperative analgesics (1.02 vs 2.76, p=0.03). There was not much difference in the occurrence of side effects in both the groups.Conclusions: Addition of fentanyl to intrathecal bupivacaine for cesarean section increases the duration of postoperative analgesia without increasing maternal or neonatal side effects.

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