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

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.

Epidural Bupivacaine-Dexmedetomidine versus Bupivacaine-Fentanyl for Anesthesia in Knee Surgeries

Background Epidural anesthesia is one of the preferred modes of regional anesthesia for lower limb orthopedic surgeries. This technique provides not only peri-operative anesthesia but also post-operative analgesia. Bupivacaine is commonly used local anesthetic in epidural anesthesia, many adjuvants added to local anesthetics to enhance the quality and duration of surgical anesthesia, among them are opioids, alpha 2 agonists. Opioids like fentanyl have been a popular choice, it offers faster onset and prolongs the duration of analgesia. Recently, alpha 2 agonists like clonidine and dexmedetomidine have been also used in prolonging the duration of epidural analgesia. Aim of the Work To compare the efficacy of using fentanyl and dexmedetomidine with bupivacaine in epidural block for knee surgeries, the time of onset of sensory, motor blockade and the duration of this blockade. Patients and Methods After obtaining approval from the Research Ethical Committee of Ain Shams University, this study was conducted in the operating theatres of Ain Shams University Hospital. It was a prospective double-blind randomized clinical study. Study period was 6 months. Results A total of 50 patients out of 71 consecutive patients met the inclusion criteria and consented for study. These 50 patients were randomized into two groups of 25 each. Out of the total patients, 33 were male and 17 were female. Conclusion Dexmedetomidine as an adjuvant to epidural bupivacaine is a better alternative to fentanyl as it shows faster onset of sensory and motor block, lesser time to attain maximum sensory level and prolonged duration of anesthesia.

COMPARATIVE STUDY BETWEEN EPIDURAL BUPIVACAINE WITH BUPRENORPHINE AND EPIDURAL BUPIVACAINE FOR POST-OPERATIVE ANALGESIA IN ABDOMINAL AND LOWER LIMB SURGERY

Background: Epidural administration of various analgesics gained increasing popularity following the discovery of opioid receptors in the spinal cord capable of producing potent analgesia. This effect seems to be greatest when epidural anaesthesia in continued in the post-operative period as epidural analgesia. It is now clear that epidural administration of opioids. Ours was a comparative study between epidural bupivacaine with buprenorphine and epidural bupivacaine for post-operative analgesia in abdominal and lower limb surgery. Methods: 60 patients undergoing lower abdominal and lower limb surgeries of either sex with ASA grade 1 and 2 aged between 20 and 60 years for divided into two groups. After completion of the surgery and when the effect of local anaesthetic wears of and the patients complains of pain the intended study drugs were given when visual analogue pain score touched 5 cm mark. Group – A: Patients received 8ml of 0.25% bupivacaine + 0.15mg of buprenorphine. Group – B: patients received 0.25% of bupivacaine alone. In the post-operative period the following parameters were studied, 1. Onset of analgesia, 2. Duration of analgesia, 3. Vital parameters such as heart beat, blood pressure, respiratory rate, sedation score and visual analogue score were recorded, 4. Side effects like nausea, vomiting, hypotension, respiratory depression, and pruritus allergic reaction were looked for. Results: It is observed that onset of analgesia in Group A (0.25% bupivacaine + 0.15mg buprenorphine) was 7.35 min. When compared to Group B which 15.5 min, which is statically signicant (P<0.05). Duration of analgesia in Group A is 17.23 hrs compared to Group B, which is 5.2 hrs, this is statically signicant (P<0.05). Visual analogue scale was reduced in Group A compared to Group B Conclusions: Addition of buprenorphine to bupivacaine by epidural injection for post-operative analgesia improves the onset, The duration and the quality of analgesia

A COMPARATIVE STUDY OF EPIDURAL BUPIVACAINE WITH CLONIDINE AND EPIDURAL BUPIVACAINE WITH MAGNESIUM SULPHATE FOR PERIOPERATIVE ANALGESIA IN PATIENTS UNDERGOING LOWER LIMB SURGERY

Background: Epidural anaesthesia is a safe and inexpensive technique with advantage of providing surgical anaesthesia and prolonged postoperative analgesia. Use of adjuvant drugs with local anaesthetics increases its potency and decreases its dose requirement. Aims and Objectives: The aim of the study was to compare the perioperative analgesia effect of adjuvant clonidine with adjuvant magnesium sulphate when used in epidural anaesthesia with bupivacaine hydrochloride. Materials and Methods: A randomized, double blind, controlled study was conducted for 12 months in a tertiary care hospital of India. A total (n=60) patient aged 20-60 years, weight 50-75 kgs of either sex with ASA I and ASA II waiting for lower limb surgery were randomly allocated into two equal groups. Group BC (n=30) received epidural bupivacaine (0.5%) with clonidine (75 mcg) and Group BM (n=30) received epidural bupivacaine (0.5%) with magnesium sulphate (50 mg). Similar anaesthesia technique was performed for both the groups. Onset of anaesthesia, duration of anaesthesia and analgesia, haemodynamic and respiratory parameters were recorded at various time interval. Result: Onset of anaesthesia was faster and statistically signicant (p<0.0001) in Group BM but duration of anaesthesia and analgesia were longer and statistically signicant (p<0.0001) in Group BC. There was comparable demographic, haemodynamic and respiratory parameters in both the groups. Conclusion: Epidural bupivacaine with clonidine produces prolonged analgesia in comparison to epidural bupivacaine with magnesium sulphate

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

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

A PROSPECTIVE STUDY OF COMPARISON OF EPIDURAL BUPIVACAINE, FENTANYLAND THEIR COMBINATION FOR POSTOPERATIVE ANALGESIA IN LOWER ABDOMINALAND LOWER EXTREMITY SURGERY

BACKGROUND Epidural analgesia with local anaesthetics and opioids provide good control of postoperative pain in lower abdominal and lower extremity surgery. AIM To evaluate and compare the analgesic action and adverse effects of epidural bupivacaine, fentanyl and their combination in postoperative period. METHODS 75 patients undergoing elective infraumbilical surgery were allocated in three groups in a randomized double blinded fashion. Postoperative analgesia was maintained with continuous infusion of epidural drug in the following manner: Group B: Injection Bupivacaine 0.125% @ 0.1mL/kg/hr through epidural route; Group F: Injection Fentanyl 4µg/mL @ 0.1mL/kg/hr through epidural route; Group BF: Injection Bupivacaine 0.0625% and Fentanyl 2µ/mL @ 0.1mL/kg/hr through epidural route. RESULTS VAS score were almost similar in all three groups at 00, 04, 08hrs and not clinically significant at that point of time. VAS score showed significant difference at 12, 20 and 24 hrs, being persistently lower in Gr BF than Gr B and Gr F. According to VRS Scale Score at 04 hrs majority of patients of all three groups had mild-to-moderate pain (p=0.278). At 08 hrs, 24% (p=0.082), 12 hrs 60% (<0.001), 16 hrs 68% (<0.001), 20 hrs 88% (<0.001) and 24 hrs 84% (<0.001) of Gr BF patients were pain free which are clinically significant. At the end of 08, 12, 16, 20, 24 postoperative hours, no patients of any groups had residual motor paralysis. Rescue analgesic needed in Gr BF patients were significantly less than other two groups. CONCLUSION Combined bupivacaine and fentanyl infusion through an epidural route provides better analgesia in comparison to bupivacaine and fentanyl alone. Total drug, rescue analgesic requirement and adverse effects are much lower in combined group.