Spinal Anaesthesia Failure Risk Followed by Failed Epidural Block in Caesarean Deliveries

Background: There is a risk associated with spinal anaesthesia failure after immediate deliverance of epidural anaesthesia. Objective: To assess the risk of spinal anaesthesia failure followed by failed epidural block in caesarean deliveries. Study Design: Retrospective study Place and Duration of Study: Department of Obstetrics & Gynaecology, Khairpur Medical College Khairpur Mir’s from 1st July 2020 to 30th June 2021. Methodology: One hundred and seventy labour cases who have been given epidural anaesthesia and were prepared for caesarean section through spinal anaesthesia were included. The demographic and clinical information of each pregnant female was documented. Proper epidural dosage was maintained during labour. Results: The mean age of the patients was 26.5±5.2 years. There was a significant increase in body mass index among epidural converted spinal aesthesia patients. The higher incidence of non-reassuring foetal heart tracing and malpresentation in failure cases were found. Conclusion: There is a 11.17% risk of spinal anaesthetics failure for attaining block height when administered within 30 min of epidural dose. Keywords: Epidural, Spinal anaesthesia, Anaesthesia, Caesarean

Analgesic Effects of Epidural Labor Analgesia at Different Periods and Its Effects on Maternal and Infant Outcomes and MiRNA-146b Level

This paper aimed to analyze the analgesic effects of continuous epidural labor analgesia (ELA) at different periods and its effects on postpartum depression, maternal and infant outcomes, and maternal blood pressure. Giving birth in our hospital from September 2017 to August 2019, 119 primiparas with spontaneous delivery were enrolled and divided into an observation group (65 cases) and a control group (54 cases). Patients in the observation group received epidural block analgesia in advance, whereas those in the control group received epidural block analgesia routinely. At 25 days after delivery, breast milk samples were collected, in which miRNA-146b level was detected by PCR. The patients were compared between the two groups with respect to progress of labor, analgesic effects during 3 stages of labor, labor outcomes, adverse reactions, and levels of NO, ANP, and ET-1 in the parturients’ umbilical artery blood. Compared with those in the control group, patients in the observation group had a remarkably higher miRNA-146b level in the breast milk ( P < 0.05 ), remarkably lower average Visual Analogue Scale (VAS) scores during the active phase and the second stage of labor ( P < 0.05 ), and remarkably higher levels of NO, ANP, and ET-1 ( P < 0.05 ). There were no statistically significant differences in adverse reactions and modes of delivery between the two groups ( P < 0.05 ). ELA starting from the latent phase can improve the miRNA-146b level in maternal breast milk, alleviate labor pain of parturients, and shorten stages of labor. Therefore, our study is worthy of clinical promotion. We still need to do more experiments and use more data to conclude more scientific results in future research work.

Perioperative effect of dexmedetomidine on quality of analgesia and hemodynamic parameters in vaginal hysterectomy: A tertiary centre experience

Vaginal hysterectomy Surgery with long acting local anaesthetic like bupivacaine still requires higher doses of analgesics in the post-operative period. Dexmedetomidine is highly selective αadrenoreceptor agonist and sympatholytic drug is a useful adjunct drug in patients undergoing vaginal hysterectomy under continuous spinal epidural block (CSE). We sought to study duration of perioperative analgesia, observe the intra-operative and post-operative hemodynamic changes and post-operative sedation effect of dexmedetomidine.: The study groups were divided as Group D (study group) administered 1 µg/kg Dexmedetomidine and Group C (control group) administered 0.9% saline drip at the rate of 1ml/kg. Dexmedetomidine group had prolonged duration of sensory blockade, duration for 2 dermatomal regression of sensory blockade and the duration for motor block regression to Modified Bromage scale 0. This group had prolonged duration of Time to first request for rescue analgesic.14% patients required mephentermine for management of hypotension.Intraoperative diastolic blood pressure (DBP) was lower in study group while Intraoperative Systolic blood pressure (SBP) was comparable in both the groups. Intravenous dexmedetomidine significantly decreases the heart rate and is associated with higher incidence of bradycardia. It is effective in providing postoperative analgesia and in preventing postoperative shivering with reduced incidence of postoperative nausea and vomiting.

A Comparative Study between Caudal and Penile Blockade in Pediatric Patients Undergoing Hypospadias Repair

Background Regional anesthesia, in combination with general anesthesia, is frequently used for children undergoing surgical procedures. Aim of the Work to compare postoperative analgesia between caudal block and penile block with bupivacaine in elective hypospadias repair cases in pediatric patients. Patients and Methods This study is a randomized clinical study conducted in the operating theaters of pediatric surgery unit in Ain shams university hospitals. The study was performed after ethical committee approval and informed consent from the parents after full explanation of the procedure, possible side effects and complications. This study was done in the period between March 2019 and August 2019.it included sixty male children undergoing hypospadias repair. Results Postoperative pain was evaluated by FLACC pain score at PACU, 2, 4 and 8, 12, 16 and 24 hrs. There was a significant increase in the pain score in group C starting from the fourth hour postoperativly and thereafter every hour, while the lowest pain scores were recorded in group P (P &lt; 0.05). Also, the time to first need for rescue analgesia was significantly shorter in group C (240 +/-105 min) compared with group P (720 +/-301) (P&gt;0.01).The total rescue analgesic requirement was significantly lower in group P (168.26 +/22.69) than group C (573.8+/- 124.1) (P &lt; 0.01).Postoperative time of ambulation was significantly lower in group C (6.95+/- 3.22) compared with group P (5.28+/-1.99) (P &lt; 0.01). Conclusion Dorsal penile nerve block in children undergoing penile surgery provides effective and a longer duration of postoperative analgesia and decreased postoperative analgesic requirements with more hemodynamic stability both intraoperatively and postoperatively, as it is safer and easier to perform, with higher success rates than caudal epidural block, which is invasive and shows some difficulty in practice.

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.