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Background: The combination of Ropivacaine and Dexmedetomidine has been suggested to enhance the efficacy of epidural anesthesia. This study aims to compare the effects of Ropivacaine alone with Ropivacaine and Dexmedetomidine for postoperative analgesia in lower abdominal surgeries. Methods: This randomized controlled trial included 122 adult patients scheduled for elective lower abdominal surgeries. Participants were randomly assigned into two groups: Group R (Ropivacaine 0.75%) and Group RD (Ropivacaine 0.75% with Dexmedetomidine). Onset and duration of sensory and motor blockades, sedation scores, and hemodynamic parameters were assessed. Statistical analyses were performed using t-tests and chi-square tests, with p<0.05 considered significant. Results: The onset of sensory and motor blockades was significantly faster in Group RD compared to Group R (6.1±2.5 vs. 11.1±3.1 minutes, p=0.009; 10±2.5 vs. 17±3.1 minutes, p=0.005, respectively). The duration of sensory and motor blocks was significantly prolonged in Group RD (349±52 vs. 196±12.5 minutes, p=0.007; 240±12 vs. 150±34 minutes, p=0.002, respectively). Group RD exhibited more intense motor blockade (Bromage 4: 34.4% vs. 0%, p=0.002) and higher sedation scores (p=0.004). Hemodynamic parameters were comparable between the groups, with no significant side effects observed. Conclusion : Dexmedetomidine, when added to Ropivacaine for epidural anesthesia, enhances the onset, intensity, and duration of sensory and motor blockades and provides better sedation scores without compromising safety. This combination is effective and safe for lower abdominal and lower limb surgeries. [ABSTRACT FROM AUTHOR]

Background and Aims: One major limitation of the spinal block remains the inability to extend the duration of the block intraoperatively unless planned before with spinal or epidural catheters and/or intrathecal additives. This study was designed to compare the effects of intravenous dexmedetomidine versus low-dose ketamine–dexmedetomidine combination infusion on spinal anaesthesia in lower limb orthopaedic surgeries. Methods: This randomised study was conducted in 60 patients scheduled for unilateral lower limb surgeries under spinal anaesthesia. Patients were randomised into Group D (n = 30) (0.5 µg/kg of intravenous (IV) dexmedetomidine bolus followed by maintenance infusion at 0.5 µg/kg/h) and Group LKD (n = 30) (IV bolus of 0.5 µg/kg of dexmedetomidine and 0.2 mg/kg of ketamine, followed by maintenance infusions of dexmedetomidine and ketamine at 0.5 µg/kg/h and 0.2 mg/kg/h, respectively). Ramsay Sedation Scale score of 3–4 was maintained. The t -test or the Wilcoxon–Mann–Whitney U test was used to compare the parameters between groups. Results: The mean sacral segment 1 (S1) regression time was 390.3 [standard deviation (SD):84.38] [95% confidence interval (CI): 360.13, 420.53] versus 393.23 (SD: 93.01) (95% CI: 363.04, 423.43) min in Group D versus Group LKD respectively ((P = 0.701). The number of episodes of hypotension was significantly higher in Group D (19 patients) compared to Group LKD (nine patients) (P = 0.001). Pre- and postoperative stress markers (24 h) and the incidence of postoperative nausea and shivering were comparable between the two groups (P > 0.05). Tramadol requirement in the postoperative period was significantly less in Group LKD compared to Group D (P = 0.003). Conclusion: The duration of S1 regression was similar between group dexmedetomidine (Group D) and group low-dose ketamine and dexmedetomidine (Group LKD). [ABSTRACT FROM AUTHOR]

Introduction: Anesthesiologist play a main role in providing comfort to patient, monitor the patient and maintain normal physiological levels. With the advancement of anaesthesia different techniques are being used in combination with different drugs for providing pain relief. With introduction of levobupivacaine and ropivacaine, a new era of pain relief had begun. Materials and Methods: A total number of 200 patients, 100 in each group were selected for study; patients were allocated randomly into groups by lottery method. Group LB, n=100: Consists of patients who received 20 ml of Levobupivacaine 0.5% in epidural route and Group R, n=100: Consists of patients who received 20 ml of Ropivacaine 0.75% in epidural route. After fulfilling the inclusion and exclusion criteria, the patients were enrolled into the study and informed written consent was obtained from all patients. The pulse rate, respiratory rate, blood pressure and SpO2 were recorded before starting the case. Peripheral venous conflation was done with 18G IV cannula and all the patients were preloaded with 10ml/kg Ringer Lactate solution. Results: On set time of sensory blockade is taken from the completion of injection of study drug till the patient does not feel the pin prick. The mean time of onset of sensory block to T10 level in group LB was10.02±3.21 min, in group R was 9.10±2.20 min and is considered to be statistically not significant. The mean time to attain maximum sensory level 15.6±3.70 min for group LB, 14.50±2.80 min for group R, which is not statistically significant. Conclusion: Our study has shown that two drugs were same in sensory block characteristics such as mean on set time of sensory blockade, mean time to attain maximum sensory level, maximum level of sensory blockade, two segment regression time, and duration of analgesia. Also motor parameters such as mean time of onset of motor block, and duration of motor block and quality of motor block were comparable between the groups with a statistically insignificant p value. With respect to haemodynamic parameters and side effect profiles, both Levobupivacaine and Ropivacaine were comparable. Both drugs could be better alternatives to Bupivacaine in epidural anaesthesia. [ABSTRACT FROM AUTHOR]

Background: This comparative study aimed to evaluate the impact of adding dexmedetomidine as an adjuvant to 0.75% isobaric ropivacaine in subarachnoid block for patients undergoing total abdominal hysterectomy. Methods: Fifty female patients within the age range of 35-65 years, classified as ASA grades I and II, were included in this study. They were divided into two groups: Group A (Dexmedetomidine) and Group B (Control). Various parameters were assessed, including the duration of sensory and motor blockade, duration of analgesia, and hemodynamic parameters. Results: The addition of dexmedetomidine significantly prolonged the duration of sensory blockade (142.20 ± 5.61 vs. 74.40 ± 3.91 minutes, p < 0.001), motor blockade (233.80 ± 4.15 vs. 140.80 ± 5.53 minutes, p < 0.001), and analgesia (358.80 ± 7.26 vs. 179.60 ± 7.76 minutes, p < 0.001) compared to the control group. Hemodynamic parameters remained stable, and the incidence of side effects was low. Conclusion: The addition of dexmedetomidine to ropivacaine in subarachnoid block provides prolonged sensory and motor blockade, leading to extended postoperative analgesia, without compromising hemodynamic stability. This approach presents a promising option for pain management in patients undergoing total abdominal hysterectomy. [ABSTRACT FROM AUTHOR]

Context: Spinal anesthesia is the preferred anesthetic technique for cesarean section. Lateral and sitting positions are commonly used for performing subarachnoid block in parturients. Maternal positioning affects the spread of local anesthetic drugs and affects the onset and level of block. Faster onset of block is associated with hemodynamic changes having detrimental effects in parturients. Aims: The aim of our study is to evaluate the effectiveness of two maternal positions – lateral and sitting. Materials and Methods: This prospective randomized control study was conducted on 100 parturients undergoing elective cesarean section under spinal anesthesia. They were randomly assigned into two groups. Group L received spinal anesthesia in lateral and group S in sitting position. Time to achieve T5 blockade, hemodynamics, motor blockade, fetal pH, and Apgar score were noted. Independent sample 't' test, Chi-square test, and paired t test were used for statistical analysis. Results: Time to achieve T5 dermatomal level was less in group L which was statistically significant (2.60 ± 0.535 vs. 4.34 ± 0.745 min, P < 0.001). Number of attempts required and time taken for giving spinal was significantly more in group L. The drop in mean arterial pressure and requirement of phenylephrine was more in lateral position. Conclusion: Adoption of sitting position while performing subarachnoid block for cesarean section was found to be superior to lateral position in view of better hemodynamic stability, need for fewer attempts, and better maternal comfort, though time to achieve T5 block was longer. [ABSTRACT FROM AUTHOR]

Background: Upper limb processes are frequently performed under brachial plexus block alone or in conjunction with local anesthesia. Brachial plexus block can be conducted by any of the methods--blind; directed nerve stimulator (NS) or ultrasound (US)-guided. Over the last centuries, the evoked potentials method has been recognized as the gold standard for nerve detection in the area. Method: This study was done on 20 patients who fit under inclusion criteria. Written informed consent to be taken from all patients. Results: Neurostimulation block had shorter execution time, faster on sent of motor and sensory blockade with lesser needle attempts Conclusions: Neurostimulation guided brachial plexus block had lesser needle attempts, faster execution time, and faster onset of motor and sensory block and lesser complication [ABSTRACT FROM AUTHOR]

Background and Aims: Ultrasound (US)‑guided transversus abdominis plane (TAP) block is used as a part of a multimodal analgesic regimen in the postoperative period. Lateral approach TAP block (LTAP) has been widely used for postoperative analgesia after lower abdominal surgeries. Posterior approach TAP block (PTAP), which is achieved by more posterior blockade of the anterior ramus of the spinal nerve, also provides profound postoperative analgesia after transverse lower abdominal incision. We investigated the dermatomal sensory block following LTAP and PTAP under US guidance. Material and Methods: Twenty‑seven adult female patients undergoing the laparoscopic resection of ovarian tumors under general anesthesia were randomly divided into two groups, those receiving LTAP (Group L, n = 14) and those receiving PTAP (Group P, n = 13). Before induction of general anesthesia, all patients were given bilateral TAP blocks with 15 ml of 0.25% levobupivacaine on each side under US guidance, and the sensory blockade was evaluated. Results: The data are expressed as median (interquartile range [IQR]). PTAP produced a median sensory blockade to sharp touch of three dermatomal segments (IQR 3-4), the most cephalad being T‑10 (IQR T‑9-T‑10), whereas LTAP produced blockade of a median of two segments (IQR 2-2, P = 0.002), the most cephalad being T‑10 (IQR T‑10-T‑10, P = 0.005). Conclusions: PTAP produced a sensory block that involved a greater number of dermatomes and involvement of more cephalad dermatome blocked to sharp touch, compared with LTAP under US guidance. [ABSTRACT FROM AUTHOR]

Background: The spread of local anaesthetics during spinal anaesthesia is affected by various factors and can be unpredictable especially in parturients undergoing caesarean section. Factors like abdominal girth, symphysis fundal height etc have to studied to know their impact on level of sensory blockade. We hypothesized a study to find any correlation between weight of the baby and the level of sensory blockade. Methods: 46 parturients posted for elective caesarean section belonging to American Society of Anaesthesiologists (ASA) physical status 1 and 2 were included in the study. Maternal height and weight were noted down before entering operation theatre. All patients were instituted subarachnoid block with 2 cc of 0.5% of hyperbaric bupivacaine in sitting position. Level of sensory blockade was assessed with pin prick along midline of the patient every min till 5th minute and 5 minutes till 15th minute. The birth weight of baby was recorded soon after delivery. Results: The weight of the baby and height of the mother were correlated with the sensory blockade of T4. The number of babies weighing more than 3.5 kgs were 3 in our study out of which 2 babies were associated with maximum sensory blockade at 15th minute. It amounts to 66.7% when compared with 14.7% in babies weighing 2.5 to 3.5 kgs which is suggestive of significance ('P' value of 0.093). Conclusion: There is no statistically significant correlation between weight of the baby and the level of sensory blockade. [ABSTRACT FROM AUTHOR]

Background: Ropivacaine (S (-)-1-propyl-2", 6"; pipecoloxylidide hydrochloride) a newer long-acting amide local anesthetic has various clinical and pharmacokinetic advantages over bupivacaine. Aims: The aim of this study is to compare the onset as well as the duration of sensory block, hemodynamic variables, and postoperative analgesia with 0.5%, 0.75% ropivacaine and 0.5% bupivacaine after epidural anesthesia for lower limb orthopedic surgery. Patients and Methods: Sixty American Society of Anesthesiologists I and II patients scheduled for lower limb orthopedic surgery were enrolled into this randomized, double-blind study. Epidural block was obtained with 15 ml of 0.5% ropivacaine (Group I), 15 ml of 0.75% ropivacaine (Group II), and 15 ml of 0.5% bupivacaine (Group III). The onset time, duration, and maximum level of sensory blockade achieved, as well as hemodynamic parameters and any side effects, were noted and treated accordingly. Postoperative monitoring for pain by visual analog scale (VAS) was done every 2 hourly for 24 h and transient neurological symptoms for 72 h. Statistical Analysis: Chi-square test for nonparametric data and ANOVA for parametric data. Results: Demographic characteristics were similar among groups. The onset of sensory block varied from 22.35 ± 2.74 min (mean ± standard deviation [SD]) in Group I, 16.95 ± 2.96 min (mean ± SD) in Group II, and 19.70 ± 2.25 min (mean ± SD) in Group III. The mean duration of analgesia in Group III (157 ± 14.90 min)was comparable to Group II (149 ± 16.51 min) but it was significantly more than Group I (141.5 ± 17.55 min). Postoperatively, VAS scores were higher in Group I patients who required more number of postoperative epidural top-ups with tramadol. Adverse effects were noted and treated accordingly. There was no incidence of transient neurological symptoms postoperatively. Conclusion: Both ropivacaine and bupivacaine provided effective epidural anesthesia for lower limb surgery. Postoperative pain was less with 0.5% bupivacaine and 0.75% ropivacaine as compared to 0.5% ropivacaine. [ABSTRACT FROM AUTHOR]

Introduction: Hip fractures are often encountered in the elderly and present special problems to the anaesthesiologist. Fascia iliaca compartment block is another technique with the intent to block all the three nerves like 3-in-1 nerve block. Aim: To evaluate the analgesic efficacy of ultrasound guided fascia iliaca compartment block to facilitate positioning of patients with hip fracture for spinal anaesthesia. Materials and Methods: This prospective study was conducted in 50 patients aged between 40-80 years, belonging to American Society of Anesthesiologists (ASA) physical status I-III undergoing surgery for hip fracture. All 50 patients received an ultrasound guided Fascia Iliaca Compartment Block (FICB) in the premedication room with 30 mL of 0.5% ropivacaine by 23G spinal needle. Sensory blockade was evaluated 5, 10 and 20 minutes after ropivacaine administration using loss of perception to cold in the lateral, anterior and medial part of the thigh. Visual analogue scale scores were noted before the block, 20 minutes after block and during positioning for spinal anaesthesia. Patient's acceptance for FICB was evaluated 24 hour after arriving back to the orthopaedics ward using a two-point score. Any episode of hypotension or bradycardia was noted and managed accordingly. Results: In lateral part of thigh, at 5 minutes sensory blockade was present in 33 patients (66%) and at 10 minutes sensory blockade was present in 45 cases (90%). In anterior part of thigh, sensory blockade was present in 34 cases (68%) at 5 minutes time interval and at 10 minutes sensory blockade was present in 48 cases (96%). In medial part of thigh, 28 cases (56%) had sensory blockade at 5 minutes and at 10 minutes in 43 cases (86%). Sensory blockage was same at 20 minutes as on 10 minutes interval in all thigh parts. Before FIC block average VAS was 7.5 which was decreased to average of 2.94 at 20 minutes after block which was statistically significant (p<0.01). During positioning for spinal anaesthesia, 46 patients had VAS less than 4. Positioning during spinal anaesthesia was assessed unsatisfactory (0) in 2 cases (4%), satisfactory (1) in 5 cases (10%), good (2) in 25 cases (50%) and excellent (3) in 18 cases (36%). Conclusion: Ultrasound guided FICB can be performed safely without complications in controlling pain for patients with hip fracture. Performing an FICB before positioning for spinal anaesthesia provides good pain management and facilitates spinal performance with wide patient acceptance, hence improving overall quality and efficiency of care. [ABSTRACT FROM AUTHOR]