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Background: Bupivacaine, the most commonly used drug for a central neuraxial blockade, also carries undesirable effects like a prolonged postoperative motor blockade. The objective of the study was to compare the intensity of sensory and motor blockade, hemodynamic effects, and adverse effects, if any, between the two drugs. Patients and Methods: A randomized, double-blind study was carried out on 100 patients. Patients were divided into two groups of 50 patients each. Group L received 20 ml of 0.5% levobupivacaine epidurally, and Group B received 20 ml of 0.5% bupivacaine epidurally. We observed the characteristics of the sensory and motor blockade in both groups. Results: The hemodynamic effects of both drugs were statistically and clinically comparable. The total duration of the sensory blockade with levobupivacaine was 366.60 ± 29.25 min compared to 370.80 ± 37.73 min with bupivacaine (P = 0.535). The total duration of the motor blockade with levobupivacaine was 139.20 ± 27.15 min compared to 172.80 ± 26.77 min (P < 0.001) with bupivacaine. Conclusion: Levobupivacaine produces shorter motor blockade, which may provide early ambulation of patients in day care surgeries. In surgical procedures requiring extensive motor blockade, epidural levobupivacaine may not be an appropriate choice.

Introduction Spinal anesthesia is the most consistent block for lower limb orthopedic surgeries. We conducted this randomized prospective study to evaluate comparative efficacy of intrathecal dexamethasone with fentanyl and normal saline as adjuvants to hyperbaric bupivacaine in spinal anesthesia administered to patients scheduled for lower limb orthopedic surgery. Materials and methods 105 patients scheduled for lower limb orthopedic surgeries under spinal anesthesia were included in this clinical trial. After randomization, patients received an intrathecal injection of hyperbaric bupivacaine (12.5 mg) with 4 mg of dexamethasone in group I, hyperbaric bupivacaine (12.5 mg) with 25 ug fentanyl with 0.5 ml of normal saline in group II and hyperbaric bupivacaine (12.5 mg) with normal saline (1 ml) in group III, so as to make volume of drug equal in all three groups. The observer evaluated the sensory and motor blocks and other parameters like time to self-void, stay in post-anesthesia care unit (PACU) and complications. Results The total duration of sensory blockade was found to be 311.43, 197.86 and 115.29 minutes and motor blockade of 223.43, 163.86 and 83.0 minutes in groups I, II and III respectively. The PACU stay was 233.14, 173.86 and 93.00 minutes in groups I, II and III, respectively. The average time to self-void was 400.00, 315.29 and 203.00 in three groups, respectively. Conclusion Intrathecal dexamethasone seemed to be an effective adjuvant to spinal bupivacaine as it prolongs the duration of analgesia, stable hemodynamic profile with minimal side effects. Further studies are required to evaluate the optimum dose and long-term safety of intrathecal dexamethasone.

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.

BACKGROUND Uncontrolled postoperative pain may produce a range of detrimental acute and chronic effects. Spinal anaesthesia provided by Bupivacaine may be too short for providing postoperative analgesia. This study is conducted to evaluate the efficiency of intrathecal Fentanyl and intrathecal Dexmedetomidine as an adjuvant to hyperbaric Bupivacaine with regards to onset and duration of sensory and motor blockade as well as postoperative analgesia and adverse effects. The aim of this study is to study the duration of sensory and motor block of dexmedetomidine and fentanyl. MATERIALS AND METHODS Hundred patients aged 18 - 55 years were randomly divided into two groups by a computer program; each group consisting of 50 patients of either sex belonging to ASA Class 1 and 2, posted for elective lower abdominal surgeries were given spinal anaesthesia using Bupivacaine 0.5% heavy 2.5 mL with either Fentanyl 25 ug Group F or preservative-free Dexmedetomidine 5 ug Group D. Assessment of sensory and motor blockade were done at the end of each minute till the maximum level achieved. Measurement of blood pressure, pulse rate, respiratory rate and arterial oxygen saturation were obtained. Postoperatively, patients were observed for the duration of analgesia, time taken for complete regression of sensory blockade and time taken for complete recovery of motor power. RESULTS Our results showed a statistically highly significant prolongation of sensory and motor blockade, time taken for sensory regression by two segments and postoperative analgesia in Dexmedetomidine group compared to Fentanyl group. Incidence of pruritus is significantly high in fentanyl group. CONCLUSION Dexmedetomidine in the dose of 5 ug significantly prolongs the duration of sensory and motor blockade, time taken for sensory regression by two segments and duration of postoperative analgesia than Fentanyl 25 ug when added to Bupivacaine 0.5% heavy.

BACKGROUND Different local anaesthetics are used for epidural anaesthesia, most popular in India being lidocaine and bupivacaine. Bupivacaine is a longacting amide local anaesthetic, which is widely used for many years. However, it is associated with a number of side effects like Central Nervous System (CNS) toxicity and cardiotoxicity. Ropivacaine has been introduced recently in India and has been developed as a possible alternative to bupivacaine. It has a lower lipophilicity than bupivacaine and hence associated with a decreased potential for CNS and cardiotoxicity. The aim of the study is to compare the time of onset of sensory and motor block, duration of sensory and motor blockade and also the haemodynamic changes produced by bupivacaine 0.5% and ropivacaine 0.75% for epidural in elective lower limb and lower abdominal surgeries. MATERIALS AND METHODS 60 patients aged 18-55 yrs. scheduled for elective lower limb and lower abdominal surgeries belonging to ASA class I and II were given epidural anaesthesia using 15 mL of 0.5% bupivacaine (group B) and 15 mL of 0.75% ropivacaine (group R). Assessment of the sensory and motor blockade was done at intervals till maximum level achieved. Measurements of blood pressure, heart rate and arterial oxygen saturation were obtained at various time intervals. The total duration of the sensory blockade and motor blockade were also noted. RESULTS Our results showed no significant difference between the groups regarding sensory and motor onset time and time to attain and maximum level of sensory block. Our results also showed a significant difference in the intensity of motor blockade and the time to attain the maximum motor blockade, the total duration of analgesia and duration of motor blockade. CONCLUSION Hence, it is concluded that epidural ropivacaine 0.75% produces a more intense as well as prolonged motor blockade and prolonged sensory blockade than 0.5% bupivacaine. Epidural ropivacaine 0.75% can be a safe and effect alternative to bupivacaine 0.5% in lower limb and lower abdominal surgeries.

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.

AIM Ever since the times spinal anaesthesia has been introduced by August Bier, multiple drugs at different dosages, concentrations and differing baricities have been studied. This study was conducted to compare the anaesthetic efficacy of intrathecal isobaric 0.5% ropivacaine, isobaric 0.5% bupivacaine and isobaric levobupivacaine in lower abdominal and lower limb surgeries, in 150 ASA grade I and II patients of both sexes in the age group of 19-65 years undergoing elective surgery under spinal anaesthesia. MATERIALS & METHODS After getting ethical committee approval and informed written consent from the patients, 150 patients were allocated into three groups of 50 patients each. The baseline pulse rate and mean arterial pressure were recorded. The first group A received 3ml of isobaric 0.5% ropivacaine (5mg/ml), the second group received 3ml of isobaric 0.5% bupivacaine and the third group C received 3ml of isobaric levobupivacaine intrathecally. The onset of sensory and motor blocks, duration of sensory and motor blocks was recorded in three groups. RESULTS The results were analyzed statistically using epidemiologically information package. On comparison of data we have found that the intrathecal isobaric 0.5% ropivacaine produces delayed onset of both sensory and motor block but of shorter duration which is statistically significant when compared with that of isobaric 0.5% bupivacaine and levobupivacaine. There is no significant inter-group difference between bupivacaine and levobupivacaine except for the mean duration of sensory block, which is more in levobupivacaine group. The quality of motor block which was assessed by Bromage scale, shows relatively lesser degree of motor block for ropivacaine group, when compared with that of bupivacaine and levobupivacaine groups. The haemodynamics were also recorded. The incidence of hypotension and Bradycardia is more in bupivacaine group. The height of block (peak sensory level) is higher for bupivacaine group followed by levobupivacaine and then ropivacaine. T4+T6% of Groups A, B& C are 5%, 48% and 44% respectively.

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.

Background: The level of sensory block in postoperative epidural analgesia has been correlated with conventional contrast epidurography in only one study, while low-dose CT scan epidurography with multiplanar reconstruction may be a better tool for this purpose. Objectives: The primary objective of this study was to evaluate, by CT imaging and digital multiplanar reconstruction, the spread and distribution of contrast medium injected into the epidural space through a catheter inserted in a low thoracic position for postoperative analgesia. Materials and Methods: Ten patients undergoing major abdominal cancer surgery with effective epidural analgesia were prospectively included at postoperative day three. Two consecutive boluses of 5 mL of a mixture of ropivacaine and contrast medium were injected at 15 minutes intervals into the epidural space. Multislice low-dose CT scan epidurography and an assessment of the sensory block were performed before and after injection of the second bolus. The primary objective was to assess the contribution of CT scan epidurography to predict a correlation between the level of sensory block and the spread of the contrast medium in the epidural space; the secondary objective was to determine the agreement between the two methods. Results: The spread of contrast material and the clinical sensory block significantly increased after the second injection (32%; P < 0.05). However, no highly significant correlation was observed between the two methods. A gap of two spinal segments of CT opacification was observed in two patients and was confirmed by clinical assessment. Conclusions: CT epidurography is not closely correlated with a clinical assessment of epidural block; thus, a clinical assessment of the sensory block is mandatory. The use of opioid analgesia in combination with local anesthetics may compensate for the lack of efficacy of local anesthetics alone.

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.