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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).

Background: The combined spinal-epidural (CSE) anesthesia technique gives a reliable subarachnoid block as well as the flexible epidural block. One of the modified technique of CSE is epidural volume expansion (EVE) in which normal saline or local anesthetic (LA) is instilled though epidural catheter leading to increase in level of sensory blockade. Aim of the study was to compare two different volumes of normal saline for enhancing the effects of spinal anaesthesia in adult patients undergoing elective lower limb surgeries. Methods: 90 patients were randomly divided into two group. Group A - 45 patients who were received intrathecal 2.0ml of 0.5% hyperbaric bupivacaine and epidural 10ml of 0.9% normal saline for EVE using CSE technique. Group B - 45 patients who were received intrathecal 2.0ml of 0.5% hyperbaric bupivacaine and epidural 15ml of 0.9% normal saline for EVE using CSE technique. Results: The demographic data were comparable in both groups. Significant difference was seen in total duration of sensory blockade between group A (192.11±9.80) and group B (Mean ± SD 215.33±17.57minutes) (p

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]

Introduction: The emergence of levobupivacaine and ropivacaine has marked a new phase in advanced pain management techniques. This study aimed to create a comparative framework and assess the effects of epidural levobupivacaine and ropivacaine in surgeries of the lower limb. Methodology: The study involved 100 patients, evenly split into two different groups where each group was assigned 50 candidates. The assignment of patients to these groups was carried out randomly using a lottery-based approach. In Group Levo (n=50), patients were administered 20 ml of 0.5% Levobupivacaine via the epidural pathway, whereas in Group Ropi (n=50), 20 ml of 0.75% Ropivacaine was administered through the same route. Results: The time it took for the sensory block to begin was measured hinged on the completion of the injection until the patient no longer perceived the pinprick sensation. The mean of the onset of time of sensory block reaching up to the T10 level was 12.04 ± 2.71 minutes in group Levo and 11.13 ± 3.10 minutes in group Ropi. Nonetheless, this variation was determined to significantly lack statistical aspects. Conclusion: The results of our study indicated that both drugs exhibited similarities in sensory block attributes. These attributes include the average time it took for sensory blockade to begin and the duration until the highest sensory point was reached. Recommendation: During follow-up and discharge planning, limbs should be checked for numbness and/or weakness, and the patient should be asked about urine retention or headache. Usual medication can be resumed on the day of the procedure. If there is significant limb weakness, sensory loss, or headache, an unplanned overnight admission may be necessary.

ObjectivesThis study investigated the effects of 1 μg/kg/h intravenous constant rate infusion (CRI) of dexmedetomidine on the sensory and motor blockade for femoral and sciatic nerve blocks in dogs undergoing stifle surgery.Materials and methodsClient-owned dogs referred for stifle surgery were enrolled in this prospective, randomized, blinded study. Dogs were pre-medicated with acepromazine (0.005–0.01 mg/kg intramuscularly, IM); anesthesia was induced with propofol intravenously and maintained with isoflurane in a mixture of air and oxygen. Electrolocation-guided sciatic and femoral nerve blocks with lidocaine 2% (0.15 mL/kg) were performed using the parasacral and lateral pre-iliac approaches, respectively. After performing local block, a systemic infusion of saline solution (group C) or dexmedetomidine (group D) was started at a CRI at 1 ml/kg/h and continued until the end of surgery. Dexmedetomidine was infused at a dose of 1 μg/kg/h. Respiratory and hemodynamic variables were recorded during surgery. Sensory and motor blockade was evaluated by response to pinching the skin innervated by the sciatic/femoral nerves, with forceps and by observing the dogs' ability to walk and testing proprioception at 30, 60, 120, 180, and 240 min after extubation. Analgesia was monitored with SF-GCPS. Methadone IM was administered as rescue analgesia. Intraoperative data were analyzed by analysis of variance, while postoperative data were analyzed by the independent two-tailed t-test and a Kaplan–Meier test (p < 0.05).ResultsTwenty dogs were included in this study (10/group). A significant difference in the recovery of sensory nerve function was observed between the groups. The mean durations of the sensory blockade for femoral and sciatic nerves, respectively, was longer (p < 0.001) for group D [168 (146–191, 95% CI), 161 (143–179, 95% CI) min] than in group C [120 (96.1–144, 95% CI), 116 (90.9–142, 95% CI]. No differences in the recovery of patellar and tibial reflexes, proprioceptive function, and ability to walk were found among groups. The overall postoperative rescue analgesia requirement was significantly different (p = 0.019) between groups, with an incidence of 5/10 (50%) dogs in group D and 10/10 (100%) dogs in group C.ConclusionDexmedetomidine administered as a CRI (1 μg/kg/h) combined with local lidocaine increases the duration of the sensory component of the sciatic and femoral nerve blocks and reduces the requirement for additional analgesia during the immediate postoperative hours.

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)., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Indian Journal of Anaesthesia.)

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.

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.

Introduction Persistent postoperative pain leads to impaired patient recovery and delays in discharge of patients. The aim was to compare the efficacy of 0.5% bupivacaine to two varying concentrations of ropivacaine, specifically 0.5% and 0.75%, along with fentanyl as a continuous epidural infusion in providing adequate pain relief for patients subjected to infraumbilical surgeries. Materials and methods A prospective randomized comparative study was carried out on 150 patients and was divided into three groups, namely group B, group R, and group RP. Group B indicates (0.5% bupivacaine), group R means (0.5% ropivacaine), and finally, group RP means (0.75% ropivacaine); the three groups had 50 patients each. Group B was administered an epidural infusion of bupivacaine at a concentration of 0.5%, group R was given 0.5% ropivacaine, and group RP was treated with 0.75% ropivacaine; all three groups included 40 mcg fentanyl. The duration of the motor and sensory blockade and the time needed for the first rescue analgesia after the stoppage of epidural infusion were assessed in all three groups. The data were statistically analyzed using the ANOVA, "post hoc Tukey," and chi-square tests. Results Comparison of the duration of motor and sensory blockade among all three groups showed that group RP (0.75% ropivacaine with 2 mcg/cc fentanyl) had the longest duration of 328.8 and 406 minutes, and the difference was statistically significant (p < 0.001). Comparison of the time of stoppage of epidural infusion to the requirement of first rescue analgesia showed that the group that received 0.75% ropivacaine with 40 mcg fentanyl had the highest value of 258.6 minutes and was statistically significant (p < 0.001). Conclusion Epidural intraoperative infusion of 0.75% ropivacaine with fentanyl offers better postoperative pain relief as compared to both 0.5% bupivacaine and 0.5% ropivacaine with fentanyl., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Pandey et al.)

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.

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]

Abstract Objective To compare the effects of epidural injection of three volumes of lidocaine injected at the third (T3) or eleventh thoracic vertebra (T11) in conscious dogs to induce thoracic epidural anesthesia (TEA) and to measure the epidural dispersion of iohexol under similar conditions. Study design Prospective crossover experiment. Animals A group of five Beagle dogs weighing 10.4 ± 0.5 kg (mean ± standard deviation). Methods Each dog was anesthetized twice, separated by 1 week, for inserting an epidural catheter at the lumbosacral space and advancing the tip to T3 (treatment TEA T3) or T11 (treatment TEA T11). For each treatment, three volumes of 2% lidocaine (0.05, 0.10 and 0.20 mL kg–1) were administered at 24 hour intervals, and sensory blockade (SB) of dermatomes was estimated by pinching the skin with mosquito forceps. Under identical conditions of injection volume and site, iohexol was administered 3 hours after lidocaine injection to identify epidural distribution (ED) using computed tomography. The effects of injection site and volume on SB of thoracic dermatomes and ED were analyzed using a linear mixed model (p < 0.05). Results Thoracic SB and ED significantly increased as the volume increased (p < 0.001 and p < 0.001, respectively), and significantly decreased in TEA T3 than in TEA T11 (p = 0.011 and p = 0.002, respectively). Cervical SB was obtained in three of five dogs in TEA T3 and two of five dogs in TEA T11 injected with 0.20 mL kg–1. One dog showed temporary inspiratory stridor probably caused by bilateral laryngeal paralysis, but no hypoxia. Conclusions and clinical relevance TEA induced at T3 produced less thoracic SB than did TEA at T11 with the same volumes of lidocaine. The cervical SB obtained with the highest volume of lidocaine may increase the risk of laryngeal paralysis and pulmonary aspiration. [ABSTRACT FROM AUTHOR]

Spinal anesthesia frequently results in hypotension due to high sympathetic blockade. The aim of this study was to examine effect of sitting for 5 minutes compared to immediately lying down after 10 mg of 0.5% hiperbaric bupivacaine administration with regards to the mean arterial pressure and level sensory blockade in patients who underwentd spinal anesthesia. This was a single blind randomized controlled trial in 36 patients with American Society of Anesthesiologists (ASA) I–II undergoing lower abdominal and lower extremities surgery under spinal anesthesia in Dr. Hasan Sadikin General Hospital Bandung during the period of March to May 2015. Data were statistically analyzed using Mann Whitney test for mean arterial pressure and Kolmogorov Smirnov test for level sensory blockade. The results showed a decrease of mean arterial pressure in group 1 (sitting 5 minutes) which was lower than group 2 (immediately lying down) with significant difference (p

Lower extremity orthopedic surgery performed with regional epidural anesthesia was still have weakness which is long onset of time. This study was conducted to determine the onset time and duration time of sensory blockade epidural anesthesia between the use of dexamethasone 5 mg addition to 0.5% bupivacaine for lower limb orthophedic surgery. The study was using randomized controlled blind method on 32 ASA I–II patients undergoing lower limb orthopedic surgery under epidural anesthesia. Consecutive sampling and random allocation of block of permutation groups was applied. In group I, dexamethasone 5 mg was added to bupivacaine 0.5% 15 mL while in group II NaCl 1 mL was added to bupivacaine 0.5% 15 mL. The results were statistically tested using t-test and Mann-Whitney test. It was shown that the onset time of sensory blockade was not significantly faster when dexamethasone was added in bupivacaine 0.5%, 13.56 minutes versus 14.31 minutes (p=0.27). The duration time of sensory blockade in dexamethasone in bupivacaine 0.5% group was longer 399.81 minutes, compared to the bupivacaine 0.5% group, 227.43 minutes (p=0.00). In conclusions, the addition of dexamethasone 5 mg to bupivacaine 0.5% 15 mL does not produced faster onset time. However, the duration sensory blockade time is longer than bupivacaine 0,5% 15 mL is used.

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 twopoint 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

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]

Objectives: This study investigated the effects of 1 μg/kg/h intravenous constant rate infusion (CRI) of dexmedetomidine on the sensory and motor blockade for femoral and sciatic nerve blocks in dogs undergoing stifle surgery., Materials and Methods: Client-owned dogs referred for stifle surgery were enrolled in this prospective, randomized, blinded study. Dogs were pre-medicated with acepromazine (0.005-0.01 mg/kg intramuscularly, IM); anesthesia was induced with propofol intravenously and maintained with isoflurane in a mixture of air and oxygen. Electrolocation-guided sciatic and femoral nerve blocks with lidocaine 2% (0.15 mL/kg) were performed using the parasacral and lateral pre-iliac approaches, respectively. After performing local block, a systemic infusion of saline solution (group C) or dexmedetomidine (group D) was started at a CRI at 1 ml/kg/h and continued until the end of surgery. Dexmedetomidine was infused at a dose of 1 μg/kg/h. Respiratory and hemodynamic variables were recorded during surgery. Sensory and motor blockade was evaluated by response to pinching the skin innervated by the sciatic/femoral nerves, with forceps and by observing the dogs' ability to walk and testing proprioception at 30, 60, 120, 180, and 240 min after extubation. Analgesia was monitored with SF-GCPS. Methadone IM was administered as rescue analgesia. Intraoperative data were analyzed by analysis of variance, while postoperative data were analyzed by the independent two-tailed t -test and a Kaplan-Meier test ( p < 0.05)., Results: Twenty dogs were included in this study (10/group). A significant difference in the recovery of sensory nerve function was observed between the groups. The mean durations of the sensory blockade for femoral and sciatic nerves, respectively, was longer ( p < 0.001) for group D [168 (146-191, 95% CI), 161 (143-179, 95% CI) min] than in group C [120 (96.1-144, 95% CI), 116 (90.9-142, 95% CI]. No differences in the recovery of patellar and tibial reflexes, proprioceptive function, and ability to walk were found among groups. The overall postoperative rescue analgesia requirement was significantly different ( p = 0.019) between groups, with an incidence of 5/10 (50%) dogs in group D and 10/10 (100%) dogs in group C., Conclusion: Dexmedetomidine administered as a CRI (1 μg/kg/h) combined with local lidocaine increases the duration of the sensory component of the sciatic and femoral nerve blocks and reduces the requirement for additional analgesia during the immediate postoperative hours., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Stabile, Lacitignola, Acquafredda, Scardia, Crovace and Staffieri.)

Elderly patients who require surgical interventions often have multiple comorbidities that complicate their intraoperative and postoperative care. Surgical team members should consider all potential problems that elderly patients may experience and base perioperative care on their assessment. This article discusses the use of the transversus abdominis plane (TAP) block in elderly patients undergoing surgical procedures to relieve pain and reduce the use of narcotics or sedatives during the immediate and extended postoperative recovery period. By reducing postoperative pain and the use of sedatives and narcotics, the TAP block improves pain management and helps reduce the incidence of postoperative delirium, pneumonia, urinary retention, and falls. [ABSTRACT FROM AUTHOR]

Background Levobupivacaine toxicity reports are rare, and when they do occur, toxic symptoms are frequently treatable with minimal morbidity and mortality. However, levobupivacaine has not entirely replaced bupivacaine in clinical practice. Moreover, the experience of intrathecal anesthesia with levobupivacaine is not well documented. Hence, the purpose of this study is to assess the quality and duration of sensory and motor blockade of levobupivacaine and its side effects, if any, compared to intrathecal bupivacaine during infraumbilical surgeries. Methods After approval by the Institutional Ethical Committee of Kurunji Venkatramana Gowda (KVG) Medical College and Hospital, Sullia, 90 patients aged between 18 and 65 years, of either sex, who were scheduled for elective abdominoperineal, urological, or lower limb surgeries under intrathecal anesthesia were enrolled in this prospective study from January 2013 to June 2014. The selected patients were randomly assigned to three groups of 30 each: group HB (3 mL of 0.5% hyperbaric bupivacaine), group IB (3 mL of 0.5% isobaric bupivacaine), and group IL (3 mL of 0.5% isobaric levobupivacaine). Motor blockade was assessed using the modified Bromage scale. Intergroup comparison was done using Tukey's post hoc test. The incidence of adverse effects was analyzed using a chi-squared test. Significance was defined as P<0.05. Results In our study, the mean age of patients in the three groups was comparable (P>0.05), i.e., group IB was 39.23±11.78 years, group HB was 43.63±11.33 years, and group IL was 39.8±12.07 years. The time of onset of sensory block was 6.57±1.794 minutes in group IB, 2.30±1.343 minutes in group HB, and 4.57±1.960 minutes in group IL, and this variation was statistically highly significant (P<0.001). A total of 15 patients suffered hypotension intraoperatively, of which eight belonged to group HB, four to group IB, and the rest to group IL. Intraoperative or postoperative nausea/vomiting was seen in five patients in group IB, two patients in group HB, and one patient in group IL. In the postoperative period, the mean heart rate (HR) was 77.47±4.88/minute in group IB, 68.78±7.88/minute in group HB, and 72.15±8.83/minute in group IL. The data was statistically highly significant (P<0.001). Conclusion Our study revealed that 15 mg of isobaric levobupivacaine (3 mL of 0.5%), the new racemic isomer of bupivacaine, was intermediate in its anesthetic properties when compared to isobaric bupivacaine and hyperbaric bupivacaine. The onset of sensory and motor blockade is slower than hyperbaric bupivacaine but faster than isobaric bupivacaine with a higher level of maximum sensory block., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Goyal et al.)

Introduction Day-care surgery has become an immensely popular modality of treatment throughout the globe. Ureteroscopic lithotripsy (URSL) surgery is commonly performed on a day-care basis, and the duration of surgery ranges from 15 minutes to 45 minutes. URSL is routinely done under spinal anaesthesia. Spinal anaesthesia with conventional drugs has its problems like delayed regression and urinary retention, necessitating a longer hospital stay, thereby increasing the time and resources needed. For day-care surgery, short-acting local anaesthetics have a quicker onset with fewer side effects, and drugs that ensure quicker hospital discharge are more often preferred over long-acting anaesthetics. For spinal anaesthesia, we planned to perform a randomised prospective study to compare the effectiveness of 40 mg of preservative-free 1% chloroprocaine over 10 mg of plain 0.5% isobaric bupivacaine. Materials and method After obtaining clearance from the institute's ethical committee and written informed consent from the patients, 64 patients between the ages of 18 and 50 years of either sex belonging to American Society of Anesthesiologists (ASA) 1 and 2 scheduled for URSL surgery were included in our study. They were randomised using a computer-generated sealed envelope technique into two groups. Group C received 4 ml of 1% isobaric chloroprocaine, and group B received 2 ml of 0.5% isobaric bupivacaine in the intrathecal space. The primary outcome was to compare the in-hospital time among both groups. Our secondary outcomes were the onset time of motor and sensory blocks, the duration of the blocks, time to unaided ambulation and voiding, the need for an overnight stay, and the side effects like postoperative nausea and vomiting (PONV), and urinary retention. The data were analysed using the unpaired t-test and chi-square test and calculated by SPSS 20.0 software version (IBM Corp., Armonk, NY). Results Final analyses were done among 60 patients. In-hospital time was significantly lower in group C as compared to group B (p<0.05). The onset time of sensory and motor blockade was significantly lower in group C as compared to group B (p<0.005). The duration of sensory and motor blockade was significantly less in group C as compared to group B (p<0.005). The time for unaided voiding and ambulation was less in group C as compared to group B. The need for an overnight stay was only needed in group B. The incidence of PONV and urinary retention was higher in group B. Conclusion In URSL surgery, the use of intrathecal 1% isobaric chloroprocaine 40 mg resulted in a reduced hospital stay time as compared to the use of intrathecal 10 mg of 0.5% isobaric bupivacaine. Also, it resulted in a significantly faster onset and faster regression of the block, less duration of the blockade, shorter time to ambulation and micturition, and a requirement for an overnight stay when compared with isobaric spinal bupivacaine., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, M et al.)

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., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Kaur et al.)

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., Competing Interests: There are no conflicts of interest.

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.

Clinically there is a need for local anesthetics with a greater specificity of action on target cells and longer duration. We have synthesized a series of local anesthetic derivatives we call boronicaines in which the aromatic phenyl ring of lidocaine was replaced with ortho-, meta-, C,C'-dimethyl meta- and para-carborane clusters. The boronicaine derivatives were tested for their analgesic activity and compared with lidocaine using standard procedures in mice following a plantar injection. The compounds differed in their analgesic activity in the following order: ortho-carborane = C,C'-dimethyl meta-carborane > para-carborane > lidocaine > meta-carborane derivative. Both ortho-boronicaine and C,C'-dimethyl meta-boronicaine had longer durations of analgesia than lidocaine. Differences in analgesic efficacies are rationalized by variations in chemical structure and protein binding characteristics., (© 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)