Journal of Anaesthesiology Clinical Pharmacology, 2015
Background and Aims: Bupivacaine is more cardiotoxic than ropivacaine. Ropivacaine provides effec... more Background and Aims: Bupivacaine is more cardiotoxic than ropivacaine. Ropivacaine provides effective spinal anesthesia for lower limb and hip surgeries. This prospective study was designed to compare the efficacy and safety of intrathecal hyperbaric ropivacaine with hyperbaric bupivacaine for patients undergoing limb and hip surgeries. Material and Methods: Two hundred patients aged 40-75 years, with American Society of Anesthesiologists I and II of either gender were randomly divided into Group R (Ropivacaine) and Group B (Bupivacaine) to receive an intrathecal injection of 3 ml of hyperbaric ropivacaine 0.5% or 3 ml of hyperbaric bupivacaine 0.5%, respectively. Onset and duration of sensory blockade were determined using the pinprick method by a three-point scale at T-10 dermatome. Onset and duration of motor block were assessed by modified Bromage scale. Duration of postoperative analgesia, hemodynamic changes, central nervous system and cardiovascular system toxicity or any adverse effects were observed. Results: The mean onset of sensory block (6 ± 1.3 min vs. 3 ± 1.1 min; P < 0.001) and motor block (13 ± 1.6 min vs. 9 ± 1.3 min; P < 0.05) was significantly slower in ropivacaine group as compared to bupivacaine group. The total duration of sensory block was significantly shorter in the ropivacaine group (160 ± 12.9 min) than in the bupivacaine group (260 ± 16.1 min; P < 0.05). The mean duration of motor block was also shorter in the ropivacaine group compared to bupivacaine group (126 ± 9.2 min vs. 174 ± 12.6 min; P < 0.05). Quality of anesthesia was comparable in two groups (P = 0.04). Conclusion: We conclude that hyperbaric bupivacaine used intrathecally has a faster onset of sensory block and prolonged duration of analgesia compared to hyperbaric ropivacaine.
Background and Objectives: We evaluated the effect of adding dexamethasone to ropivacaine for sup... more Background and Objectives: We evaluated the effect of adding dexamethasone to ropivacaine for supraclavicular brachial plexus blockade. The primary endpoints were the onset and total duration of sensory and motor block, quality of analgesia and duration of analgesia. Methods: Eighty patients of age group 20-50 years, scheduled for various elective orthopaedic surgeries on forearm and around the elbow under supraclavicular brachial block were divided into 2 equal groups in a randomized, double-blinded fashion. In group R (n=40), 30ml (150 mg) of 0.5% ropivacaine +2ml saline and in group RD (n=40), 30ml (150 mg) of 0.5% ropivacaine +2ml dexamethasone (8mg) were given. Motor and sensory block onset times, block durations, quality of intraoperative analgesia and duration of analgesia were recorded. Results: Demographic data and surgical characteristics were similar in both groups. The sensory and motor block onset time was earlier in group RD as compared to group R (P<0.05). Sensory and motor blockade duration were longer in group RD than in group R (P<0.001). Duration of analgesia was longer in group RD than in group R (P<0.001). The 24 hour Visual Analog Scale was more in group R as compared to group RD. The quality of anaesthesia was excellent in both the groups. Mean arterial blood pressure levels in groups at 5, 10, 15, 30, 45, 60, 90,120 and 150 minutes were statistically insignificant between the two groups (P>0.05). The mean pulse rate at different time intervals were statistically insignificant between the groups (P>0.05). Conclusions: Dexamethasone added to ropivacaine for supraclavicular brachial plexus block prolongs the duration of the block and the duration of postoperative analgesia.
American Journal of Advanced Drug Delivery, Dec 30, 2013
Objectives: In this clinical study hyperbaric ropivacaine in spinal anaesthesia for lower limb an... more Objectives: In this clinical study hyperbaric ropivacaine in spinal anaesthesia for lower limb and hip surgery was evaluated and results obtained were compared with those using hyperbaric bupivacaine. Methodology: Two hundred patients scheduled for lower limb and hip surgery were randomly divided into two groups of 100 patients each. These patients received a spinal injection of either 3ml (15mg) of 0.5% hyperbaric ropivacaine or 3ml (15mg) of 0.5% hyperbaric bupivacaine using 25G Quincke type spinal needle. The parameters studied were-onset and total duration of sensory block, onset and total duration of motor block, quality of intraoperative anaesthesia, hemodynamic alterations, and any intraoperative and postoperative complications. Results: The mean onset of sensory block (6±1.3min vs. 3±1.1min; p value<0.05) and motor block (13±1.6min vs. 9±1.3min; p value< 0.05) was significantly slower in ropivacaine group as compared to bupivacaine group. The total duration of sensory block was significantly shorter in ropivacaine group (160±12.9min) than in bupivacaine group (260±16.1min; p value <0.05). The mean duration of motor block was also shorter in ropivacaine group compared to bupivacaine group (126±9.2min vs. 174±12.6min; p value<0.05). Conclusion: The quality of anaesthesia was excellent in both the groups. In conclusion, a solution of ropivacaine (hyperbaric) can be used for spinal anaesthesia and is comparable with hyperbaric bupivacaine in terms of quality of block, but has shorter recovery profile.
Objective: The aim of this study was to evaluate the effectiveness of prophylactic intravenous ke... more Objective: The aim of this study was to evaluate the effectiveness of prophylactic intravenous ketamine in the prevention of shivering during spinal anesthesia for elective lower limb surgery and comparing it with intravenous tamodol. Method: After ethical committee approval and informed consent, 90 patients of American Society of Anesthesiologist (ASA) grades I and II of either sex, aged 18-60 years scheduled for elective orthopedic surgery of lower limbs under spinal anesthesia were randomized into three equal groups (envelope randomization). Just after intrathecal bupivacaine injection, all patients received prophylactically intravenous drug as either normal saline (Group S, n=30) or ketamine 0.5mg/kg (Group K, n =30) or tramodol 0.5mg/kg (Group T, no=30) for shivering. The incidence and the degree of shivering, the effectiveness and the side-effects of ketamine and tramodol in preventing shivering during intraoperative period were
International Journal of Biomedical and Advance Research, 2015
Objective: To evaluate the type and extent of hemodynamic changes associated with Laryngoscopy, E... more Objective: To evaluate the type and extent of hemodynamic changes associated with Laryngoscopy, Endotracheal intubation and Pneumoperitoneum in patients undergoing elective laparoscopic cholecystectomy, and to study the role of intravenous Clonidine Hydrochloride in attenuating hemodynamic response in these patients.Methods: 100 adult patients of either sex, with ASA physical status I and age 20 50 years were randomly allocated to receive Inj. clonidine hydrochloride 3?g/kg diluted in 10 ml Normal saline ( group 1) or 10 ml Normal saline as placebo ( group 2) fifteen minutes prior to induction of general anesthesia. Study parameters including heart rate, blood pressure (systolic, diastolic, mean arterial pressure) and rate pressure product were monitored and recorded at various intervals during the procedure.Results: Inter group comparison showed a highly significant rise (p<0.001) in heart rate in group 2 (placebo) during various interval compared to group 1 (clonidine group). B...
Objective : The aim of this study was to evaluate the effectiveness of prophylactic intravenous k... more Objective : The aim of this study was to evaluate the effectiveness of prophylactic intravenous ketamine in the prevention of shivering during spinal anesthesia for elective lower limb surgery and comparing it with intravenous tamodol. Method : After ethical committee approval and informed consent, 90 patients of American Society of Anesthesiologist (ASA) grades I and II of either sex, aged 18-60 years scheduled for elective orthopedic surgery of lower limbs under spinal anesthesia were randomized into three equal groups (envelope randomization). Just after intrathecal bupivacaine injection, all patients received prophylactically intravenous drug as either normal saline (Group S, n=30) or ketamine 0.5mg/kg (Group K, n =30) or tramodol 0.5mg/kg (Group T, no=30) for shivering. The incidence and the degree of shivering, the effectiveness and the side-effects of ketamine and tramodol in preventing shivering during intraoperative period were recorded. Results: The groups were comparable...
Journal of Anaesthesiology Clinical Pharmacology, 2013
To compare insertion characteristics of 2 different supraglottic devices [I-gel and Proseal laryn... more To compare insertion characteristics of 2 different supraglottic devices [I-gel and Proseal laryngeal mask airway (PLMA)] and to observe any associated complications. Study Design: This prospective, randomized study was conducted in 80 patients [Group I-I-gel insertion (n = 40) and Group P-LMA Proseal insertion (n =40)] of ASA grades I/II, of either sex in the age group 18-65 years. Both groups were compared with respect to ease of insertion, insertion attempts, fiberoptic assessment, airway sealing pressure, ease of gastric tube placement, and other complications. Materials and Methods: All patients were asked to fast overnight. Patients were given alprazolam 0.25 mg orally at 10 p.m. the night before surgery and again 2 hours prior to surgery with 1-2 sips of water. Glycopyrrolate 0.2 mg, metoclopramide 10 mg, and ranitidine 50 mg were administered intravenously to the patients 45 minutes prior to the surgery. Once adequate depth of anesthesia was achieved either of the 2 devices, selected using a random computerized table, was inserted by an experienced anesthesiologist. In group I, I-gel was inserted and in patients of group P, PLMA was inserted. Statistical Analysis: Student t-test and Mann-Whitney test were employed to compare the means; for categorical variables, Chi-square test was used. Result: Mean insertion time for the I-gel (11.12 ± 1.814 sec) was significantly lower than that of the PLMA (15.13 ± 2.91 sec) (P = 0.001). I-gel was easier to insert with a better anatomic fit. Mean airway sealing pressure in the PLMA group (29.55 ± 3.53 cm H 2 O) was significantly higher than in the I-gel group (26.73 ± 2.52 cm H 2 O; P = 0.001). Ease of gastric tube insertion was significantly higher in the I-gel group (P = 0.001). Incidence of blood staining of the device, sore throat and dysphagia were observed more in PLMA group. No other complications were observed in either of the groups.
Background and Objectives: We evaluated the effect of adding dexamethasone to ropivacaine for sup... more Background and Objectives: We evaluated the effect of adding dexamethasone to ropivacaine for supraclavicular brachial plexus blockade. The primary endpoints were the onset and total duration of sensory and motor block, quality of analgesia and duration of analgesia. Methods: Eighty patients of age group 20-50 years, scheduled for various elective orthopaedic surgeries on forearm and around the elbow under supraclavicular brachial block were divided into 2 equal groups in a randomized, double-blinded fashion. In group R (n=40), 30ml (150 mg) of 0.5% ropivacaine +2ml saline and in group RD (n=40), 30ml (150 mg) of 0.5% ropivacaine +2ml dexamethasone (8mg) were given. Motor and sensory block onset times, block durations, quality of intraoperative analgesia and duration of analgesia were recorded. Results: Demographic data and surgical characteristics were similar in both groups. The sensory and motor block onset time was earlier in group RD as compared to group R (P<0.05). Sensory and motor blockade duration were longer in group RD than in group R (P<0.001). Duration of analgesia was longer in group RD than in group R (P<0.001). The 24 hour Visual Analog Scale was more in group R as compared to group RD. The quality of anaesthesia was excellent in both the groups. Mean arterial blood pressure levels in groups at 5, 10, 15, 30, 45, 60, 90,120 and 150 minutes were statistically insignificant between the two groups (P>0.05). The mean pulse rate at different time intervals were statistically insignificant between the groups (P>0.05). Conclusions: Dexamethasone added to ropivacaine for supraclavicular brachial plexus block prolongs the duration of the block and the duration of postoperative analgesia.
Background: Intrathecal α2 agonists prolong the duration of action of local anesthetics and reduc... more Background: Intrathecal α2 agonists prolong the duration of action of local anesthetics and reduce the required dose. Dexmedetomidine is a α2 receptor agonist and its α2/α1 selectivity is 8 times higher than that of clonidine. Aims: In this study, we aimed to investigate the effect of adding dexmedetomidine to intrathecal bupivacaine on the onset time and duration of motor and sensory blocks. Methods: Patients were randomly assigned into two groups. Group B(n= 30) patients received 3ml (15mg) of 0.5% bupivacaine +0.5ml normal saline and Group BD (n= 30) patients received 3ml (15 mg) of 0.5% bupivacaine + 0.5ml (5μg) dexmedetomidine. The parameters studied were-onset and total duration of sensory block, onset and total duration of motor block, the most elevated dermatome level, hemodynamic alterations, and any intraoperative and postoperative complications. Results: The two groups were matched for demographic data. Sensory and motor block onset times were similar in both groups. The regression of the sensory block to S1 dermatome and regression of complete motor block were longer in Group BD than Group B (p<0.001). No significant difference were seen between the groups relative to the maximum level of sensory block (p=0.340). Statistically there were no significant differences in hemodynamic alterations and other adverse effects between the groups. Conclusion: We conclude that intrathecal dexmedetomidine addition to bupivacaine for spinal anaesthesia prolongs sensory and motor block durations without any significant adverse effects.
Objective: To evaluate the type and extent of hemodynamic changes associated with Laryngoscopy, E... more Objective: To evaluate the type and extent of hemodynamic changes associated with Laryngoscopy, Endotracheal intubation and Pneumoperitoneum in patients undergoing elective laparoscopic cholecystectomy, and to study the role of intravenous Clonidine Hydrochloride in attenuating hemodynamic response in these patients. Methods: 100 adult patients of either sex, with ASA physical status I and age 20 – 50 years were randomly allocated to receive Inj. clonidine hydrochloride 3μg/kg diluted in 10 ml Normal saline (group 1) or 10 ml Normal saline as placebo (group 2) fifteen minutes prior to induction of general anesthesia. Study parameters including heart rate, blood pressure (systolic, diastolic, mean arterial pressure) and rate pressure product were monitored and recorded at various intervals during the procedure. Results: Inter group comparison showed a highly significant rise (p<0.001) in heart rate in group 2 (placebo) during various interval compared to group 1 (clonidine group)....
Background Levobupivacaine is a relatively new amide local anesthetic, and it has been already in... more Background Levobupivacaine is a relatively new amide local anesthetic, and it has been already investigated in epidural and locoregional techniques, but more has to be known regarding its characteristics in spinal anesthesia. Aims The aim of our study was to compare clinical and anesthetic features of levobupivacaine and racemic bupivacaine when intrathecally administered in patients undergoing elective Cesarean section. Patients and methods Hundred patients of ASA I and II were randomized to receive an intrathecal injection of one of two local anesthetic solutions. Each patient in group L (n = 50) received 2 ml of isobaric levobupivacaine 5 mg/ml (10 mg) with 15 μg of fentanyl, whereas each patient in group B (n = 50) received 2 ml of hyperbaric bupivacaine (10 mg) with 15 μg of fentanyl. The parameters studied were onset and total duration of sensory block, onset and total duration of motor block, the quality of intraoperative anesthesia, hemodynamic alterations, and any intraoperative and postoperative complications. Results There were no significant differences in demographic or surgical variables between the two groups. There was no significant difference in the quality of anesthesia and intraoperative side effects in the two groups. Time to complete regression of motor blockade was statistically lower in group L (135 ± 15.6 vs. 145 ± 20.5 min; P < 0.005) compared with group B. There were no significant differences in onset of sensory and motor block in the two groups. The total duration of sensory at T 12 level in group L (168.3 ± 15.6 vs. 172.2 ± 20.5 min; P > 0.005) was nonsignificant when compared with group B. Conclusion Levobupivacaine, the pure S (-) enantiomer of racemic bupivacaine, is an equally effective local anesthetic for spinal anesthesia for Cesarean section, compared with racemic bupivacaine.
Bupivacaine is more cardiotoxic than ropivacaine. Ropivacaine provides effective spinal anesthesi... more Bupivacaine is more cardiotoxic than ropivacaine. Ropivacaine provides effective spinal anesthesia for lower limb and hip surgeries. This prospective study was designed to compare the efficacy and safety of intrathecal hyperbaric ropivacaine with hyperbaric bupivacaine for patients undergoing limb and hip surgeries. Two hundred patients aged 40-75 years, with American Society of Anesthesiologists I and II of either gender were randomly divided into Group R (Ropivacaine) and Group B (Bupivacaine) to receive an intrathecal injection of 3 ml of hyperbaric ropivacaine 0.5% or 3 ml of hyperbaric bupivacaine 0.5%, respectively. Onset and duration of sensory blockade were determined using the pinprick method by a three-point scale at T-10 dermatome. Onset and duration of motor block were assessed by modified Bromage scale. Duration of postoperative analgesia, hemodynamic changes, central nervous system and cardiovascular system toxicity or any adverse effects were observed. The mean onset ...
International Journal of Biomedical and Advance Research, 2013
Background and Objectives: We evaluated the effect of adding dexmedetomidine to ropivacaine for a... more Background and Objectives: We evaluated the effect of adding dexmedetomidine to ropivacaine for axillary brachial plexus blockade. The primary endpoints were the onset and duration of sensory and motor block and duration of analgesia. Methods: Eighty patients scheduled for elective forearm and hand surgery were divided into 2 equal groups in a randomized, double-blind fashion. The 4 main nerves in the axilla (musculocutaneus, radial, median, ulnar) were identified using neural stimulation. Patients were assigned randomly into 2 groups. In group R (n=40), 40ml (200 mg) of 0.5% ropivacaine +1ml saline and in group RD (n=40), 40ml (200 mg) of 0.5% ropivacaine +1ml dexmedetomidine (50µg) were given. Motor and sensory block onset times, block durations, and duration of analgesia were recorded. Results: Demographic data and surgical characteristics were similar in both groups. Sensory and motor block onset times were shorter in group RD than in group R (P<0.05). Sensory and motor blockade durations were longer in group RD than in group R (P<0.001). Duration of analgesia was longer in group RD than in group R (P<0.001). Systolic arterial blood pressure levels in group RD at 10, 15, 30, 45, 60, 90, and 120 minutes were significantly lower than those in group R (P<0.05). Diastolic arterial blood pressure levels in group RD at 60, 90, and 120 minutes were significantly lower than those in group R (P<0.05). Heart rate levels in group RD, except basal measurements, were significantly lower than those in group R (P<0.05). In group RD, bradycardia was observed in 7 patients, although there was no bradycardia in group R (P<0.05). Conclusions: Dexmedetomidine added to ropivacaine for axillary brachial plexus block shortens the onset time and prolongs the duration of the block and the duration of postoperative analgesia. However, dexmedetomidine also may lead to bradycardia.
Journal of Anaesthesiology Clinical Pharmacology, 2015
Background and Aims: Bupivacaine is more cardiotoxic than ropivacaine. Ropivacaine provides effec... more Background and Aims: Bupivacaine is more cardiotoxic than ropivacaine. Ropivacaine provides effective spinal anesthesia for lower limb and hip surgeries. This prospective study was designed to compare the efficacy and safety of intrathecal hyperbaric ropivacaine with hyperbaric bupivacaine for patients undergoing limb and hip surgeries. Material and Methods: Two hundred patients aged 40-75 years, with American Society of Anesthesiologists I and II of either gender were randomly divided into Group R (Ropivacaine) and Group B (Bupivacaine) to receive an intrathecal injection of 3 ml of hyperbaric ropivacaine 0.5% or 3 ml of hyperbaric bupivacaine 0.5%, respectively. Onset and duration of sensory blockade were determined using the pinprick method by a three-point scale at T-10 dermatome. Onset and duration of motor block were assessed by modified Bromage scale. Duration of postoperative analgesia, hemodynamic changes, central nervous system and cardiovascular system toxicity or any adverse effects were observed. Results: The mean onset of sensory block (6 ± 1.3 min vs. 3 ± 1.1 min; P < 0.001) and motor block (13 ± 1.6 min vs. 9 ± 1.3 min; P < 0.05) was significantly slower in ropivacaine group as compared to bupivacaine group. The total duration of sensory block was significantly shorter in the ropivacaine group (160 ± 12.9 min) than in the bupivacaine group (260 ± 16.1 min; P < 0.05). The mean duration of motor block was also shorter in the ropivacaine group compared to bupivacaine group (126 ± 9.2 min vs. 174 ± 12.6 min; P < 0.05). Quality of anesthesia was comparable in two groups (P = 0.04). Conclusion: We conclude that hyperbaric bupivacaine used intrathecally has a faster onset of sensory block and prolonged duration of analgesia compared to hyperbaric ropivacaine.
Journal of Anaesthesiology Clinical Pharmacology, 2015
Background and Aims: Bupivacaine is more cardiotoxic than ropivacaine. Ropivacaine provides effec... more Background and Aims: Bupivacaine is more cardiotoxic than ropivacaine. Ropivacaine provides effective spinal anesthesia for lower limb and hip surgeries. This prospective study was designed to compare the efficacy and safety of intrathecal hyperbaric ropivacaine with hyperbaric bupivacaine for patients undergoing limb and hip surgeries. Material and Methods: Two hundred patients aged 40-75 years, with American Society of Anesthesiologists I and II of either gender were randomly divided into Group R (Ropivacaine) and Group B (Bupivacaine) to receive an intrathecal injection of 3 ml of hyperbaric ropivacaine 0.5% or 3 ml of hyperbaric bupivacaine 0.5%, respectively. Onset and duration of sensory blockade were determined using the pinprick method by a three-point scale at T-10 dermatome. Onset and duration of motor block were assessed by modified Bromage scale. Duration of postoperative analgesia, hemodynamic changes, central nervous system and cardiovascular system toxicity or any adverse effects were observed. Results: The mean onset of sensory block (6 ± 1.3 min vs. 3 ± 1.1 min; P < 0.001) and motor block (13 ± 1.6 min vs. 9 ± 1.3 min; P < 0.05) was significantly slower in ropivacaine group as compared to bupivacaine group. The total duration of sensory block was significantly shorter in the ropivacaine group (160 ± 12.9 min) than in the bupivacaine group (260 ± 16.1 min; P < 0.05). The mean duration of motor block was also shorter in the ropivacaine group compared to bupivacaine group (126 ± 9.2 min vs. 174 ± 12.6 min; P < 0.05). Quality of anesthesia was comparable in two groups (P = 0.04). Conclusion: We conclude that hyperbaric bupivacaine used intrathecally has a faster onset of sensory block and prolonged duration of analgesia compared to hyperbaric ropivacaine.
Background and Objectives: We evaluated the effect of adding dexamethasone to ropivacaine for sup... more Background and Objectives: We evaluated the effect of adding dexamethasone to ropivacaine for supraclavicular brachial plexus blockade. The primary endpoints were the onset and total duration of sensory and motor block, quality of analgesia and duration of analgesia. Methods: Eighty patients of age group 20-50 years, scheduled for various elective orthopaedic surgeries on forearm and around the elbow under supraclavicular brachial block were divided into 2 equal groups in a randomized, double-blinded fashion. In group R (n=40), 30ml (150 mg) of 0.5% ropivacaine +2ml saline and in group RD (n=40), 30ml (150 mg) of 0.5% ropivacaine +2ml dexamethasone (8mg) were given. Motor and sensory block onset times, block durations, quality of intraoperative analgesia and duration of analgesia were recorded. Results: Demographic data and surgical characteristics were similar in both groups. The sensory and motor block onset time was earlier in group RD as compared to group R (P<0.05). Sensory and motor blockade duration were longer in group RD than in group R (P<0.001). Duration of analgesia was longer in group RD than in group R (P<0.001). The 24 hour Visual Analog Scale was more in group R as compared to group RD. The quality of anaesthesia was excellent in both the groups. Mean arterial blood pressure levels in groups at 5, 10, 15, 30, 45, 60, 90,120 and 150 minutes were statistically insignificant between the two groups (P>0.05). The mean pulse rate at different time intervals were statistically insignificant between the groups (P>0.05). Conclusions: Dexamethasone added to ropivacaine for supraclavicular brachial plexus block prolongs the duration of the block and the duration of postoperative analgesia.
American Journal of Advanced Drug Delivery, Dec 30, 2013
Objectives: In this clinical study hyperbaric ropivacaine in spinal anaesthesia for lower limb an... more Objectives: In this clinical study hyperbaric ropivacaine in spinal anaesthesia for lower limb and hip surgery was evaluated and results obtained were compared with those using hyperbaric bupivacaine. Methodology: Two hundred patients scheduled for lower limb and hip surgery were randomly divided into two groups of 100 patients each. These patients received a spinal injection of either 3ml (15mg) of 0.5% hyperbaric ropivacaine or 3ml (15mg) of 0.5% hyperbaric bupivacaine using 25G Quincke type spinal needle. The parameters studied were-onset and total duration of sensory block, onset and total duration of motor block, quality of intraoperative anaesthesia, hemodynamic alterations, and any intraoperative and postoperative complications. Results: The mean onset of sensory block (6±1.3min vs. 3±1.1min; p value<0.05) and motor block (13±1.6min vs. 9±1.3min; p value< 0.05) was significantly slower in ropivacaine group as compared to bupivacaine group. The total duration of sensory block was significantly shorter in ropivacaine group (160±12.9min) than in bupivacaine group (260±16.1min; p value <0.05). The mean duration of motor block was also shorter in ropivacaine group compared to bupivacaine group (126±9.2min vs. 174±12.6min; p value<0.05). Conclusion: The quality of anaesthesia was excellent in both the groups. In conclusion, a solution of ropivacaine (hyperbaric) can be used for spinal anaesthesia and is comparable with hyperbaric bupivacaine in terms of quality of block, but has shorter recovery profile.
Objective: The aim of this study was to evaluate the effectiveness of prophylactic intravenous ke... more Objective: The aim of this study was to evaluate the effectiveness of prophylactic intravenous ketamine in the prevention of shivering during spinal anesthesia for elective lower limb surgery and comparing it with intravenous tamodol. Method: After ethical committee approval and informed consent, 90 patients of American Society of Anesthesiologist (ASA) grades I and II of either sex, aged 18-60 years scheduled for elective orthopedic surgery of lower limbs under spinal anesthesia were randomized into three equal groups (envelope randomization). Just after intrathecal bupivacaine injection, all patients received prophylactically intravenous drug as either normal saline (Group S, n=30) or ketamine 0.5mg/kg (Group K, n =30) or tramodol 0.5mg/kg (Group T, no=30) for shivering. The incidence and the degree of shivering, the effectiveness and the side-effects of ketamine and tramodol in preventing shivering during intraoperative period were
International Journal of Biomedical and Advance Research, 2015
Objective: To evaluate the type and extent of hemodynamic changes associated with Laryngoscopy, E... more Objective: To evaluate the type and extent of hemodynamic changes associated with Laryngoscopy, Endotracheal intubation and Pneumoperitoneum in patients undergoing elective laparoscopic cholecystectomy, and to study the role of intravenous Clonidine Hydrochloride in attenuating hemodynamic response in these patients.Methods: 100 adult patients of either sex, with ASA physical status I and age 20 50 years were randomly allocated to receive Inj. clonidine hydrochloride 3?g/kg diluted in 10 ml Normal saline ( group 1) or 10 ml Normal saline as placebo ( group 2) fifteen minutes prior to induction of general anesthesia. Study parameters including heart rate, blood pressure (systolic, diastolic, mean arterial pressure) and rate pressure product were monitored and recorded at various intervals during the procedure.Results: Inter group comparison showed a highly significant rise (p<0.001) in heart rate in group 2 (placebo) during various interval compared to group 1 (clonidine group). B...
Objective : The aim of this study was to evaluate the effectiveness of prophylactic intravenous k... more Objective : The aim of this study was to evaluate the effectiveness of prophylactic intravenous ketamine in the prevention of shivering during spinal anesthesia for elective lower limb surgery and comparing it with intravenous tamodol. Method : After ethical committee approval and informed consent, 90 patients of American Society of Anesthesiologist (ASA) grades I and II of either sex, aged 18-60 years scheduled for elective orthopedic surgery of lower limbs under spinal anesthesia were randomized into three equal groups (envelope randomization). Just after intrathecal bupivacaine injection, all patients received prophylactically intravenous drug as either normal saline (Group S, n=30) or ketamine 0.5mg/kg (Group K, n =30) or tramodol 0.5mg/kg (Group T, no=30) for shivering. The incidence and the degree of shivering, the effectiveness and the side-effects of ketamine and tramodol in preventing shivering during intraoperative period were recorded. Results: The groups were comparable...
Journal of Anaesthesiology Clinical Pharmacology, 2013
To compare insertion characteristics of 2 different supraglottic devices [I-gel and Proseal laryn... more To compare insertion characteristics of 2 different supraglottic devices [I-gel and Proseal laryngeal mask airway (PLMA)] and to observe any associated complications. Study Design: This prospective, randomized study was conducted in 80 patients [Group I-I-gel insertion (n = 40) and Group P-LMA Proseal insertion (n =40)] of ASA grades I/II, of either sex in the age group 18-65 years. Both groups were compared with respect to ease of insertion, insertion attempts, fiberoptic assessment, airway sealing pressure, ease of gastric tube placement, and other complications. Materials and Methods: All patients were asked to fast overnight. Patients were given alprazolam 0.25 mg orally at 10 p.m. the night before surgery and again 2 hours prior to surgery with 1-2 sips of water. Glycopyrrolate 0.2 mg, metoclopramide 10 mg, and ranitidine 50 mg were administered intravenously to the patients 45 minutes prior to the surgery. Once adequate depth of anesthesia was achieved either of the 2 devices, selected using a random computerized table, was inserted by an experienced anesthesiologist. In group I, I-gel was inserted and in patients of group P, PLMA was inserted. Statistical Analysis: Student t-test and Mann-Whitney test were employed to compare the means; for categorical variables, Chi-square test was used. Result: Mean insertion time for the I-gel (11.12 ± 1.814 sec) was significantly lower than that of the PLMA (15.13 ± 2.91 sec) (P = 0.001). I-gel was easier to insert with a better anatomic fit. Mean airway sealing pressure in the PLMA group (29.55 ± 3.53 cm H 2 O) was significantly higher than in the I-gel group (26.73 ± 2.52 cm H 2 O; P = 0.001). Ease of gastric tube insertion was significantly higher in the I-gel group (P = 0.001). Incidence of blood staining of the device, sore throat and dysphagia were observed more in PLMA group. No other complications were observed in either of the groups.
Background and Objectives: We evaluated the effect of adding dexamethasone to ropivacaine for sup... more Background and Objectives: We evaluated the effect of adding dexamethasone to ropivacaine for supraclavicular brachial plexus blockade. The primary endpoints were the onset and total duration of sensory and motor block, quality of analgesia and duration of analgesia. Methods: Eighty patients of age group 20-50 years, scheduled for various elective orthopaedic surgeries on forearm and around the elbow under supraclavicular brachial block were divided into 2 equal groups in a randomized, double-blinded fashion. In group R (n=40), 30ml (150 mg) of 0.5% ropivacaine +2ml saline and in group RD (n=40), 30ml (150 mg) of 0.5% ropivacaine +2ml dexamethasone (8mg) were given. Motor and sensory block onset times, block durations, quality of intraoperative analgesia and duration of analgesia were recorded. Results: Demographic data and surgical characteristics were similar in both groups. The sensory and motor block onset time was earlier in group RD as compared to group R (P<0.05). Sensory and motor blockade duration were longer in group RD than in group R (P<0.001). Duration of analgesia was longer in group RD than in group R (P<0.001). The 24 hour Visual Analog Scale was more in group R as compared to group RD. The quality of anaesthesia was excellent in both the groups. Mean arterial blood pressure levels in groups at 5, 10, 15, 30, 45, 60, 90,120 and 150 minutes were statistically insignificant between the two groups (P>0.05). The mean pulse rate at different time intervals were statistically insignificant between the groups (P>0.05). Conclusions: Dexamethasone added to ropivacaine for supraclavicular brachial plexus block prolongs the duration of the block and the duration of postoperative analgesia.
Background: Intrathecal α2 agonists prolong the duration of action of local anesthetics and reduc... more Background: Intrathecal α2 agonists prolong the duration of action of local anesthetics and reduce the required dose. Dexmedetomidine is a α2 receptor agonist and its α2/α1 selectivity is 8 times higher than that of clonidine. Aims: In this study, we aimed to investigate the effect of adding dexmedetomidine to intrathecal bupivacaine on the onset time and duration of motor and sensory blocks. Methods: Patients were randomly assigned into two groups. Group B(n= 30) patients received 3ml (15mg) of 0.5% bupivacaine +0.5ml normal saline and Group BD (n= 30) patients received 3ml (15 mg) of 0.5% bupivacaine + 0.5ml (5μg) dexmedetomidine. The parameters studied were-onset and total duration of sensory block, onset and total duration of motor block, the most elevated dermatome level, hemodynamic alterations, and any intraoperative and postoperative complications. Results: The two groups were matched for demographic data. Sensory and motor block onset times were similar in both groups. The regression of the sensory block to S1 dermatome and regression of complete motor block were longer in Group BD than Group B (p<0.001). No significant difference were seen between the groups relative to the maximum level of sensory block (p=0.340). Statistically there were no significant differences in hemodynamic alterations and other adverse effects between the groups. Conclusion: We conclude that intrathecal dexmedetomidine addition to bupivacaine for spinal anaesthesia prolongs sensory and motor block durations without any significant adverse effects.
Objective: To evaluate the type and extent of hemodynamic changes associated with Laryngoscopy, E... more Objective: To evaluate the type and extent of hemodynamic changes associated with Laryngoscopy, Endotracheal intubation and Pneumoperitoneum in patients undergoing elective laparoscopic cholecystectomy, and to study the role of intravenous Clonidine Hydrochloride in attenuating hemodynamic response in these patients. Methods: 100 adult patients of either sex, with ASA physical status I and age 20 – 50 years were randomly allocated to receive Inj. clonidine hydrochloride 3μg/kg diluted in 10 ml Normal saline (group 1) or 10 ml Normal saline as placebo (group 2) fifteen minutes prior to induction of general anesthesia. Study parameters including heart rate, blood pressure (systolic, diastolic, mean arterial pressure) and rate pressure product were monitored and recorded at various intervals during the procedure. Results: Inter group comparison showed a highly significant rise (p<0.001) in heart rate in group 2 (placebo) during various interval compared to group 1 (clonidine group)....
Background Levobupivacaine is a relatively new amide local anesthetic, and it has been already in... more Background Levobupivacaine is a relatively new amide local anesthetic, and it has been already investigated in epidural and locoregional techniques, but more has to be known regarding its characteristics in spinal anesthesia. Aims The aim of our study was to compare clinical and anesthetic features of levobupivacaine and racemic bupivacaine when intrathecally administered in patients undergoing elective Cesarean section. Patients and methods Hundred patients of ASA I and II were randomized to receive an intrathecal injection of one of two local anesthetic solutions. Each patient in group L (n = 50) received 2 ml of isobaric levobupivacaine 5 mg/ml (10 mg) with 15 μg of fentanyl, whereas each patient in group B (n = 50) received 2 ml of hyperbaric bupivacaine (10 mg) with 15 μg of fentanyl. The parameters studied were onset and total duration of sensory block, onset and total duration of motor block, the quality of intraoperative anesthesia, hemodynamic alterations, and any intraoperative and postoperative complications. Results There were no significant differences in demographic or surgical variables between the two groups. There was no significant difference in the quality of anesthesia and intraoperative side effects in the two groups. Time to complete regression of motor blockade was statistically lower in group L (135 ± 15.6 vs. 145 ± 20.5 min; P < 0.005) compared with group B. There were no significant differences in onset of sensory and motor block in the two groups. The total duration of sensory at T 12 level in group L (168.3 ± 15.6 vs. 172.2 ± 20.5 min; P > 0.005) was nonsignificant when compared with group B. Conclusion Levobupivacaine, the pure S (-) enantiomer of racemic bupivacaine, is an equally effective local anesthetic for spinal anesthesia for Cesarean section, compared with racemic bupivacaine.
Bupivacaine is more cardiotoxic than ropivacaine. Ropivacaine provides effective spinal anesthesi... more Bupivacaine is more cardiotoxic than ropivacaine. Ropivacaine provides effective spinal anesthesia for lower limb and hip surgeries. This prospective study was designed to compare the efficacy and safety of intrathecal hyperbaric ropivacaine with hyperbaric bupivacaine for patients undergoing limb and hip surgeries. Two hundred patients aged 40-75 years, with American Society of Anesthesiologists I and II of either gender were randomly divided into Group R (Ropivacaine) and Group B (Bupivacaine) to receive an intrathecal injection of 3 ml of hyperbaric ropivacaine 0.5% or 3 ml of hyperbaric bupivacaine 0.5%, respectively. Onset and duration of sensory blockade were determined using the pinprick method by a three-point scale at T-10 dermatome. Onset and duration of motor block were assessed by modified Bromage scale. Duration of postoperative analgesia, hemodynamic changes, central nervous system and cardiovascular system toxicity or any adverse effects were observed. The mean onset ...
International Journal of Biomedical and Advance Research, 2013
Background and Objectives: We evaluated the effect of adding dexmedetomidine to ropivacaine for a... more Background and Objectives: We evaluated the effect of adding dexmedetomidine to ropivacaine for axillary brachial plexus blockade. The primary endpoints were the onset and duration of sensory and motor block and duration of analgesia. Methods: Eighty patients scheduled for elective forearm and hand surgery were divided into 2 equal groups in a randomized, double-blind fashion. The 4 main nerves in the axilla (musculocutaneus, radial, median, ulnar) were identified using neural stimulation. Patients were assigned randomly into 2 groups. In group R (n=40), 40ml (200 mg) of 0.5% ropivacaine +1ml saline and in group RD (n=40), 40ml (200 mg) of 0.5% ropivacaine +1ml dexmedetomidine (50µg) were given. Motor and sensory block onset times, block durations, and duration of analgesia were recorded. Results: Demographic data and surgical characteristics were similar in both groups. Sensory and motor block onset times were shorter in group RD than in group R (P<0.05). Sensory and motor blockade durations were longer in group RD than in group R (P<0.001). Duration of analgesia was longer in group RD than in group R (P<0.001). Systolic arterial blood pressure levels in group RD at 10, 15, 30, 45, 60, 90, and 120 minutes were significantly lower than those in group R (P<0.05). Diastolic arterial blood pressure levels in group RD at 60, 90, and 120 minutes were significantly lower than those in group R (P<0.05). Heart rate levels in group RD, except basal measurements, were significantly lower than those in group R (P<0.05). In group RD, bradycardia was observed in 7 patients, although there was no bradycardia in group R (P<0.05). Conclusions: Dexmedetomidine added to ropivacaine for axillary brachial plexus block shortens the onset time and prolongs the duration of the block and the duration of postoperative analgesia. However, dexmedetomidine also may lead to bradycardia.
Journal of Anaesthesiology Clinical Pharmacology, 2015
Background and Aims: Bupivacaine is more cardiotoxic than ropivacaine. Ropivacaine provides effec... more Background and Aims: Bupivacaine is more cardiotoxic than ropivacaine. Ropivacaine provides effective spinal anesthesia for lower limb and hip surgeries. This prospective study was designed to compare the efficacy and safety of intrathecal hyperbaric ropivacaine with hyperbaric bupivacaine for patients undergoing limb and hip surgeries. Material and Methods: Two hundred patients aged 40-75 years, with American Society of Anesthesiologists I and II of either gender were randomly divided into Group R (Ropivacaine) and Group B (Bupivacaine) to receive an intrathecal injection of 3 ml of hyperbaric ropivacaine 0.5% or 3 ml of hyperbaric bupivacaine 0.5%, respectively. Onset and duration of sensory blockade were determined using the pinprick method by a three-point scale at T-10 dermatome. Onset and duration of motor block were assessed by modified Bromage scale. Duration of postoperative analgesia, hemodynamic changes, central nervous system and cardiovascular system toxicity or any adverse effects were observed. Results: The mean onset of sensory block (6 ± 1.3 min vs. 3 ± 1.1 min; P < 0.001) and motor block (13 ± 1.6 min vs. 9 ± 1.3 min; P < 0.05) was significantly slower in ropivacaine group as compared to bupivacaine group. The total duration of sensory block was significantly shorter in the ropivacaine group (160 ± 12.9 min) than in the bupivacaine group (260 ± 16.1 min; P < 0.05). The mean duration of motor block was also shorter in the ropivacaine group compared to bupivacaine group (126 ± 9.2 min vs. 174 ± 12.6 min; P < 0.05). Quality of anesthesia was comparable in two groups (P = 0.04). Conclusion: We conclude that hyperbaric bupivacaine used intrathecally has a faster onset of sensory block and prolonged duration of analgesia compared to hyperbaric ropivacaine.
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