A comparative study of intrathecal levobupivacaine-clonidine and bupivacaine in the quality of anesthesia for patients undergoing hernioplasty

Background: Bupivacaine is most commonly used amino-amide drug for subarachnoid block in hernioplasty. Levobupivacaine has similar pharmacological activity to that of bupivacaine with minimal cardiotoxicity. Clonidine, an α2 adrenergic agonist, potentiates the action of local anesthetics when used intrathecally and enhances post-operative analgesia. Aims and Objectives: This prospective, comparative, observational study was aimed to compare the effects of 0.5% levobupivacaine with clonidine and 0.5% hyperbaric bupivacaine in patients undergoing hernioplasty for the quality of surgical anesthesia and hemodynamic changes with any significant intraoperative complications. Materials and Methods: After receiving approval from the institutional ethics committee and written informed consent, 80 male patients aged between 18 and 60 years, BMI 150 cm, and American society of anesthesiologists physical status1 and 2 posted for elective hernioplasty were enrolled into two equal groups of 40 patients, group LC and group B. Patients in group LC received 15 mg 0.5% isobaric levobupivacaine with 30 μg clonidine and patients in group B received 15 mg hyperbaric bupivacaine intrathecally. SPSS version 20 was used for analysis, and P<0.05 was considered statistically significant. Results: In group LC, onsets of both sensory and motor blocks were delayed, whereas durations of motor and sensory block with analgesia were longer. Tachycardia, hypotension, nausea, vomiting, and shivering were observed greater in numbers in group B, whereas incidence of bradycardia was more in group LC. Conclusion: Prolonged duration of sensory and motor block, prolonged analgesic effect, and hemodynamic stability without any significant adverse effects may make this combination a better alternative to hyperbaric bupivacaine for hernioplasty

Efficacy of transdermal buprenorphine patch on post-operative pain relief after elective spinal instrumentation surgery

Background and Aims: Transdermal buprenorphine patch (TDB) is increasingly used for chronic pain management because of non-invasive dosing, longer duration of action and minimal side effects. However its role in acute post-operative pain management for spinal instrumentation surgery is not well established. The aim of this study was to evaluate the analgesic efficacy of buprenorphine patch for postoperative pain relief in patients undergoing spinal instrumentation surgery. Methods: In this randomised, placebo-controlled, double-blinded, prospective study, 70 adult patients undergoing elective spinal instrumentation surgery were randomly allocated into two groups-TDB Group (buprenorphinepatch) and TDP Group (placebo patch). Time to first rescue analgesic requirement was the primary outcome. All patients also were monitored for total rescue analgesic requirement, drug-related adverse effect and haemodynamic status till 48 h after surgery. Statistical analysis was carried out using student independent t-test if normally distributed or with Mann–Whitney U-test if otherwise. Results: Time to first post-operative rescue analgesic (tramadol) requirement was much delayed in TDB Group than TDP Group (708.0 ± 6.98 min vs 54 ± 0.68 min, P < 0.001) and the total tramadol requirement was higher in TDB Group (490.60 ± 63.09 averagevs. 162.93 ± 63.91 mg, P < 0.001). Intra-and post-operative haemodynamic status was also stable in TDB Group without any adverse event. Conclusion: A TDB patch (10 μg/hour) applied 24 hours before surgery can be used as a postoperative analgesic for lumber fixation surgery without any drug-related adverse effect