To evaluate the efficacy of ropivacaine with dexmedetomidine and ropivacaine with dexamethasone in fascia iliaca compartment block for post-operative pain relief in fracture femur surgeries: A comparative randomized study

Background: Patients with femur fracture experience severe post-operative pain. Fascia iliaca compartment block (FICB) is a safe and effective approach for providing post-operative analgesia. Aims and Objectives: The aim of the study was to compare the post-operative pain relief with dexmedetomidine and dexamethasone with ropivacaine in FICB. Materials and Methods: This prospective, double-blinded, randomized controlled, and clinical study was done on 105 patients, with ASA physical status I-II, aged between 18 and 70 years, undergoing surgery for femur fracture. Patients were randomly allocated into three groups. All patients received FICB by landmark technique before spinal anesthesia. Group A patients received 38 mL of 0.25% ropivacaine and dexmedetomidine, Group B received 38 mL of 0.25% ropivacaine and dexamethasone and Group C received 38 mL of 0.25% ropivacaine. Patients were assessed for analgesia during positioning and post-operative period using visual analog scale (VAS). Hemodynamic parameters and time for first rescue analgesia were recorded. Results: The mean VAS score at 6 h after surgery was 0.74±0.95 in Group A, in Group B 2.26±0.95, and in Group C was 4.23±1.17, which was statistically significant (P<0.05). The time for first rescue analgesia was 13.03±1.79 h in Group-A, 8.31±1.11 h in Group B and 5.94±0.87 h in Group C (P<0.001). Conclusion: Addition of dexmedetomidine or dexamethasone to ropivacaine for FICB in femur fracture patients prolongs post-operative analgesia compared to ropivacaine alone

A comparative evaluation of 0.25% bupivacaine and 0.25% levobupivacaine in peritubal infiltration in percutaneous nephrolithotomy

Background: Percutaneous nephrolithotomy (PCNL) is a routine endourologic procedure in patients with renal calculi. Although it is less painful than open surgery, pain around the nephrostomy tube is a clinical problem; therefore, good post-operative analgesia is required to alleviate pain. Peritubal infiltration can be one of the choices to alleviate pain around the nephrostomy tube. Aims and Objectives: The aim of this study was to evaluate the efficacy of peritubal infiltration of local anesthetics for post-operative pain following PCNL. Materials and Methods: A total of 60 patients with American Society of Anesthesiologists Grade I/II scheduled for elective PCNL surgeries were randomly allocated into two groups. Group L received levobupivacaine 0.25% (30 mL) and Group B received bupivacaine 0.25% (30 mL). The duration of rescue analgesia, total dose of tramadol consumption in 24 h, hemodynamic parameters, and adverse events during the post-operative period were noted. Results: The mean duration of rescue analgesia in Group L was 274.50±24.89 min and in Group B was 275.33±23.04 min which was not significant (P>0.05). Conclusion: Peritubal infiltration of 0.25% levobupivacaine and 0.25% bupivacaine is efficient in alleviating post-operative pain after PCNL. Both drugs can be used for infiltration around nephrostomy tubes in PCNL surgeries safely and are associated with minimal side effects

A comparative study of levobupivacaine alone and in combination with dexamethasone in caudal block for pediatric patient undergoing infraumbilical surgeries

Background: The caudal epidural block is one of the most commonly used regional techniques for post-operative pain management in pediatric age group patients undergoing infraumbilical surgeries. Adjuvants use increases the duration of analgesia and decrease local anesthetic dose requirement so decreasing the risk of toxicity. Aims and Objectives: The aim of present study was to evaluate and compare the efficacy of caudal block with 0.25% levobupivacaine 1 mL/kg and 0.25% levobupivacaine 1 mL/kg+dexamethasone 0.1 mg/kg for post-operative pain relief in pediatric patients undergoing infraumbilical surgeries. The secondary objective of the study was to compare hemodynamic parameters and side effects if any. Materials and Methods: A prospective, randomized, comparative, and double-blind study design was conducted in 60 patients in JAH super specialty group of hospitals. All patients belonging to physical status of American Society of Anesthesiologists Grade I and II, aged 1–6 years, were randomly allocated into two groups: Group 1 (n=30) received levobupivacaine 0.25% 1 mL/kg in 0.5 mL saline and Group 2 (n=30) received levobupivacaine 0.25% 1 ml/kg with dexamethasone 0.1 mg/kg for caudal block in pediatric patients undergoing infraumbilical surgeries. Primary outcome was duration of analgesia using face, legs, activity, cry, and consolability scale at interval of 0, 15, 30, 60, 90, 120, 150, and 180 min postoperatively. The secondary outcome of study included hemodynamic parameters and adverse events during the post-operative period. Results: The mean duration of analgesia in Group 1 (L) was 430.77±16.71 min and in Group 2 (L+D) was 805.00±36.71 min with statistically significant result. Conclusion: On adding dexamethasone to levobupivacaine in caudal block significantly prolongs duration of analgesia in post-operative period. It also provides more hemodynamic stability during intraoperative and post-operative period and associated with minimal side effects

A comparative study of levobupivacaine 0.25% with dexmedetomidine and dexamethasone as adjuvant in caudal block for pediatric patients undergoing infraumbilical surgeries

Background: The caudal epidural block is one of the most commonly used regional techniques for post-operative pain management in pediatric age group patients undergoing infraumbilical surgeries. Adjuvants use increase the duration of analgesia and decrease local anesthetic dose requirement, thereby decreasing the risk of toxicity. Aims and Objectives: The aim of the present study was to compare the prolongation of the duration of analgesia, hemodynamic parameters, and side effects if any, provided by the addition of dexmedetomidine (DEX) or dexamethasone as an adjuvant to levobupivacaine in the caudal block. Materials and Methods: A total of 60 patients with the American Society of Anesthesiologists grade I/II scheduled for elective infraumbilical surgeries were randomly allocated into two groups of 30 each. Group 1 received levobupivacaine 0.25% 1 mL/kg+DEX 1 mcg/kg and Group 2 received levobupivacaine 0.25% 1 mL/kg+dexamethasone 0.1 mg/kg for caudal block. The duration of analgesia, hemodynamic parameters, and adverse events during the post-operative period were noted. Results: There was no statistically significant difference in hemodynamic parameters between Group 1 and Group 2. Post-operative face, leg, activity, cry, consolability, (FLACC) pain scores were significantly lower in Group 1 when compared with Group 2. The mean duration of analgesia was prolonged in Group 1 at 824.23±53.53 min than in Group 2 with a mean duration of analgesia 480.50±31.66 min which was statistically significant (P0.05). Conclusion: The addition of DEX to levobupivacaine in caudal block significantly prolongs the duration of analgesia in post-operative period in comparison to the addition of dexamethasone with levobupivacaine. It also provides more hemodynamic stability during the intraoperative and post-operative period, lower FLACC pain scores, and is associated with minimal side effects

A comparative study of intravenous dexmedetomidine and intravenous clonidine for attenuating pressor responses to laryngoscopy and endotracheal intubation

Introduciton: Laryngoscopy and intubation are noxious stimuli that activate sympathetic nervous system causing tachycardia and hypertension. Both Clonidine and Dexmedetomidine are α2 agonist attenuate sympathoadrenal response by inhibiting norepinephrine release but dexmedetomidine has 8 times greater affinity than Clonidine.Aims and objective: The aim is to compare the effects of IV Clonidine 1μg/kg and IV Dexmedetomidine 1μg/kg in attenuating hemodynamic responses during laryngoscopy and intubation. Material and method: 90 patients of age 18-60 yr of either sex of ASA 1 &amp; 2 physical status are randomly allocated into 3 groups (30 each). Group D and group C received IV Dexmedetomidine 1 μg/kg and IV Clonidine 1 μg/kg respectively diluted in 100 ml of normal saline and group P infused 100 ml of normal saline, over 10 minutes, 15 minutes before induction. HR, SBP, DBP and MAP are recorded at baseline, after drug administration &amp; after induction and laryngoscopy then at 1, 3,5,10,15 minutes after intubation.Results: HR, SBP, DBP and MAP are lower in group D and C as compared to group P at all time intervals. However these hemodynamic parameters are significantly more stable in group D compared to group C at all time intervals.Conclusion: Both Dexmedetomidine and Clonidine are effective in attenuating hemodynamic responses to laryngoscopy and intubation but Dexmedetomidine is better than Clonidine

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