Comparison of unilateral spinal anaesthesia using low dose bupivacaine with or without fentanyl in lower limb surgery

Background: Intrathecal opioids are synergistic with local anesthetics and intensifies sensory block without increasing motor block. This combination makes it possible to achieve spinal anesthesia without hemodynamic instability and adverse effects that are associated with higher doses of bupivacaine. Hence we conducted this comparative study using 5 mg of hyperbaric bupivacaine with or without fentanyl (25 µg) in unilateral spinal anaesthesia for lower limb surgery.Methods: Sixty patients were randomized into two groups with Group B receiving 0.5% bupivacaine and Group BF receiving 0.5% bupivacaine + 25 µg fentanyl intrathecal. Sensory and motor block quality and duration, post anesthesia care unit stay (PACU) and adverse effects were compared.Results: The onset of sensory block (6.17±1.44) was faster in Group B compared Group BF (6.73±1.52) and duration of sensory blockade was intensified by addition of intrathecal fentanyl in Group BF. The onset and duration of motor blockade was similar in both the groups and was not affected by addition of fentanyl in Group BF. The number and mean duration stay in PACU was found to be significantly higher in patients 24 [80%]; 30 minutes receiving fentanyl suggesting it prolonged duration of recovery. No patient in either group had hypotension, respiratory depression, sedation, nausea, vomiting, PDPH and TNS. Only 1 patient in each group experienced bradycardia and 4 patients in Group BF had mild pruritus.Conclusions: Unilateral spinal anaesthesia with 5 mg hyperbaric bupivacaine with 25 µg fentanyl is a better choice than 5 mg hyperbaric bupivacaine alone in short procedure of lower limb in orthopaedic surgery

Evaluation of efficacy of priming dose of propofol in reducing induction dose requirements in patients undergoing elective surgeries under general anaesthesia

Background: Priming principle refers to administration of a subanaestheic dose of an agent prior to its actual anaesthetic dose. Propofol is an effective substitute to thiopentone for intravenous induction. The objectives of the study were to evaluate whether priming with propofol would reduce induction of dose, reduce the peri-intubation haemodynamic changes, influence the severity of side effects and influence recall phenomenon.Methods: Sixty patients of ASA Grade 1 and 2, between 18-55 years of age group, of both sexes, were selected on the basis of eligibility criteria and scheduled for elective surgery under general anaesthesia were divided into study and control groups of 30 patients each. The total dose of propofol including the priming (25% of total) dose of propofol, heart rate and blood pressure, baseline (before induction), immediately after intubation, 1 min, 3 min, 5 min after induction, SPO2 (% of oxygen saturation), recall phenomenon and other side effects post operatively were studied.Results: The demographic data were comparable for age, weight and sex in both the groups. Total patients were divided into two groups with 30 patients each. It was observed that total induction dose of propofol was significantly decreased in the study group 72.33±9.53mg compared to control group 115.83±9.00mg. Heart rate was better maintained in study group with minimal post-intubation response. The values of systolic, diastolic and mean blood pressure observed at 1 min after induction also showed significant decrease in control group compared to study group.Conclusions: Propofol produces smooth, rapid, pleasant and safe induction. Priming with propofol can be practiced due to its cost effectiveness and better haemodynamic profile and safety