Comparison of intraoperative and postoperative analgesic efficacy of Fentanyl versus Dexmedetomidine as an adjuvant to epidural Ropivacaine in patients undergoing major abdominal surgeries: an observational study

Background: Epidural analgesia is a common method for the management of postoperative pain after major abdominal surgeries. The aim of the study was to compare the intraoperative and postoperative analgesic effect of dexmedetomidine and fentanyl as an adjuvant to epidural ropivacaine in adult patients undergoing major abdominal surgeries. Materials & Methods: This study included 80 patients between 25- 60 years age group of ASA class I- II scheduled to undergo elective major abdominal surgeries and classified randomly into two groups (each=40). Group D (Dexmedetomidine group): received 50 μg dexmedetomidine with 10 ml of 0.125% ropivacaine intraoperative over 10 mins after induction of general anesthesia followed by 2 ml (100 μg) dexmedetomidine mixed with 48 ml of 0.125% ropivacaine in a 50 ml syringe and infused epidurally at a rate of 5ml/hr for the postoperative 48 hours. Group F (fentanyl group): received 50 μg fentanyl with 10 ml of 0.125% ropivacaine intraoperative over 10 mins after induction of general anesthesia followed by 2 ml (100 μg) Fentanyl mixed with 48 ml of 0.125% ropivacaine in a 50 ml syringe and infused epidurally at a rate of 5ml/hr for the postoperative 48 hours. Patients were evaluated for rescue analgesic requirements (intraoperative fentanyl and postoperative tramadol, and diclofenac), hemodynamic stability, postoperative pain, sedation and any adverse events. Results: The quality of analgesia was better with dexmedetomidine than fentanyl group (p<0.05), and the requirement for rescue analgesia (intraoperative fentanyl and postoperative tramadol and diclofenac) was significantly lower with dexmedetomidine than fentanyl group (p<0.05). The incidence of motor block, sedation, bradycardia, hypotension and dry mouth was significantly higher with dexmedetomidine than fentanyl group (p<0.05). The incidence of nausea and vomiting, pruritis, urinary retention, and respiratory depression was significantly higher with fentanyl compared to dexmedetomidine group (p<0.05). Conclusion: Dexmedetomidine is an ideal adjuvant to epidural ropivacaine for postoperative analgesia compared to fentanyl in patients undergoing major abdominal surgeries

Comparative Study between Dexamethasone and Tramadol As an Adjuvant to Ropivacaine Vs Ropivacaine Alone In USG Guided Supraclavicular Block in Upper Limb Surgeries

Background: Brachial plexus block provides superior quality of intraoperative and postoperative analgesia and stable hemodynamics over general anesthesia. Various adjuvants have been used to prolong effects of local anesthetics like epinephrine, midazolam, magnesium sulfate, alpha-2 agonists i.e. Clonidine and dexmedetomidine, dexamethasone and tramadol. Aims & Objective: To compare the efficacy of tramadol and dexamethasone on the characteristics of the block and its effect on postoperative analgesia when added as an adjuvant to ropivacaine in USGguided supraclavicular brachial plexus block. Materials & Methods: Eighty patients belonging to American Society of Anaesthesiologists (ASA) Grade I, II and III, aged between 20 to 55 years, scheduled for undergo elective upper limb surgeries under supraclavicular brachial plexus block were enrolled in this study. Patients were equally divided into two groups : group S received 0.5% ropivacaine 30ml with Dexamethasone 2ml (8mg) and tramadol 2ml (100 mg) And group C received 0.5% ropivacaine 30ml with + normal saline 4ml. Onset and duration of sensory and motor block , duration of postoperative analgesia and any complications were observed. Results: In our study both groups were comparable with respect to their demographic profile of patients, duration of surgery and ASA status. Onset of sensory block was earlier in group S than group C (3.15 ± 0.69 minutes and 7.55± 0.89 minutes respectively, p =0.004). Onset and duration of motor block and postoperat ive analgesia were longer in group S as compared to group C (5.01± 1.33 & 12.32± 0.75 minutes respectively, P= 0.001 and 14.44± 0.635 and 8.24± 0.873hours respectively, p =0.001 for motor block and 16.53± 0.635 and 10.45 ± 0.681 minutes respectively, p= 0.001for postoperative analgesia). No ignificant side effects were noted. Conclusion: Dexamethasone and tramadol when added to ropivacaine in supraclavicular brachial plexus lock prolongs onset and duration of sensory and motor block and postoperative analgesia significantly with minimal side effects

Comparison of Effectiveness of Dexmedetomidine and Tramadol in the Treatment of Post-Neuraxial Anaesthesia Shivering

Background: Shivering is a common problem encountered after neuraxial anaesthesia and is most likely due to altered afferent thermal input from the blocked region. Tramadol a centrally acting analgesic drug, is effective in the treatment of post-anaesthetic shivering after general and neuraxial anaesthesia, by inhibiting the neuronal reuptake of noradrenaline and 5-hydroxytryptamine (5-HT), facilitates 5-HT release and activates the μ-opioid receptors. Dexmedetomidine, a potent alpha 2-adrenergic receptor agonist, acts by decreasing the vasoconstriction and is known to reduce the shivering threshold. Materials & Methods: This was a prospective, randomised, double-blinded study included 100 patients of either genders, aged 20–65 years with ASA status I-II scheduled to undergo elective surgery under spinal anaesthesia. They were then randomly allocated to receive either intravenous dexmedetomidine 0.5 μg/kg or tramadol 0.5 mg/kg. The response rate to treatment, the degree of sedation and the side-effects were recorded. Results: The response rate to treatment and bradycardia was more in the dexmedetomidine group, whereas, nausea and vomiting were observed more in tramadol group and diferrence was significant when compared between groups. Sedation score was comparable between two groups. Conclusion: Dexmedetomidine is superior to tramadol for shivering treatment, due to higher effective rate of shivering control, earlier onset of action and lesser recurrence of shivering and lower incidences of nausea and vomiting. However, dexmedetomidine is also associated with higher incidences of hypotension and bradycardia than tramadol

A Comparative Study of α2- Agonists as an Adjuvant to Ropivacaine in Epidural Anesthesia for Infraumblical Surgeries

Background: Alpha-2 agonist are being extensively evaluated as an alternative to neuraxial opoids, as an adjuvants in regional anaesthesia The faster onset of action of local anaesthetics, rapid establishment of both sensory and motor blockade, prolonged duration of analgesia into postoperative period, dose sparing action of local anaesthetics and stable cardiovascular parameters make these agents a very effective adjuvant in regional anaesthesia. The aim of our study is to compare the efficacy of two α2- adrenergic agonists, dexmedetomidine and clonidine when used as an adjuvant to ropivacaine in epidural anesthesia for infraumblical surgeries. Materials & Methods: In our study we included 50 patients, of ASA Grade-I or II, between 20- 65 years of age requiring neuraxial blockade for infraumblical surgeries. All the patients were randomly allocated into two groups of 25 each. Group-C: received 15 ml of 0.75% epidural ropivacaine with clonidine 1μg/kg Group-D: received 15 ml of 0.75% epidural ropivacaine with dexmedetomidine 1μg/kg. Patients were monitored for onset of sensory and motor blockade, time to 2 dermatome regression of sensory level, time to first demand for rescue analgesia, sedation, hemodynamic parameters and adverse effects in perioperative period. Results: The onset of sensory block (Group D-8.55 ± 2.81 min, Group C- 12.99 ± 2.96 min), duration of sensory blockade (Group D- 326 ± 35.15 and Group C- 261 ± 36.15) and sedation were found to be significantly better in the dexmedetomidine group. No significant difference was found in terms of onset of motor blockade and hemodynamic changes. Conclusion: Dexmedetomidine is a better neuraxial adjuvant compared to clonidine for providing early onset of sensory analgesia, adequate sedation and a prolonged post-operative analgesia

Comparison of Analgesic Efficacy of Caudal Block and Ultrasound Guided TAP Block In Pediatric Patients Undergoing Lower Abdominal Surgeries

Background: Caudal block is the most frequently used regional anesthetic for pediatric analgesia, technique with the disadvantage of limited duration of action associated with an undesired motor blockade and other complications. Recently, the transversus abdominis plane (TAP) block has been described as an effective technique to reduce postoperative pain intensity and morphine consumption after lower abdominal surgery. Materials & Methods: This prospective, randomized, controlled study included 40 children aged between 1 to 10 years, scheduled for elective lower abdominal surgery and divided into two groups in a double-blinded randomized manner. Group A (n=20): received single caudal dose with isobaric bupivacaine 0.25% (1.25ml/kg) and Group B (n=20): received an ultrasound guided TAB block with isobaric bupivacaine 0.25% (0.3ml/kg). The primary outcomes were the time to first analgesia in minutes and the analgesic doses (intravenous acetaminophen and rectal diclofenac) required during the first 24 h postoperatively. The secondary outcome measures included FLACC pain scale score and intraoperative hemodynamic variables. Results: No significant difference between two groups regarding demographic data and intraoperative hemodynamic values. Group B (TAP block) had a significantly longer time to first analgesia (638.50 ± 63.8 vs 268.53 ± 58.15 min) and required significantly lower doses of acetaminophen (320.5 ± 151.05 vs 653.05 ± 105.52 mg) and rectal diclofenac (0, 0, 0 vs. 0, 0, 25 mg) than group A (Caudal block). FLACC pain scale score was significantly lower in group B than in group A (P < 0.05) at 2, 4, 6, 8, 10, 12, 16, 18, 20, and 24 h postoperatively. Conclusion: TAP block provided superior analgesia compared with single dose caudal block injection with isobaric bupivacaine 0.25% in the first 24hours after surgery

Comparative Study between Intranasal Midazolam and Ketamine as a Premedication in Pediatric Surgical Patients

Background: The preoperative period is a stressful event, especially in the pediatric patients. The goals of preanesthetic medication for children include allaying patient anxiety and facilitating the smooth induction of anaesthesia. For providing premedication to pediatric surgical patients, various drugs and many routes have been studied. Midazolam, a GABA receptor inhibitor, is the most commonly used sedative drug for premedication in children. It provides effective sedation, anxiolysis, and varying degrees of anterograde amnesia. Ketamine is a phencyclidine derivative that antagonizes the N-methyl D-aspartate (NMDA) receptor which produces sedation with a trance-like state, analgesia, and preserves upper airway muscle tone and respiratory drive. Intranasal route is one of the preferred route because of the ease of administration.Aims & objectives: In this study, we compared the effects of intranasal midazolam and ketamine on preoperative sedation, parenteral separation, response to intravenous cannulation and mask acceptance in paediatric patients. Materials & Methods: Sixty children classified as ASA physical status I & II, aged between 2- 10 years, who were scheduled to undergo an elective surgeries, were enrolled for a prospective, randomized, and double-blind controlled trial. All of the children received intranasal premedication approximately 30 min before the induction of anaesthesia. Group M (n = 30) received 0.2 mg/kg of intranasal midazolam, and Group K (n = 30) received intranasal ketamine 5mg/kg. All of the patients were anesthetized with nitrous oxide, oxygen, and sevoflurane, administered via a face mask. Results: No significant differences were observed in demographic, hemodynamic, and respiratory parameters, however significant tachycardia was observed in the ketamine group. Intranasal ketamine results in more successful parental separation and yields a higher sedation score (3.87± 0.66) compared to midazolam group (2.62± 0.69) at 30 minutes, with negligible side effects. Venous cannulation and face mask acceptance was also better in the ketamine group with a significantly higher percentage of patients with satisfactory venous cannulation and face mask acceptance (p<0.05). Conclusion: Intranasal ketamine is superior in decreasing anxiety upon separation from parents and providing satisfactory conditions during mask induction and venous cannulation. No adverse effects of the premedication drugs were observed in any of the groups

Dexmedetomidine as an Intrathecal Adjuvant with Hyperbaric Bupivacaine for Lengthy Lower Limb Orthopaedic Surgeries: A Randomized Double Blinded Case Control Study

Background: Spinal anesthesia is efficient but of limited duration. Intrathecal dexmedetomidine prolongs the sensory and motor blockade of bupivacaine. This study has been designed to evaluate the addition of 10 μg of dexmedetomidine to 0.5% hyperbaric bupivacaine 4 ml intrathecally for elective lower limb orthopaedic surgeries. Aims & Objectives: To evaluate the onset and duration of sensory and motor block, the effect on hemodynamics, postoperative analgesia, and adverse effects of intrathecal dexmedetomidine with 0.5% hyperbaric bupivacaine.Patients & Methods: This is a randomized double blinded study. Forty patients classified in ASA I & II scheduled for elective lower limb orthopaedic procedures expected to extend more than 3 hrs were studied. Patients were allocated into two groups of 20 each. Group B (n=20) received 0.5 % bupivacaine 20 mg only. Group D (n=20) received intrathecal 0.5% bupivacaine 20 mg + dexmedetomidine 10 μg. Onset and duration of the sensory block, motor block, hemodynamics, pain, and sedation were assessed intraoperatively and postoperatively for 24 hrs. The incidences of adverse effects were determined. Results: There was significant difference between the two groups as regards to spinal block characteristics. The mean duration of motor block in Group B and D were 195.5 and 385.5 min, respectively. The mean duration of sensory regression to L1 in Group B and D were 167.5 and 358.5 min, respectively. Time to 2-segment regression in Group B and D were 79.5 and 132.5 min, respectively. The mean duration of analgesia in Group B and D were 223.5 min and 326.5 min, respectively. The patients in Group D had significant prolongation of the motor and sensory block (P < 0.001). Conclusion: Intrathecal dexmedetomidine in the dose of 10 μg significantly prolongs the anaesthetic effects of hyperbaric bupivacaine and can be beneficial in surgeries of long duration, precluding the need for an epidural or general anesthesia

Analgesic Efficacy of Right Subcostal Transversus Abdominis (STA) Block Supplemented by Bilateral Rectus Sheath Block (RSB) under USG Guidance and Its Comparison with Port Site Infiltration of Local Anaesthetic in Laparoscopic Cholecystectomy

Background and Aims: Pain after Laparoscopic Cholecystectomy is multifactorial, pain is most intense on the day of surgery with the incisional pain predominating over the visceral pain. Subcostal transversus abdominis (STA) block and Rectus sheath block (RSB) has been proven to reduce the pain from midline abdominal incision in laparoscopic surgery. This study aimed to compare the analgesic efficacy of USG guided subcostal transversus abdominis (STA) Block and rectus sheath block vs port site infiltration of local anesthetic in terms of quality of intraoperative and post-operative pain relief (NRS), need of rescue analgesics, hemodynamic stability and 24 hr postoperative patient satisfaction score.Methods: Sixty patients scheduled for laparoscopic cholecystectomy were randomly allocated to two groups either to receive USG guided right STA and bilateral RSB (n = 30, Group A) or port site infiltration of local anesthetic (n = 30, Group B group). Intraoperative and postoperative hemodynamics, pain score and need of rescue analgesics were monitored.Results: The study group (Group A) had significantly reduced NRS score and tramadol consumption over 24 hr. Total tramadol consumption in patients receiving port site local anaesthetic infiltrations (Group B group) was approximately twice (200 ± 100 mg) as compared to patients in block group (Group A) (100 ± 50 mg) (P < 0.0001). Conclusion: It is concluded that ultrasound-guided STA and RSB produce effective post-operative analgesia for the incisional pain in laparoscopic cholecystectomy surgeries and act as a supplementary method in multimodal analgesia