European Journal of Molecular & Clinical Medicine

In anaesthesia, circulatory stimulation during tracheal intubation are caused by the stimulation of laryngeal and tracheal tissues from both direct laryngoscopy and placement of the ET tube in the trachea. These stimuli often evoke sympathoadrenal responses characterized by changes in Blood pressure, Heart rate, Cardiac rhythm, ST segment changes, and may lead to pulmonary oedema and rupture of cerebral aneurysm. In the present study that was carried out in the Institute, we compared the efficacy of Oral Clonidine versus Intravenous Fentanylin attenuating the cardiovascular stress response to laryngoscopy and tracheal intubation.
Material and Methods: The present Prospective and Comparative study was carried out at a Tertiary Care Hospital amongst 100 patients those who were randomly allocated to two groups, Group C: Patients in this group received- 5 microgram/kg of Oral Clonidine with 2 sips of water 90 minutes prior to surgery. Group F: Patients in this group received 100ml of normal saline over 10 minutes and 2 microgram /kg of fentanyl in 5ml of normal saline, 5 minutes prior to laryngoscopy and intubation.
Results: Out of 100 subjects, 32% subjects were in the age group 21 to 30 years and 22% in 41 to 50 years. The mean heart rate during Laryngoscopy in the groups Fentanyl and Clonidine were 108.58 and 91.56 respectively. The mean SBP during Laryngoscopy in the groups Fentanyl and Clonidine was 139.84 and 124.78 respectively and the mean SBP at 1 minute after intubation was 137.14 and 121.94 respectively. The mean DBP during laryngoscopy in the groups Fentanyl and Clonidine were 91.18 and 82.68. and at 1 minute after intubation, it was 88.36 and 78.52 respectively. The mean MAP at 1 minute after intubation in the groups Fentanyl and Clonidine were 101.54 and 92.98 respectively
Conclusion: Oral Clonidine 5 μg/kg proved to keep the hemodynamics in stable manner during laryngoscopy and endotracheal intubation and up to 30 mins post-intubation. Fentanyl in the dosage of 2 μg /kg given 5 minutes before laryngoscopy and intubation attenuated the hemodynamic changes, but was not equally effective in reducing the increase in heart rate and blood pressure.  

Background: The primary reason for epidural analgesia is labour pain. It is the only method
that effectively reduces intense labour pain. It provides a labour trial for high-risk patients
who have had a previous Caesarean section, anticipates a challenging intubation, and is
obese Objectives :To compare the efficacy of Bupivacaine and Fentanyl v/s Bupivacaine
and Butorphanol regarding onset of analgesia, duration of analgesia, quality of analgesia and
fetal out come in epidural labour analgesia.Methodology: One hundred primigravida
patients between the ages of 18 and 26 with ASA grades 1 and 2 were chosen at random and
split into two groups of fifty each. Patients in Group 1 received 0.1% Bupivacaine and
0.0002% Fentanyl by lumbar epidural method, while patients in Group 2 received 0.1%
Bupivacaine and 1 mg Butorphanol. Throughout the surgery, the mother's and foetus'
hemodynamics were monitored. The onset, duration, and quality of analgesia, the length of
labour, the frequency of instrumental deliveries, the frequency of side effects, and the
outcome for the newborn were all noted, compared, and statistically assessed

To compare the effects of intrathecal Bupivacaine-Fentanyl (25 µg) combination with that of intrathecal Bupivacaine-Saline combination in patients undergoing Appendicectomy under spinal anaesthesia with regard to, Characteristics of sensory block, Duration of motor block, Quality of surgical anaesthesia, Haemodynamic and respiratory changes, Adverse Effects, if any.
Methods: A total of 60 patients aged between 20 to 40 years of either sex belonging to ASA Grade I & II posted for elective Appendicectomy under Spinal Anaesthesia were selected randomly for the study during the period starting from December 2021 to November 2022, at Department of Anesthesia & Critical Care, Dr B.R Ambedkar Medical College, Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka, India. The Study was approved by the Hospital Ethical Committee.
Results: The incidence of intraoperative complications was compared in both the groups. The addition of Fentanyl to intrathecal Bupivacaine did not produce any significant cardiovascular changes (Bradycardia, Hypotension). Respiratory depression was not observed in either of the groups. Nausea & vomiting was seen in 16.6% of the patients in group BS as compared to 3.5% in Group BF. The incidence of pruritus was higher in Group BF but none of the patients required any medication. Postoperative analgesia was assessed by the VNRS score. A significantly lower VNRS score (superior pain relief) was observed in Group BF with average duration of analgesia being 5 hours. The patients were followed up for 24 hours and showed no neurological sequelae.
Conclusion: We conclude that the addition of 25mg of preservative free Fentanyl to hyperbaric Bupivacaine administered intrathecally to a patient undergoing Appendicectomy provides improved quality of surgical anaesthesia, haemodynamic stability and significant post- operative analgesia with minimal side effects. However, the study needs to be conducted on a larger population for further evaluation

Background: Labor epidural analgesia is an effective method of reducing pain during labor. For labour epidural, opioid sparing analgesia is gaining popularity.Opioidsparing drugs like dexmedetomidinehas been as an adjuvant to local anaesthetics with fewer side effects in various techniques and its less explored in labor epidural analgesia. Objective: To compare analgesic effects of dexmedetomidine and fentanyl when added to ropivacaine for labor epidural analgesia. Materials and methods: An observational comparative study was done after obtaining approval from ethicalcommittee(IEC/NMCH/15/02/2022_7), 60 nulliparous parturients were divided into 2 groups to receive either dexmedetomidine 0.5mcg/ ml with 0.2% ropivacaine (10 ml) or fentanyl 2mcg /ml with 0.2%ropivacaine 10ml.Onset and duration of sensory blockade was noted after giving first bolus. Results: The mean onset time of sensory-block in fentanyl group is higher thandexmedetomidine group. The duration of the sensory blockade showed a statisticallysignificant difference between the two study groups (p<0.05).There was significant alteration seen in hemodynamics between the study groups. No side effects were encountered in either group. Conclusion: Dexmedetomidineis superior to fentanyl as an adjuvant to ropivacainefor opioid sparing analgesia in labor epidural by providing longer duration of sensory blockade without any side effects.

Sub arachnoid blockade is the common form of centrineuraxial blockade performed for lower limb orthopaedic surgeries. The resulting nerve block using a local anesthetic agent ensures the patient well-being, while motor block facilitates the surgeon’s work. 0.5% hyperbaric bupivacaine is the most frequently used drug for SAB. After randomization patients were split into groups of 30 each by computer-generated random numbers, sealed in an envelop as slips folded in the OT complex. An independent observer picked up these slips and performed spinal or epidural anesthesia. Electrocardiogram (ECG), and a baseline reading of SpO2, heart rate (HR) and blood pressures, systolic (SBP) and diastolic (DBP) were recorded. This was an investigator and participant blinded study. The drugs that was given to the two different groups are as follows.
Group A: Patients were administered with 15 mg bupivacaine 0.5% (H).
Group B: Patients were administered with 7.5 mg bupivacaine 0.5% (H) + 25mcg fentanyl.
Mean of Time for Sensory Regression to S1 is lesser in group B patients as compared to Group A and is statistically significant with p value of 0.0002. Mean of Time for Motor regression to Bromage 0 is lesser in group B patients as compared to Group A and is statistically significant with p value of < 0.001.

Epidural analgesia is the most commonly used technique for inducing postoperative analgesia in lower limb surgeries. Higher concentrations of bupivacaine have been found to be greater motor blockade and it can be minimized by using lower concentrations of bupivacaine (0.1% -0.125%).
Aim: To evaluate the block characteristics, hemodynamic response, and post-operative epidural analgesia between 0.125% Bupivacaine versus 0.1% Bupivacaine in patients scheduled for lower limb surgeries.
Material and Method: This observational study included 60 ASA grade 1 and 2 patients posted for lower limb surgeries. In the study, Group 1 received 0.125% bupivacaine + 2 μg/ml fentanyl, and  Group 2 received 0.1% bupivacaine + 2 μg/ml fentanyl.
Result: The onset of sensory blockade was significantly earlier in patients of Group 1 (15.17 ± 1.46 min vs 19.07 ± 1.85min), and the onset of motor blockade was significantly earlier in patients of Group 1 (28.57 ± 1.71 vs 34.5 ±1.73). Duration of analgesia was longer in group 1 when compared to group 2.  
Conclusion:  0.125% bupivacaine with 2 μg/ml was more effective and provided a longer duration of analgesia as compared to 0.1% bupivacaine with 2 μg/ml for lower limb surgeries. 

Etomidate is a rapidly acting induction agent and it has little effect on cardiovascular system and it allows rapid recovery from anaesthesia but associated with side effects. Pre-treatment with narcotic analgesics usually Fentanyl can decrease the incidence of pain on injection and myoclonus during induction of anaesthesia with Etomidate and also attenuates the stress response to endotracheal intubation.
OBJECTIVE: The objective was to find an optimal pre induction dose of &many with etomidate as induction agent which attenuates the haemodynamic changes and side-effects during induction and intuhatidn.
METHODS AND METHODS: Patients scheduled for elective surgeries under general anaesthesia were eligible for the study. 30 Patients were randomly assigned to two groups according to the pretreatment dose of Fnetanyl.
1)      Group I received 2 µg/kg of  Fentanyl
2)      Group II received 5 µg/kg of Fentanyl
         After 5 minutes of administration of either one of these all patients where induced with  Etomidate at a dose of 0.3 mg/kg.
RESULTS: We found that the hemodynamic response and side effects were lower in group II with increasing dose of Fentanyl. But at the same time there was increasing incidence of post operative nausea & vomiting and apnoea in group II.
CONCLUSION: We concluded that at a dose of 5 µg/kg of fentanyl, there is reduction of side effects of etomidate and also there is attenuation of hemodynamic response to intubation in patients undergoing elective surgeries under general anaesthesia with etomidate as induction agent.

Spinal anaesthesia requires a small volume of drug to produce profound sensory and motor blockade but has limited duration of action. An adjunct to local anaesthetic produces a better-quality regional block.The present study was aimed to evaluate the study and tolerability of combined use of intrathecal neostigmine and fentanyl as an adjunct to bupivacaine for postoperative analgesia in patients posted for abdominal surgeries under spinal anaesthesia. Material and Methods: Present study was single-center, prospective, comparative, observational study, conducted in patients of age group of 20-60 years, of either gender, ASA grade I/II, Elective patients undergoing Lower Abdominal Surgeries. 60 patients were divided by computer assisted randomization table into 2 groups of 30 subjects each as GROUP B (BUPIVACAINE Group) & GROUP C (COMBINED Fentanyl Neostigmine Group). Results: There was no significant difference in age distribution, gender distribution & ASA grade in two groups. (p>0.05). The mean duration of sensory block was found to be 194.16 ±21.43 minutes in group C while 153.03 ±19.19 minutes in group B, difference was statistically highly significant. (P <0.0001). The mean duration of motor block was found to be 197.18 ±21.78 minutes in group C while 169.26 ± 19.38 minutes in group B, difference was statistically highly significant. (P <0.0001) There was no difference when two groups were compared statistically for complications. (p>0.05) post-operative analgesia remained for longer duration in Group C, 7.40 ± 1.21 hours as compared to 5.32 ± 1.21hours in Group B, difference was statistically significant (P <0.05). Conclusion: Spinal neostigmine added to bupivacaine and fentanyl provided a significantly longer surgical analgesia and insignificant adverse effects who had lower abdominal surgery under spinal anaesthesia.

Spinal anaesthesia is the most preferred technique for infraumbilical surgeries.Hyperbaric Ropivacaine has been shown to produce reliable and predictable anaesthesia for surgery. Fentanyl, a synthetic lipophilic opioid and Dexmedetomidine, a new highly selective α2-agonist, have been used as neuraxial adjuvants in spinal anaesthesia to prolong intraoperative and postoperative analgesia. The present prospective randomized study is undertaken to investigate and compare the clinical effects of 0.75% hyperbaric ropivacaine with additives such as fentanyl and dexmedetomidine on spinal anaesthesia for infraumbilical surgeries.
Aim: To compare the clinical effects of intrathecal 2ml of 0.75% hyperbaric ropivacaine with fentanyl 25μg and dexmedetomidine 10μg as additives in patients undergoing elective infraumbilical surgeries.
Materials & Methods: The study was conducted on 90 patients of both sexes, aged 18-60 years, of class I or II of the American Society of Anesthesiologists classification, who underwent elective infraumbilical surgery. Patients were randomly assigned to three groups (30 patients each): group RC (control group) received 2ml (15mg) of 0.75% hyperbaric ropivacaine plus 0.5ml of normal saline (0.9%) at a total volume of 2.5ml intrathecally, whereas group RF received 2ml (15mg) of 0.75% hyperbaric ropivacaine plus 0.5ml of 25μg fentanyl (50 μg/ml) at a total volume of 2.5ml intrathecally and group RD received 2ml (15mg) of 0.75% hyperbaric ropivacaine plus 0.5ml of 10μg dexmedetomidine (50μg dexmedetomidine diluted in 2.5ml of normal saline) at a total volume of 2.5ml intrathecally. The onset, extent, duration of sensory and motor blockade, time to first rescue analgesia request, hemodynamic parameters, and side effects such as nausea, vomiting, pruritis, respiratory depression and shivering were recorded.

INTRODUCTION: When the intrathecal opioid drug was administered with the local anaesthetic in Spinal anaesthesia they develop the superior quality of analgesia. Fentanyl was found to provide safe potentiate of local anaesthetic effects by its increased lipophilic quality and decreased rostral spread. The present study was conducted to compare block characteristics of equal doses of isobaric levobupivacaine 0.5% (10 mg) with normal saline and isobaric levobupivacaine 0.5% (10 mg) plus fentanyl (25 μg), in infraumbilical surgeries under spinal anaesthesia.
MATERIALS AND METHODS: The present prospective observational study was conducted in tertiary health centre from January 2020 to June 2021 amongst 120 patients belong to ASA physical status I and II aged between 20 to 65years who underwent infraumbilical surgeries. Study population were divided into Group L: Group of 60 patients received 2 ml of 0.5% isobaric levobupivacaine (10 mg) plus 0.5 ml normal saline and Group LF: Group of 60 patients received 2 ml of 0.5% isobaric levobupivacaine (10mg) + 0.5 ml fentanyl (25 μg).
RESULTS: The mean time for onset of sensory blockade at T10 dermatome in group L (7.1±1.4 min) was late than in group LF (5±1.6 min). Higher dermatomal level of sensory blockade was achieved by addition of fentanyl. The mean time for maximum sensory blockade was earlier in group LF (8.1±1.7min) than in group L (15.6±2.1min.). Maximum motor blockade was achieved significantly earlier in group LF than group L. The total duration of sensory blockade was significantly prolonged in group LF than in group L.Total duration of analgesia in group L was 199.2 ± 10.7 min and in group LF was 263.2 ± 14.7 min.
CONCLUSION: It was concluded that addition of fentanyl to levobupivacaine leads to early onset of sensory blockade and prolonged duration of sensory blockade, motor blockade, stable hemodynamics and prolonged postoperative analgesia thus decreasing the doses of rescue analgesics.

Introduction: Regional Anaesthesia is the most common and preferred technique for elective inguinal hernia surgeries. The most commonly used anaesthetic agent for spinal anaesthesia are Lidocaine and Bupivacaine. Ropivacaine is an alternative to Bupivacaine due to its lesser degree and duration of motor blockade, good hemodynamical stability and lesser systemic toxicity. Hence this study was conducted to find out the efficacy and side effect profile of the Ropivacaine against the bupivacaine for elective inguinal surgery as part of day care surgery.
Material and Methods: This present study was a prospective study conducted at tertiary health care hospital on 80 patients undergoing elective inguinal hernia surgery divided into two groups, Group R – receives 3 ml of isobaric ropivacaine 0.5% with 0.5 ml of Fentanyl which contains 25 micrograms and Group B – receives 3 ml of hyperbaric bupivacaine 0.5% with 0.5 ml of fentanyl which contains 25 micrograms. Sensory and motor blockade were assessed along with duration and the analgesia

Introduction: Hysterectomy is routinely performed laparoscopically. It has many advantages as compared to open abdominal hysterectomy such as less post operative pain, better cosmetic results, shorter hospital stay, lower complication rate. However Laparoscopic surgeries are routinely performed under general anaesthesia with endotracheal intubation to prevent aspirations of gastric contents and respiratory embarrassment secondary to pneumoperitoneum.But it has several disadvantages like hemodynamic instability, postoperative nausea and vomiting, increased postoperative analgesic requirement, complications related to intubation or extubation and postoperative sore throat.
Material and Methods: After the approval of institutional ethics committee and written informed consent 24 ASA grade 1 and 2 patients in the age group of 35 to 55 years underwent total laparoscopic hysterectomy under spinal anaesthesia with intrathecal bupivacaine and fentanyl. Exclusion criteria included those with presence of any condition contraindicating elective surgery or spinal anaesthesia. The patients were explained during pre-operative visit about the procedure and also told that any anxiety, pain, or discomfort during the surgery would be dealt with intravenous medications or if required conversion to general anaesthesia.

Preservative free Chloroprocaine (CP) seems like a promising alternative, being a short acting agent of increasing popularity in recent years. While Chloroprocaine was withdrawn from the market in the 1980s because of concerns about neurotoxicity a new formulation without preservatives that has no longer been associated with neurotoxicity was introduced in clinical routine. After taking informed and written consent, 40 patients of either sex, aged between 18-60years, belonging to American Society of Anaesthesiologists Physical status I to III, undergoing elective perianal surgeries under spinal anaesthesia enrolled in this observational study. Our study showed mean time of onset of motor block was 8.38±1.25 minutes, mean time to achieve maximum motor block 9.45±0.71 minutes and mean time for motor regression to bromage scale 0 was 65.68±15.19 minutes. The time to void was 98.32±15.80 min and time to ambulation was 89±15.30 min the time of first postoperative analgesic requirements was 96.32±12.83 min.

Background: brachial plexus block is a common technique instead of general anaesthesia. This type of anaesthesia primarily assists in achieving the best possible operating conditions by causing muscular relaxation, maintaining a stable intraoperative hemodynamic condition, and inducing sympathetic block, which lessens postoperative discomfort, vasospasm, and edoema. Aim & Objective:1. To compare the duration of post operative analgesia 2. To compare the onset & duration of sensory and motor block, hemodynamic changes and adverse effects. Methods: Study design:  Randomized comparative study.  Study setting: Department of Anaesthesia, Kamineni Institute of Medical Sciences, Sreepuram Narketpally, India. Study duration: From January 2021 to July 2022 (1.5 year). Study population: All patients undergoing upper limb surgeries (below shoulder) under brachial plexus block by supraclavicular approach. Sample size: 105. Results: Age distribution across groups was found statistically significant (p=0.033). This infers that age has a significant impact in causing the variation in results across various groups. mean duration of sensory block measured by return of pin prick sensation was 11.537 hours, 7.81 hours and 10.048 hours in groups A, B and C respectively. p-value was statistically significant (<0.001). mean duration of motor blockade was 9.784 hours, 7.05 hours and 8.774 hours in groups A, B and C respectively. p-value was statistically significant (<0.001). mean duration of effective analgesia (VAS>4) was 14.221 hours, 9.583 hours and 12.299 hours in groups A, B and C respectively. p-value was statistically significant (<0.001). mean duration of complete analgesia (VAS>0) was 11.537 hours, 7.81 hours and 10.048 hours in groups A, B and C respectively. p-value was statistically significant (<0.001). Conclusion: dexmedetomidine is a better option than fentanyl when used for supraclavicular block techniques along with bupivacaine and lignocaine.

To compare the efficacy of epidural FENTANYL and TRAMADOL for post-operative analgesia in lower limb surgeries in terms of onset of analgesia, duration of analgesia, quality of analgesia and undesirable effect.
Material Method: This prospective randomized study was conducted to compare the analgesic efficacy and side effects of epidural fentanyl and that of epidural tramadol and included sixty (60) patients of either sex in the age range of 18-65 years, undergoing lower limb surgeries under Combined Spinal Epidural anaesthesia (CSE) with ASA physical status I & II. These were divided into two groups of 30 patients each. Group F- Fentanyl group and Group T- Tramadol group. Patients of Group F received 50 mcg of Fentanyl + 8ml of 0.125% Bupivacaine (9 ml) and that of Group T received 50 mg of Tramadol and 8ml of 0.125% Bupivacaine(9 ml).The patients were randomly given epidural fentanyl or epidural tramadol when patient complained of pain post operatively with Visual analog score 3 or above. Patients were closely monitored in the post-operative period till they had pain relief. Quality of pain relief was measured using visual analogue scale and occurrence of side effects like nausea and vomiting, pruritis, respiratory depression were noted.A detailed clinical history and physical examination of the patients was done and all vital parameters were recorded well in advance. An informed and written consent was taken from the patient for the study.
Result: Mean Time of onset of analgesia after epidural injection was 5.42 ± 1.18 minutes in Group F and 12.80 ± 1.62 minutes in Group T and the difference was found to be statistically significant. Mean Duration of analgesia was 240.22 ± 36.53 in Fentanyl group and 360.52 ± 24.83 in Tramadol groups respectively which was also statistically significant. Pruritis was significantly higher in Fentanyl group whereas nausea and vomiting was higher in tramadol group. Quality of analgesia was better following administration of epidural Fentanyl.
Conclusion: Both epidural Fentanyl and Tramadol are effective in relieving post-operative pain; however Fentanyl produced better patient satisfaction compared to tramadol but the duration of action was short.

Background & Objective - This study aimed to compare efficacy of nalbuphine and fentanyl as adjuvant to bupivacaine in providing intra-operative anesthesia and post-operative analgesia in lower limb orthopedic surgeries, and to compare the characteristic of sensory and motor block, hemodynamic parameter, time of first rescue analgesia and adverse effects between two groups.
Method- In this clinical trial, 80 patients undergoing elective lower limb orthopedic surgeries under spinal anesthesia were randomly allocated in two groups. In group BN, the patients received 0.5% 3ml (Heavy Bupivacaine + 800 mcg Nalbuphine. In group BF patients received 0.5% 3ml (Heavy Bupivacaine + 25mcg Fentanyl.
Result & interpretation- The Onset of motor block, maximum level of block and time to reach peak level of block was significantly faster in group BF.While duration of motor block and time for first rescue analgesia was significantly prolonged in BN group. However, there was no significant difference in time for two segment regression=0.157 (NS) and hemodynamic changes.
Conclusion- We conclude that combination of fentanyl as adjuvant to bupivacaine provides higher segmental level sensory blockage, faster sensory and motor blockage than nalbuphine. But nalbuphine gives longer time of post-operative analgesia than fentanyl.

The aim of this study is to compare the efficacy of dexmedetomidine and Fentanyl on onset and duration of sensory, motor blockade and duration of analgesia. The present study to compare the analgesic efficacy of Dexmedetomidine and Fentanyl as adjuvant to Levobupivacaine and Ligcocaine in PNS guided Supraclavicular Brachial Plexus block" was carried out in Department of Anesthesiology index medical college Hospital and Research centre, Indore M.P. after approval of institutional ethical committee in 60 patients of ASA 1 & ASA II posted for elective upper-limb surgery.

Background: Supraclavicular approach of brachial plexus block has been popular technique in delivery of anesthesia in patients undergoing upper limb surgeries. Of various local anesthetics, bupivacaine is used most frequently for brachial plexus block. Any adjuvant to the local anesthetics for brachial plexus block prolongs its analgesic effect. Hence the present study was undertaken to compare the effect of dexmedetomidine and fentanyl as adjuvant to bupivacaine in supraclavicular nerve block for upper limb surgeries. Methods: A total 100 patients of ASA grade I and II were enrolled and randomly divided into two equal groups. Group A received 25-30mL of 0.5% Bupivacaine + 50μg Fentanyl and group B received 25-30mL of 0.5% Bupivacaine + 50μg Dexmedetomidine. The onset time and duration of sensory and motor blockade were recorded. Hemodynamic variables and duration of analgesia were recorded for 24 hours postoperatively. Results: The onset of sensory and motor block was significantly faster, and duration of sensory and motor block was significantly prolonged in group B as compared to group A (p<0.05). Rescue analgesic requirements were significantly less in group B compared to group A (p<0.05). Hemodynamic variables did not differ between groups in the post-operative period, except the pulse rate which was found to be on the higher side for fentanyl group. Conclusion: Addition of 50μg dexmedetomidine to 25-30ml bupivacaine 0.5% in supraclavicular brachial plexus block was more effective in prolongation of sensory and motor duration as well as providing adequate intra-operative analgesia when compared to 50μg fentanyl with 25-30ml bupivacaine 0.5%, without producing any adverse events.

Aim: The purpose of the present study was to assess the efficacy of fentanyl transdermal patch in case of impacted mandibular third molar surgery.
Methodology: 20 patients within the age group of 18–40 years with asymptomatic impacted mandibular third molars were equally divided into 2 groups as group A & group B which underwent surgery in Local Anaesthesia. In every patient one side belonged to group A and other side belonged to group B. 50 μg FTS was applied in group A while placebo patch was applied in group B.
Results: Patients in group A performed significantly better than group B in terms of mean pain intensity scores assessed by VAS and VRS along with minimum need of post-operative rescue analgesics.
Conclusion: It was found that FTS resulted in significantly better pain relief, longer pain-free intervals, and lesser post-operative analgesic consumption.

Background: Spinal anaesthesia is preferred technique for conducting abdominal hysterectomy, but it is insufficient to provide post-operative analgesia adequately. The addition of local anaesthetic adjuvants increases subarachnoid block efficacy and prolongs postoperative analgesia. Due to its fast onset with a limited time of action with minimal cephalic spread, Fentanyl is preferred as an adjuvant in spinal anaesthesia. Adding Fentanyl to a low dose, Bupivacaine offers improved surgical anaesthesia and increased block reliability. Ketamine has several clinically useful properties, including analgesia and less cardiorespiratory depressant effects than other anaesthetic agents, in fact it causes some stimulation of the cardiovascular system.
Objectives: To compare the Duration of the postoperative analgesia (Time of 1st rescue Analgesic) between intrathecal administration of Ketamine and fentanyl with bupivacaine. To compare the duration and onset of sensory and motor block (modified bromage scale), the effect on hemodynamic parameter, Degree of sedation and side –effects (post-operative nausea and vomiting, pruritus, shivering, urinary retention and any other).
Methodology: Two group were included in this study i.e. Group A & Group B. Both group had 18 cases for total abdominal hysterectomy Group A(n=10)- received 15mg of Bupivacaine 0.5% along with Fentanyl 25 mcg intrathecally and Group B (n=10)-received 15mg of Bupivacaine 0.5% along with Ketamine 25 mgintrathecally. The onset of sensory and motor block, duration of block, hemodynamic parameter, sedation score, total postoperative analgesia time, and side effects if any will be recorded.
Results: Demographic variables were compared between both groups A and B. Group A is A significant faster onset of sensory block was found in ketamine group in comparison to fentanyl group. (p-value<0.001). While the time to achieve the highest level of sensory block was found to be almost similar in both the groups.
Conclusion: ketamine or fentanyl to spinal bupivacaine were equally effective in pain control after abdominal hysterectomy

Background:Sub Arachnoid block is the safe, satisfactory and most commonly used technique for lower abdominal, pelvic and lower limbs surgeries. The duration of action of Bupivacaine is prolonged; it may not produce adequate post-operative analgesia. Hence adjuvants were used for producing prolonged post-operative analgesia. The aims and objective is to Compare the onset, duration of sensory and motor blockade and requirement of post-operative analgesia with dexmedetomidine vs fentanyl as adjuvants to intrathecal 0.5% hyperbaric bupivacaine Secondary Objectives were compare the hemodynamic effects of adding dexmedetomidine vs fentanyl as adjuvants to intrathecal bupivacaine.
Materials and Methods: Patients were allocated into one of the three groups of 50 each using computer generated random number. Patients were counselled regarding the procedures.
Results: The Onset of Sensory Block amongst the groups was statistically insignificant with P-Value of 0.279.), The mean duration of motor block was 231.16±68.56, 263±64.46 and 178.52±26.60 mins in Groups A, B and C respectively. The prolonged motor block in Group B (Dexmedetomidine) was statistically significant with P-Value of <0.0001. The mean time for first rescue analgesia was 323.44±116.29 mins in Group A, 391.52±105.63 mins in Group B and 311.80±99.15 mins in Group C. Better post-operative analgesia in Group B, P value of <0.0001.
Conclusion: From this study it can be concluded that the use of intrathecal dexmedetomidine as an adjuvant to bupivacaine seems to be a better alternative to fentanyl for long duration surgical procedures due to its prolonged duration of sensory and motor block combined with minimal side effects. However, prolonged duration of motor blockade with dexmedetomidine may be undesirable for shorter surgical procedures or ambulatory surgeries.

Background: The incidence of Chronic Kidney Disease Stage-V and dialysis population requiring renal transplantation is increasing globally. Present study was aimed to evaluate the efficacy and safety of low dose continuous infusion of dexmedetomidine on hemodynamic changes, sedation and analgesic requirement intraoperatively and immediate postoperatively in patients undergoing for renal transplantation.
Material and Methods: Present study was single-center, Randomized, prospective, double blind, placebo-controlled study, conducted patients, age between 18-60 years undergoing renal transplantation, ASA grade 2 and 3. Patients were assigned into 2 groups, as study Group (continuous infusion of dexmedetomidine at rate of 0.2 mcg/kg/h) & control Group.
Results: Among both groups, distribution of age, gender, weight, Mallampatti grades, comorbidities, mean duration of surgery, mean duration of anaesthesia were comparable & no statistically significant difference was observed (p> 0.05). Mean heart rate was lower in study group as compared to the control group and significant differences were found at all-time points of the study period (p < 0.05).  SBP & DBP after 15 minutes of induction decreased significantly from the base line value in study group, and this lasted throughout the intraoperative period till the end of surgery, the difference being statistically significant (p < 0.05) Postoperatively, SBP & DBP in the study group were less than the SBP & DBP in control group at all the time points & difference being statistically significant (p < 0.05).

Background: In this study, we wantedto compare the effectiveness of intrathecal Hyperbaric Ropivacaine with fentanyl and Hyperbaric Bupivacaine with fentanyl in perineal surgeries, to sensory block and motor block. We also compared the changes in blood pressure, heart rates and complications.
Materials and methods: This was a hospital based non-randomised control comparative study conducted among 40 patients posted for perineal surgeries to Osmania General Hospital, Afzalgunj, Hyderabad, over a period of 24 months after obtaining clearance from Institutional Ethics Committee and written informed consent from the study participants.
Results: The minimum and maximum (time of onset of motor blockade) TOM was 2 and 3 minutes in group ‘A’ and 1 and 2 minutes in group ‘B’. The mean ± SD TOM is 2.5 ± 0.51 minutes in group ‘A’ and 1.6 ± 0.51 minutes in group ‘B’. There was significant difference between two groups A and B for the parameter time of onset of motor blockade. The minimum and maximum duration of sensory blockade (DOS) was 132 and 172 minutes in group ‘A’ and 96 and 140 minutes in group ‘B’. The mean ± SD DOS is 153.4 ± 11.94 minutes in group ‘A’ and 112.0 ± 13.86 minutes in group ‘B’. There was significant difference between two groups A and B for the parameter DOS (in minutes). The minimum and maximum DOM was 165 and 198 minutes in group ‘A’ and 120 and 170 minutes in group ‘B’. The mean ± SD duration of motor blockade (DOM) was 185.2 ± 9.21 minutes in group ‘A’ and 155.8 ± 13.79 minutes in group ‘B’. There was significant difference between two groups A and B for the parameter DOM (in minutes).
Conclusion: Hyperbaric ropivacaine achieves a lesser duration of sensory and motor blockade, and lesser degree of motor blockade when compared with hyperbaric bupivacaine. Hence, hyperbaric ropivacaine with fentanyl in spinal anaesthesia is a better alternative for perineal day care surgeries

Background: In lower limb orthopedic surgeries there is significant postoperative pain, which is difficult to treat with oral or intravenous analgesics resulting in adverse endocrine, metabolic and inflammatory responses. Morphine, Pethidine, Fentanyl, and other opioids fall under the Narcotics Act whereas nalbuphine does not. So, the accessibility of Nalbuphine is not as major a concern in several hospitals in India as that of morphine and other such opioids. Present study was aimed to compare the effectiveness of 0.8mg nalbuphine with 20 mcg fentanyl as an adjuvant to hyperbaric bupivacaine in lower limb orthopedic surgeries. Material and Methods: Present study was single-center, prospective, comparative study, conducted in patients of either gender, age group of 18-60 years, belonging to ASA CLASS 1 and 2, With BMI < 30, undergoing elective orthopedic lower limb surgery. Patients were allocated in Group N- Received intrathecal 0.8 mg Nalbuphine & 3 ml 0.5 % H bupivacaine & Group F- Received intrathecal 20 mcg Fentanyl & 3 ml 0.5 % H bupivacaine.

Aims and Objectives: To compare the efficacy of sedation and time taken for extubation using
dexmedetomidine and fentanyl sedation in post-operative adult cardiac surgical patients.
Methods: A prospective randomized double-blind study involving 60 patients undergoing open heart surgery was conducted. The patients were divided into two groups, each involving 30 patients. One group received fentanyl at 1 µg/kg/h (Group A) and the other received dexmedetomidine at 0.5 µg/kg/h (Group B) for post-operative sedation with intermittent rescue dose of  fentanyl 0.5 µg/kg bolus in either group as per requirement. The efficacy of sedation was assessed using the Ramsay sedation score. The time taken for extubation from the stoppage of infusion was noted.
An open heart surgery prospective randomized double-blind trial including 60 patients was carried out. Two groups of 30 patients each were formed from the patients. With occasional rescue doses of fentanyl 0.5 g/kg bolus in either group as needed, one group (Group A) received fentanyl at 1 g/kg/h and the other (Group B) received dexmedetomidine at 0.5 g/kg/h for post-operative sedation. The Ramsay sedation score was used to evaluate the effectiveness of the sedation. It was noticed how long it took to extubate once the infusion was stopped.
 Results: Haemodynamic parameters between the two groups were comparable.  Sedation scores between fentanyl and dexmedetomidine groups were comparable. Average time (in minutes) required for extubation was 140.04 (±43.6 SD) in the dexmedetomidine group compared with 359.4 (±93.3 SD) in the fentanyl group. The difference in mean time for extubation was statistically significant. 

Background: Caesarean section is one of the most commonly performed surgical procedures worldwide and 80–90% of them are performed under spinal anaesthesia.Adding adjuvants drugs to intrathecal local anaesthetics improves quality and duration of spinal blockade, and prolongs postoperative analgesia. The aim of our study was to compare the efficacy of using intrathecal Fentanyl, morphine and Dexmedetomidine as adjuvants to Bupivacaine in patients undergoing caesarean section at a tertiary hospital.
Material and Methods: Present study was comparative study, conducted among pregnant women, 20-35 years age, ASA grade I/II, posted for elective Caesarean section. Patients received either Fentanyl or Morphine or Dexmedetomidine as adjuvants with Intrathecal Bupivacaine (H) 0.5% 10mg (2ml) with as a standard dose.
Results: In present study, 99 pregnant women, equally allotted (33 each) to each group (i.e. Group BF, Group BM & Group BD). Mean age & duration of surgery was comparable among all 3 groups & difference was not statistically significant (p>0.05). Onset of action (Group BD- 43.3 ± 10.22 secs < Group BF - 50.15 ± 10.56 secs < Group BM - 51.4 ± 9.46 secs) & Duration of analgesia (Group BD- 460.2 ± 40.27 mins > Group BM - 326.2 ± 32.92 mins> Group BF - 292.8 ± 34.61 mins) was significantly better in dexmedetomidine group as compared to fentanyl group & morphine group, difference was statistically significant (p<0.05). Maternal vitals (pulse rate, systolic blood pressure & diastolic blood pressure) were stable throughout surgery & early postoperative period among all 3 groups, difference was not statistically significant (p>0.05).
Conclusion: Intrathecal dexmedetomidine as an adjuvant to bupivacaine has early onset of action, prolonged post-operative analgesia combined with minimal side effects.

Objective: Adjuvants prolong the action of intrathecal local anesthetic agents. They have shown to have significant analgesic effects in the postoperative period much after the regression of the sensory and motor blockade. Our objective of the current study was to compare the hemodynamic profile and adverse effects (nausea, pruritus, sedation and respiratory depression) in two groups of adult patients undergoing infra-umbilical and lower limb surgery under spinal anesthesia using either intrathecal clonidine or intrathecal fentanyl as an adjuvant to intrathecal bupivacaine (0.5% heavy).
 
Materials and Methods: It was a prospective randomized study in which eighty patients posted for lower limb orthopedic surgery were divided into two groups of forty each. Group A – Received intrathecal hyperbaric bupivacaine (2.5 ml) +50 µg clonidine (diluted to 0.5 ml). Group B – Received intrathecal hyperbaric bupivacaine (2.5 ml) + fentanyl 25 µg (diluted to 0.5 ml). Duration of postoperative analgesia, sensory and motor block characteristics, hemodynamic parameters, and side effects were recorded and analyzed.

Results: Both the groups were comparable in demographic data, hemodynamic parameters, but the duration of sensory and motor blockade and duration of analgesia was significantly longer in Clonidine group when compared with the Fentanyl group, with a mild increase in sedation score.
Conclusion: Addition of 50 μg clonidine to intrathecal bupivacaine offers longer duration of postoperative analgesia than 25 μg of fentanyl but with higher sedation. Both the drugs offer similar surgical conditions and prolongs postoperative analgesia (clonidine more than fentanyl), so we suggest fentanyl as better choice when sedation is not desirable and clonidine is recommended where sedation is acceptable.

Background: To assess efficacy of epidural bupivacaine and fentanyl for labour analgesia.
Materials and Methods: One hundred ten pregnant women primigravida and multigravida (ASA grade II) age ranged 18-30 years were recruited for this observational study. All patients were given first loading dose of 10 ml 0.25% plain bupivacaine via epidural catheter followed by continuous epidural infusion of 0.0625% bupivacaine with 2.5 mcg/ml fentanyl @ 12ml/hour. The parturients were assessed for hemodynamics, mode of delivery, VAS and APGAR (neonatal outcome).
Results: There were 42 Primigravida and 68 Multigravida. The mean visual analogue score before drug was 5.42 and after drug was 2.18. Mode of delivery was natural in 95, vacuum cup assisted in 14 and caesarean section in 1 case. Patient satisfaction score was excellent in 20 patients, good in 90 and poor in 0. The difference was significant (P< 0.05). At 1 minute, APGAR score 7 was seen in 4, score 8 in 45, score 9 in 55 and score 10 in 6 patients. At 5 minutes, score 9 was seen in 25 and score 10 in 85 patients. The difference was significant (P< 0.05).
Conclusion: Epidural labour analgesia with low dose bupivacaine (0.0625%) with fentanyl (2.5 mcg/ml), given through continuous infusion technique provides good pain relief to the parturient.

Background: Pain relief during labor, in addition to promoting maternal comfort, prevents the undesirable consequences of stress. Neuraxial techniques are accepted as the gold standard for intrapartum labor analgesia. In present study, we compared fentanyl 25μg alone versus fentanyl 20μg plus bupivacaine 2.5mg as intrathecal labor analgesia with regards to progress of labor at a tertiary hospital.
Material and Methods: Present study was single-center, interventional, randomized study, conducted in Pregnant females 20-30 years, Booked antenatal cases, primigravida, full-term, singleton pregnancies, vertex presentation, in  active phase of labor with a cervical dilatation of ≥ 4 cm with normal fetal heart rate (FHR) tracings, ASA status grade I/II.
Results: 60 parturients were enrolled in present study, randomly allocated into Group F (fentanyl 25 μg) & group BF (fentanyl 20 μg plus 0.5% hyperbaric bupivacaine 2.5 mg ).  Cervical dilation at time of entry in study (cm) on admission, Onset time of Labor Analgesia (min), Duration of Labor Analgesia (min), Oxytocin units used till completed second stage, Duration of active 1^st stage / 2^nd stage (min), Total Duration of labor (min),  Rate of cervical dilatation (cm/h), APGAR score (At 1 & 5 min) were comparable in both groups & difference was not significant statistically (p>0.05). VAS scores at (60 min, 120 min, 180 min, 240 min, 300 min were less in group FB as compared to group F, but difference was not statistically significant.
Conclusion: Progress of labor, in pregnant women with intrathecal labor analgesia using fentanyl 25μg alone was comparable with fentanyl 20μg plus bupivacaine 2.5mg

Background: Caudal epidurals are commonly performed for postoperative pain management in children undergoing abdominal and lower limb surgeries. Bupivacaine is considered the most common local intrathecal anesthesia for children. Various adjuvants were combined with the local anesthetic to increase intrathecal block quality and extend analgesia duration. Present study was aimed to compare bupivacaine versus bupivacaine with fentanyl for caudal epidural anaesthesia and analgesia in children undergoing lower abdominal surgery.
Material and Methods: Present study was comparative, double blind, observational study, conducted in children aged between 1 and 10 years, either gender, ASA class I and II, scheduled to undergo lower abdominal surgery, parents consented for participation. Children were divided as Group A, receiving bupivacaine 0.25% 2 mg/kg with fentanyl (1μg/kg) & Group B receiving bupivacaine 0.25% 2 mg/kg only.
Results: Onset of Sensory block (mins) & Time to achieve the optimum level (mins) were comparable among both groups & difference was not significant statistically. We noted more duration of motor block (176.4 ± 64.4 min vs 154.5 ± 52.13 min), Prolonged duration of postoperative analgesia (320.3 ± 41.19 min vs 288.3 ± 43.1 min), less amount of rescue analgesic (73.33 ± 44.28 mg vs 85.17 ± 44.45 mg) & late requirement of rescue analgesic (272.67 ± 37.38 min vs 236.83 ±10.63) in A group as compared to Group B & difference was significant statistically. PONV & pruritis were noted in 1 patient each from group A as compared to 3 cases of PONV & 1 case of pruritis & difference was not significant statistically.
Conclusion: 1µg/kg fentanyl with 0.25%bupivacaine 2mg/kg when administered caudally provide satisfactory surgical anesthesia and post-operative analgesia with prolonged period of analgesia with without any major postoperative complications. Fentanyl produces a faster onset of analgesia with fewer side effects like nausea, vomiting.

Dexmedetomidine is a highly selective alpha 2 agonist with properties of sedation, analgesia and anxiolysis. The purpose of this narrative review was to assess the effect and safety of dexmedetomidine in not only decreasing the magnitude of haemodynamic responses to laryngoscopy, surgery and pneumoperitoneum especially when used together with fentanyl but also decreases the dose of opioids and anaesthetics in achieving adequate analgesia and anaesthesia respectively. Intraoperative administration of dexmedetomidine is associated with decreased postoperative pain, opioid and analgesic consumption and it assures haemodynamic stability.

Aim: The purpose of the present study was to assess the comparison between midazolam-nalbuphine and midazolam-fentanyl combinations for analgesic as well as sedative effect in patients who have undergone fibre-optic intubation in awake state.
Methodology: 100 patients between the age of 20 and 60 yrs of either sex, scheduled for elective surgery were included after taking written informed consent. Premedication with Inj. Glycopyrrolate 0.2 mg i.m. 30 mins before and Inj. Midazolam 1 mg i.v. 15 mins before the procedure was given. Then patients were randomly divided into 2 groups. Group N (n=30) received inj. nalbuphine 0.2 mg/kg i.v. and group B (n=30) received inj. fentanyl 2 mcg/kg i.v., both 5 mins prior to the introduction of fiberscope. The nasotracheal fiberoptic intubation was carried out using spray as you go technique. Level of sedation, intubation score and VAS score were observed along with patient comfort score
Results: Group F patients had better sedation score (P=0.328), VAS score (P=0.184), significantly better intubation score (P=0.00), intubation time (0.00) and patient comfort score (P=0.05). Hemodynamics (heart rate, systolic blood pressure, diastolic blood pressure) were significantly better in group F.
Conclusion: Fentanyl-midazolam combination for awake fibreoptic intubation using spray as you go technique, provided better sedation and analgesia, obtunded airway reflexes and minimized pressor response to awake fibreoptic intubation and provided better patient comfort.

Introduction: Spinal anaesthesia is a safe, reliable, inexpensive anaesthetic technique for regional anaesthesia. It also allows early ambulation and early rates of hospital discharges.
Material and methods: Present study was carried at tertiary care Hospital. After receiving ethical approval from the college ethical committee and CTRI registration, 64 patients aged 19 to 65 years old with ASA grade I and II physical status who were undergoing elective infra-umbilical surgeries were included in the study. Patients were randomly allocated in two groups of 32 patients each. Group C: Received 1% Isobaric Chloroprocaine 3 ml (30mg) + clonidine (30 mcg). Group F: Received 1% chloroprocaine 3ml (30 mg) + fentanyl (25 mcg). Total volume = 3.5ml. Sensory block was examined using pin prick method. Quality of motor block was examined and graded using Modified Bromage Scoring. Hemodynamic was monitored and side effects were noted.
Result: Total 64 patients were divided into two groups of 32 each. There were 17 males and 15 females in Group F. While in Group C, male and female participants were 16 each. In group F, mean onset time of sensory blockade was (3.69 ± 0.41min) and mean onset of motor blockade was (5.14 ± 0.65min). In group C, mean onset time of sensory blockade was (3.86 ± 0.28min) and mean onset of motor blockade was (5.31 ± 0.63min). In group F, mean duration of sensory blockade was (74.19 ± 3.14min) and mean duration of motor blockade was (60.24 ± 2.97min). In group C, mean duration of sensory blockade was (110.34 ± 8.45min) and mean duration of motor blockade was (94.88 ± 4.39min). In group F, 1 patient had hypotension and bradycardia while in group C,4 patients had hypotension and 3 had bradycardia. Transient neurological symptoms, respiratory depression and pruritis were not seen in any of the groups.
Conclusion: From our study we conclude that, clonidine as an adjuvant to intrathecal chloroprocaine can be used for infra-umbilical ambulatory surgeries with good sub-arachnoid block quality and lesser side effects.

Background: The process of Laryngoscopy & Intubation is a noxious stimulus, therefore constituting a period of intense sympathetic activity. Various non-pharmacological & pharmacological methods have been used to attenuate this hemodynamic response. Opioids are potent agents that can attenuate pressor response by maintaining the proper depth of anaesthesia. Although there are few studies comparing opioids in attenuating hemodynamic response during intubation, none of them incorporated measuring serum cortisol levels during intubation. Henceforth, in our study, we have compared the efficacy of bolus administration of intravenous (IV) fentanyl, IV morphine and IV nalbuphine to suppress the pressor response and serum cortisol level during laryngoscopy and endotracheal intubation.
Objectives:
1) To evaluate the efficacy of Intravenous (IV) opioids in attenuating the stress response and serum cortisol levels during endotracheal intubation.
Materials and Methods: In our study, 60 ASA I and II patients, aged between 20 to 60 years were enrolled and randomly divided into three groups. Of the three groups group I (received Fentanyl 2 mcg/kg), group II (Received Morphine 0.1mg/kg), and group III (received Nalbuphine 0.2mg/kg). Patients who are pregnant, lactating or illicitly abusing centrally acting drugs, or allergic to the drug under study are excluded from the study After random group allocation hemodynamic parameters like heart rate, blood pressure, and mean arterial pressure were monitored at baseline followed by a 1-minute interval up to 4 minutes after intubation. Furthermore, Blood sampling was done in the preoperative ward followed by a 5- and 10-minutes period after intubation intraoperatively for measuring serum cortisol levels. Conclusion: Comparatively, fentanyl caused a significant reduction in stress response during laryngoscopy and intubation followed by morphine and nalbuphine.

Background: Subarachnoid (spinal) block is a safe and effective alternative to general anesthesia for arthroscopic knee surgeries. Hyperbaric bupivacaine, the local anaesthetic most commonly used, don’t have the advantage of prolonged analgesia. Due to the early arising post-operative pain the role of various adjuvants has been proposed and evaluated. The present study was aimed to compare the clinical efficiency of intrathecal fentanyl with nalbuphine as adjuvant to 0.5% hyperbaric bupivacaine for arthroscopic knee surgeries. Patients and Methods: A total of 68 patients were randomly taken for this study and categorized into Group Ⅰ (nalbuphine) and Group II (fentanyl). Each group received 12.5mg of 0.5% heavy bupivacaine with 1 mg nalbuphine or 25μg fentanyl diluting it to 3 ml total volume. Sensory and motor block characteristics and time to first rescue analgesia were recorded as the primary end points. Drug‑related side effects of hypotension, bradycardia, respiratory depression, nausea, vomiting, shivering, urinary retention and pruritus were recorded as the secondary outcomes.
Results: Sensory and motor blockade and time for peak sensory level was earlier in group I as compared to group II. Mean time for 2 segments regression in Group I was prolonged as compared to group Ⅱ. Duration of motor block in Group I [241.471± 12.464 min]was significantly prolonged compared to Group II [179.265± 6.868 min] with (p=0.000). Sensory level at L4 in Group I was 406.618± 17.953 min and in Group II was 228.235± 8.694 min with (p=0.000). Rescue analgesia time in Group I [401.471±16.946 min] was significantly prolonged as compared to Group II [220.000±11.282 min] with (p=0.000). The adverse events in group I are lesser as compared to group II and was statistically significant.
Conclusion: Nalbuphine is a better adjuvant than fentanyl in spinal anesthesia for prolonging post-operative analgesia.

Background:This clinical study was undertaken to compare the effects of intrathecal
midazolam and fentanyl as additives to intrathecal bupivacaine 0.5 % for spinal
anaesthesia.
Materials and Methods: This prospective, randomized, comparative study was
conducted on 100 adult patients of ASA physical status 1 & 2 in the age group of 18
years to 60 years, at MAMATA GENERAL HOSPITAL, KHAMMAM. on patients
admitted for elective surgery from the period october 2017 - september 2019. Patients
belonging to Group A received 3 ml (15 mg) of hyperbaric bupivacaine (0.5 %) + 0.2 ml
(1 mg) of preservative free midazolam + 0.3 ml of normal saline and Group B received 3
ml (15 mg) of hyperbaric bupivacaine (0.5 %) + 0.5 ml (25 μg) of fentanyl. Patients were
preloaded with intravenous Ringer’s lactate solution 15 ml / kg just before
administering subarachnoid block. Subarachnoid block was administered in L3-L4
intervertebral space with 25G Quincke’s needle. Standard monitoring was carried out
in the form of pulse oximetry, ECG and non-invasive arterial blood pressure
monitoring. Pulse rate, respiratory rate, arterial blood pressure and oxygen saturation
were recorded every 5mins for first 10mins, every 10mins for next half an hour and
then every 15mins intra operatively. The following parameters were observed - onset
and duration of sensory blockade, maximum level of sensory blockade achieved, two
segment regression, onset and duration of motor blockade, duration of effective
analgesia and any side effects associated with these drugs like nausea, vomiting,
pruritis, bradycardia, and hypotension. Computer generated randomization was used
to allocate patients into two groups. Statistical analysis was done using T-test and
fischers exact test. P value of less than 0.05 was considered to be significant
Results: The present study concludes that there were no differences in the onset of
sensory and motor blockade, maximum level of sensory blockade achieved, and time for
two segment regression. 25μg intrathecal fentanyl was found to provide a longer
duration of sensory and motor blockade and prolonged the time for first rescue
analgesia as compared to 1mg intrathecal midazolam. There was no significant
difference between the two groups with respect to the occurrence of side effects.
Conclusion: Hence, we suggest that addition of intrathecal fentanyl is excellent additive
to Bupivacaine for prolongation of duration of anaesthesia without any deleterious
effects.

Introduction: One of the primary aims of anesthesia is to relieve the patient's pain and
agony, thereby the surgical procedures can be conducted without any discomfort. Relief of
intraoperative and postoperative pain has gained importance in recent years, considering the
central, peripheral and immunological stress response to tissue injury. Any expertise acquired
in this field should be extended into the postoperative period, which is the period of severe,
intolerable pain requiring attention. So there is need of extended analgesia without any side
effects in the process of achieving this goal. “Regional anaesthesia” is the term first used by
Harvey Cushing in 1901 to describe pain relief by nerve block 1. Regional nerve blocks are
based on the concept that pain stimulus conveyed by nerve fibers, which are amenable to
interruption anywhere along their pathway 2. Brachial plexus block is a valuable and safe
alternative to general anesthesia in upper limb surgeries. Interrupting the acute pain which
can help in limiting the development of chronic pain syndromes 3, 4. The effects of opioids on
regional blockade is controversial. So the present study is being undertaken to evaluate
Fentanyl as an adjuvant to Ropivacaine in supraclavicular brachial plexus block.
Methodology: Hospital based Prospective randomized single blinded study. Conducted on
eighty patients of ASA I and II posted for upper limb surgeries under supraclavicular block.
Patients were divided randomly by means of random number table generated by computer
into two groups as A and B. Each group consisting of 40 patients. Prior to the study
Institutional Ethical committee approval and consent from the patients were taken. The study
was conducted in the Department of Anesthesiology, at Katuri medical college &Hospital,
Guntur from January 2016 to October 2017.

Regional anaesthesia techniques have seen numerous modifications over the last few decades with the advent of many newer and safer local anaesthetics. Even with a variety of drugs available, the search for a safer anaesthetic agent has always been given prime importance in all anaesthesia related practices. Till date 0.5% hyperbaric bupivacaine is the most commonly used drug for orthopedic surgeries in spinal anaesthesia. The study was carried out after approval by the institutional ethical committee in the department of Anaesthesiology. Randomization was done using a random number table generated from computer software and divided into 2 groups of 40 each. Group B: 2.5 ml of 0.5% hyperbaric bupivacaine with 25 μg fentanyl, Group R: 2.5 ml of 0.75% isobaric ropivacaine with 25 μg fentanyl. The quality of anaesthesia, as graded by the surgeons, was excellent in 96.66% in both the groups. In only one patient in group R, poor quality of anaesthesia was reported by the surgeon. This patient was well built and there was some difficulty in muscle retraction. Since the patient was comfortable, no supplementation was given and surgery was completed uneventfully.

Background:Hyperbaric bupivacaine 0.5% (l0mg) with fentanyl 15mcg(0.3ml) and (2)
Hyperbaric bupivacaine 0.5% (10mg) with clonidine 45mcg. Objectives: The study
compared the onset and duration of action of intrathecal hyperbaric bupivacaine 0.5
percent and fentanyl 15mcg (group-I) to intrathecal hyperbaric bupivacaine 0.5 percent
and clonidine 45 mcg (group-II) in spinal anaesthesia in LSCS. The combination of
bupivacaine with fentanyl or clonidine assists anesthesiologists in alleviating
intraoperative discomfort by delivering superior analgesia to patients without extending
recovery.
Materials and Methods: The study included 80 female patients with ASA grade I (n=40
in each group). The time of onset of sensory and motor block, duration of analgesia, 2-
segment regression, intraoperative discomfort, hemodynamic stability, time to
micturition, visual analogue score, and postoperative analgesic requirements were all
evaluated.
Results: In group II, the onset of sensory and motor block was substantially later than
in group I (p0.001). Hemodynamic alterations did not differ between groups (p>0.05).
Intraoperatively, 1 patient reported pruritis, and 2 patients had postoperative urinary
II78.506.12min and groupII-—121.284.09 min) and regression of sensory level to L2
dermatome (group-I - 142.206.73 min and group II 166.405.79 min) were significantly
longer in group II (p0.001). The duration of analgesia in group II was 210.186.79
minutes, whereas in group II it was 323.5610.53 minutes, which is significant (p0.001).
The VAS scores in group II were considerably lower after 3 hours (p0.05), 6 hours
(p0.001), and 12hours (p0.001).
Conclusion: The addition of intrathecal clonidine 45 mcg to hyperbaric bupivacaine in
spinal anaesthesia gives greater analgesia with less perioperative discomfort, a longer
duration of analgesia, and a reduction in postoperative analgesic requirements.

Background: The present aim of the study is to compare the clinical efficacy of
dexmedetomidine versus fentanyl added to intrathecal levobupivacaine for orthopedic
surgeries on the lower limb.
Materials and Methods: The current study was a prospective randomized double-blind
comparative study. This study was done in 90 ASA grade I & II patients. The patients
were aged between 18 to 60 years scheduled for elective orthopedic surgeries under
spinal anaesthesia at Government General Hospital, Kurnool District, Andhra Pradesh.
The patients were distributed into three groups (30 patients each). Namely., Group-C
[Study group LN:15mg of 0.5% of Levobupivacaine + 0.5 ml of normal saline]-Total-
3.5ml, Group-D [Study group LD:15mg of 0.5% of Levobupivacaine + 5 mcg (0.05ml=2
units from insulin syringe) of dexmedetomidine+0.45 ml of normal saline]-Total-3.5ml
and, Group-F [Study group LF: 15 mg of 0.5% of Levobupivacaine + 25 mcg of
fentanyl]- Total =3.5 ml.

Intrathecal hyperbaric bupivacaine for orthopedic surgeries has faster onset but episodes of hypotension, nausea, vomiting is more than intrathecal isobaric ropivacaine. Maximum level of sensory block height is higher with intrathecal bupivacaine compared to ropivacaine in equipotent doses. To detect a significant difference in mean duration of sensory block between groups B (Bupivacaine with fentanyl) and group R (Ropivacaine with fentanyl) with α = 0.05 & power = 80% the minimum number of 40 cases was required in each group. Randomization was done using a random number table generated from computer software and divided into 2 groups of 40 each. The mean of mean blood pressure showed a significant and consistent fall from the baseline after the sub arachnoid block. This fall was seen in both the groups and was statistically highly significant but was clinically within normal physiological limits. Similarly, the difference in the mean of mean blood pressure between the groups were statistically highly significant but were clinically comparable.

Background: Opioids and local anaesthetics act synergistically and it’s a popular technique to combine bupivacaine and fentanyl in spinal anaesthesia for caesarean delivery. The aim of the study was to find out optimal dose combination of bupivacaine and fentanyl for spinal anaesthesia for better quality of perioperative analgesia and reduction of feto-maternal adverse outcome during caesarean section.
Methods: Three hundred and four parturients scheduled for caesarean delivery were randomly allocated to four groups of 76 each. Data of 298 parturients (Gp I=73, Gp II=75, Gp III=75 and GP IV=75) was included in the primary outcome analysis. The control group received 12 mg of 0.5% hyperbaric bupivacaine for spinal anaesthesia. Fentanyl 15, 20 or 25 μg was added to each study group who received 9 mg of 0.5% hyperbaric bupivacaine in spinal anaesthesia. Onset and duration of spinal anaesthesia, hemodynamic parameters, intraoperative nausea & vomiting (IONV), failed block, APGAR score and other side effects were noted.
Results: The duration of effective and complete analgesia was significantly longer in all fentanyl groups. However, increasing the dose of fentanyl from 15 to 25 μg had little effect on further prolongation of analgesia. Duration of motor blockade was significantly prolonged in control group. The incidence of hypotension and IONV episodes were significantly low in the study groups.
Conclusion: Bupivacaine and fentanyl have super additive effect in spinal block. However, strict drug dose calculation is required in spinal anaesthesia to minimize adverse outcomes during caesarean delivery. Spinal anaesthesia with fentanyl 15 μg and 0.5% hyperbaric bupivacaine, 9 mg provides optimal surgical conditions for caesarean delivery with negligible side effects as compared to other dose combinations.

Background: Various adjuvants have been used with local anesthetics in spinal
anesthesia to avoid intraoperative visceral and somatic pain and to provide prolonged
postoperative analgesia.
Aims: To compare the intraoperative effects of a single low dose of intrathecal tramadol
and intrathecal fentanyl with hyperbaric bupivacaine hydrochloride.
Materials and methods: Fifty patients undergoing Orthopaedic Surgery were randomly
allocated to two groups to be given the following agents by intrathecal route: Group A:
0.5% Bupivacaine 3.0 ml and 25 micro grams fentanyl and Group B: received 0.5%
Bupivacaine 3.0 ml and 25 milligrams tramadol. Intraoperative hemodynamics, pain
scores (assessed using a visual analogue scale), post-operative pain relief and side effects
in both groups was evaluated clinically.
Results: Intraoperatively no significant differences in BP, pulse rate and respiratory
rate were noted. Time to full motor recovery was not delayed in any of the patients in
both the groups. The mean duration of analgesia did not differ in both groups. Mean
duration of analgesia in Group A was 562 minutes and in Group B was 551.2 min. Time
for two segment regression did not differ in both the groups. The patients in both the
groups showed minimal side effects, like nausea, vomiting and pruritis. The incidence of
side effects were statistically in significant.
Conclusions: Both intrathecal tramadol and intrathecal fentanyl act synergistically to
potentiate bupivacaine induced sensory spinal block. Excellent surgical anesthesia and
an extended analgesia was observed in post-operative period with minimum side effects
were observed in both groups.

Introduction: Spinal anesthesia is most commonly used for lower abdominal surgeries due to its low cost and ease of administration as well as rapid onset of anaesthesia. Adjuvants like Fentanyl and dexmedetomidine are used to accelerate and prolong the anaesthetic effect depending on the purpose. This study was done to compare the effects of intrathecal hyperbaric bupivacaine with fentanyl and bupivacaine with dexmedetomidine for lower abdominal surgeries.

Background: The present study was undertaken to highlight the benefits of avoiding suxamethonium, using only the opioid-propofol technique for routine intubation in paediatric age groups.
Objective: the advent of shorteracting opioid drugs, intubating the trachea has been particularly successful when these drugs are used in combination with propofol. Propofol has been reported to possess some characteristics that provide adequate conditions for intubation in combination with fentanyl 1,2 or alfentanil 3,4 or remifentanil 5.6.
Material & Method: Sixty children of ASA grade I or II scheduled to undergo elective surgery under general anesthesia were studied. They were randomly divided into two groups of thirty patients each.
Group I: Inj. fentanyl 4 μg.kg-1 and 5 minutes later Inj. propofol 3mg. kg-1 was given.
Group II: Inj. propofol 3 mg. kg-1 followed by Inj. suxamethonium 1mg.kg-1 was given.
Intubation in all cases was done by senior anaesthesiologist, 60 secs after induction with propofol. Intubation scores were recorded according to Helbo-HansenRaulo and Trap-Anderson scoring system. Acceptable intubating conditions (i.e., excellent and good) were observed in 26 (86.7%) out of 30 patients in Fentanyl group. The systolic blood pressure and heart rate, decreased significantly after intubation at 3 and 5 minutes in group Fentanyl when compared with pre-induction values (P<0.001).
Result & Conclusion: Results of present study suggest that in premedicated healthy children administration of fentanyl 4μg.kg-1 in combination with propofol 3mg.kg-1, after adequate waiting period of 6min, reliably provides good to excellent conditions for tracheal intubation and blunts the pressor response to intubation adequately without significant cardiovascular depression. Thus ideal intubating conditions can be achieved without muscle relaxants using fentanyl and propofol and provide an useful alternative technique for tracheal intubation when neuromuscular blocking drugs are contraindicated or should be avoided. Refinement of this technique by adjustment of the dose of fentanyl and propofol, and addition of Lignocaine may minimize incidence of coughing and might improve intubating conditions further.

Background: Various adjuvants have been used with local anaesthetics in spinal
anaesthesia to prolong postoperative analgesia. Dexmedetomidine, the new highly
selective α2-agonist drug, is now being used as a neuraxial adjuvant. The aim of this
study was to evaluate the onset and duration of sensory and motor block, hemodynamic
effect, postoperative analgesia, and adverse effects of dexmedetomidine, or fentanyl
when given intrathecally with hyperbaric 0.5% bupivacaine.
Materials and Methods: Ninety patients classified in American Society of
Anaesthesiologists classes I and II scheduled for lower abdominal surgeries requiring
spinal anaesthesia were studied. Patients were randomly allocated to receive either 12.5
mg hyperbaric bupivacaine plus 10 μg dexmedetomidine (group D, n=30) or 12.5 mg
hyperbaric bupivacaine plus 25 μg fentanyl (group F, n=30) intrathecal. The control
group received 12.5 mg hyperbaric bupivacaine intrathecally (n=30).
Results: Patients in the dexmedetomidine group (D) had a significantly longer sensory
and motor block time than patients in the fentanyl group (F) and control group (B).
VAS score at rescue analgesia was significantly higher in the control group. Duration of
analgesia was significantly more in the dexmedetomidine, and fentanyl group as
compared to control. The total duration of analgesia was longer with dexmedetomidine
than fentanyl. Sedation scores were significantly higher in the Dexmedetomidine group.
No hemodynamic changes were noted in any group.
Conclusion: Intrathecal dexmedetomidine and fentanyl as adjuvants to hyperbaric
bupivacaine prolong sensory and motor block with minimal hemodynamic instability
and reduced demand for rescue analgesia. Intrathecal dexmedetomidine has a longer
duration of analgesia than fentanyl.

Introduction: Epidural anesthesia is a type of neuraxial anesthesia; used for anesthesia of
abdominal, pelvic, and lower extremity procedures and, less commonly, thoracic procedures
and as a supplement to general anesthesia for thoracic, abdominal, and pelvic procedures and
for postoperative analgesia following aforementioned procedures.
Aims: A clinical study comparing efficacy of epidural plain Bupivacaine and combination of
Bupivacaine plus Fentanyl in abdominal and lower limb surgeries.
Materials and Methods: The present clinical study has been carried during 2017-2019,The
Study was under taken to compare the efficacy of Bupivacaine and combination of
Bupivacaine with fentanyl regarding onset, duration and quality of analgesia when given
extraduraly.The study was conducted on 100 adult patients of ASA grade Ι and ΙΙ.
Results: The time of onset of analgesia was determined by pin prick method every one
minute till there was absence of pain sensation and maximum sensory blockade. The quality
of analgesia was recorded as excellent, good, fair and poor. Duration of analgesia was
deduced by testing every 15 minutes with pinprick method for return of sensation in two
dermatomes below the highest level of block achieved i.e., 2-segment regression. The
complications were noted.
Conclusion: The onset of analgesia was quick and time for complete analgesia was earlier in
Bupivacaine and Fentanyl combination group when compared to Bupivacainegroup.The
quality of analgesia was excellent in Bupivacaine and Fentanyl group when compared to
Bupivacainegroup.

Aim: To compare the effects of fentanyl 25microgram and clonidine 30 microgram as
additives to 3 ml of 0.5 % hyperbaric bupivacaine for spinal anaesthesia in lower
extremity orthopedic and urological surgeries.
Materials and methods: This prospective, randomized, double blind study was
conducted on 60 adult patients of ASA physical status 1 & 2 in the age group of 20 years
to 60 years, posted for elective lower limb and urological surgeries under spinal
anaesthesia. Patients belonging to group BF received 3 ml (15 mg) of hyperbaric
bupivacaine (0.5 %) + 0.5 ml (25 microgram) fentanyl. Patients of group B received 3
ml (15 mg) of hyperbaric bupivacaine (0.5 + 0.2 ml (30 microgram) clonidine + 0.3 ml of
normal saline. The following parameters were observed - onset and duration of sensory
block, onset and duration of motor block, durations of complete and effective analgesia
and any side effects associated with these drugs.
Results: The present study showed that the duration of sensory and motor block was
prolonged with the addition of 30 microgram clonidine to intrathecal hyperbaric
bupivacaine as compared to 25 micrograms of fentanyl, same as the duration of
complete and effective analgesia. Both groups were comparable in hemodynamic
stability and there were no significant adverse effects.
Conclusion: Compared to fentanyl 25 microgram, clonidine 30 microgram as additive to
intrathecal hyperbaric bupivacaine for spinal anaesthesia, prolonged the duration of
complete and effective analgesia, which was statistically significant

Introduction: Epidural anesthesia is a type of neuraxial anesthesia; used for anesthesia of abdominal, pelvic, and lower extremity procedures and, less commonly, thoracic procedures and as a supplement to general anesthesia for thoracic, abdominal, and pelvic procedures and for postoperative analgesia following aforementioned procedures.
Aims: A clinical study comparing efficacy of epidural plain Bupivacaine and combination of Bupivacaine plus Fentanyl in abdominal and lower limb surgeries.
Materials and Methods: The present clinical study has been carried during 2017-2019,The Study was under taken to compare the efficacy of Bupivacaine and combination of Bupivacaine with fentanyl regarding onset, duration and quality of analgesia when given extraduraly.The study was conducted on 100 adult patients of ASA grade Ι and ΙΙ.
Results: The time of onset of analgesia was determined by pin prick method every one minute till there was absence of pain sensation and maximum sensory blockade. The quality of analgesia was recorded as excellent, good, fair and poor. Duration of analgesia was deduced by testing every 15 minutes with pinprick method for return of sensation in two dermatomes below the highest level of block achieved i.e., 2-segment regression. The complications were noted.
Conclusion: The onset of analgesia was quick and time for complete analgesia was earlier in Bupivacaine and Fentanyl combination group when compared to Bupivacainegroup.The quality of analgesia was excellent in Bupivacaine and Fentanyl group when compared to Bupivacainegroup.