Online ISSN: 2515-8260

Keywords : fentanyl


Clinical Efficacy of Dexmedetomidine Versus Fentanyl Added to Intrathecal Levobupivacaine for Orthopedic Surgery

V. Sreelatha, Padmaja, Sudheer Kumar Gowd, Divya Manogna

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 892-913

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.

Comparison of Adjuvant Intrathecal Dexmedetomidine or Fentanyl to Hyperbaric Bupivacaine for Postoperative Analgesia - A Randomized, Double-Blind Controlled Study

Nishigandha Mahajan, Shilpa Sharda, Krishan Gopal Jangir, Swati Sharma

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 1145-1153

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.

A study to compare the effects of low dose intrathecal fentanyl and low dose intrathecal tramodol combined with 0.5% bupivacaine heavy in patients undergoing orthopaedic surgeries

Dr. P. Anand Vijaya Bhasker, Dr Priyanka Priyadarshini.C, Dr Pasham Abbaiah, Dr Ramakrishna Shatagopam

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 4804-4813

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.

Comparative study of low dose subarachnoid bupivacaine (9 mg) with different dose combinations of fentanyl versus standard dose bupivacaine (12 mg) in parturients undergoing caesarean section

Ashok Rout, Sunny Eapen, Dewendra J Gajbhiye, P Ansuman Abhisek, Pradeep Kedar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1499-1506

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.

Study to assess the effectiveness of Ropivacaine versus Ropivacaine plus Fentanyl combination in Brachial Plexus block by supraclavicular approach

Dr. Padmalatha Seelam, Dr. Manoj Patruni, Dr. Vengamamba Thummala, Dr. Vadlamudi Rajesh Kumar, Dr. Nalli Venkata Krishna Mallik

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1597-1607

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.

A CLINICAL STUDY COMPARING EFFICACY OF EPIDURAL PLAIN BUPIVACAINE AND BUPIVACAINE PLUS FENTANYL IN ABDOMINAL AND LOWERLIMB SURGERIES

Dr . P. Sravani, Dr. Sathish Bobba ,Dr . Sairaj V

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 5943-5951

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.

Comparison of Analgesic Effect of Fentanyl and Clonidine Added Intrathecally with Bupivacaine in LSCS

Firasath, Abhinaya, Raja Shekar Reddy Motkar, Khaja Layeeq Ur Rahman

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 6094-6103

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.

Comparative study of intrathecal fentanyl and dexmedetomidine as adjuvant with bupivacaine in elective lower abdominal surgeries

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1704-1711

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.

Comparison of the Effects of Midazolam (1mg) and Fentanyl (25 Mcg) as Additives to Intrathecal 3ml of 0.5% Bupivacaine (15mg) For Spinal Anaesthesia

Srikanth Allam, D Amrutha Lakshmi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 9921-9936

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.

Assessment of intubating conditions and haemodynamic responses in children using fentanyl and propofol and its comparison with muscle relaxant technique

Dr. Arata Kumar Swain, Dr. Suryasnata Sahoo, Dr. Sabyasachi Das

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1879-1892

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.

A randomized double blind comparative study of the effects of fentanyl and clonidine as additives to intrathecal hyperbaric bupivacaine for spinal anaesthesia

Dr T Tejaswini, Dr Muthavarapu. P.K. Teja, Dr Natra Sarala

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 10257-10266

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

A CLINICAL STUDY COMPARING EFFICACY OF EPIDURAL PLAIN BUPIVACAINE AND BUPIVACAINE PLUS FENTANYL IN ABDOMINAL AND LOWERLIMB SURGERIES.

Dr . P. Sravani, Dr. Sathish Bobba, Dr . Sairaj V .

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 10707-10714

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.

A prospective randomised comparative study of intrathecal nalbuphine versus intrathecal fentanyl as adjuvant to 0.5% hyperbaric bupivacaine for arthroscopic knee surgeries under subarachnoid block

Dr. M Sreya Santhoshi and Dr. Vishwa Saineer

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2091-2099

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.

Intrathecal 0.75% ropivacaine with fentanyl and 0.5% bupivacaine with fentanyl for lower limb surgeries: Changes in blood pressure

Dr. Arjun Nair, Dr. Pramod Kohli, Dr. Sachin Kumar, Dr. Maitree Pandey, Dr. Prashantha Kumar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2427-2432

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.

The onset and duration of sensory and motor block between intrathecal 0.75% ropivacaine with fentanyl and 0.5% bupivacaine with fentanyl for lower limb surgeries

Dr. Arjun Nair, Dr. Pramod Kohli, Dr. Sachin Kumar, Dr. Maitree Pandey, Dr. Prashantha Kumar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2433-2440

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.

A comparative study on fentanyl, morphine and nalbuphine in attenuating stress response and serum cortisol levels during endotracheal intubation

Henin Mohan, Sharan Rajkumar V, Vinodh Mani, Bharath S

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2585-2595

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.