European Journal of Molecular & Clinical Medicine

The provision of adequate analgesia is necessary after any surgery and is all the more important in children. Pain after surgery is inevitable. It has been recognized for some time that management of acute pain, especially postoperative pain, has been consistently and systematically inadequate, situation being worse in children.
Methodology: After careful pre-anaesthetic check-up children posted for elective sub-umbilical surgeries between age groups of 3-8yrs of ASA I & II were randomly divided into 2 equal groups. Group L received levobupivacaine 0.25% 1ml/kg + 2mcg/kg clonidine and Group R received ropivacaine 0.25% 1ml/kg + 2mcg/kg clonidine. Following intrathecal administration of these drugs, intraoperative hemodynamic changes, postoperative pain relieving quality and rescue analgesia were studied. Hemodynamic parameters were monitored in the intraoperative and postoperative period. Incidence of side effects were also noted.
Conclusion: Addition of clonidine as an adjuvant to both the groups were significantly increase in Post-operative analgesic quality with perioperative hemodynamic stability with minimum side effects. Thus making it evident the clonidine as an adjuvant to Ropivacaine and levobupivacaine can be safely used for single shot caudal block in children undergoing elective subumbilical surgeries.

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.

Regional anaesthesia has been preferred over general anaesthesia in many orthopaedic surgeries due to lack of associated complications in regional blocks. Increasing the duration of local anaesthetic action can obtain the desired effect of prolongation of the postoperative patient comfort. Many adjuvants to local anaesthetics such as epinephrine, clonidine, opioids, dexmedetomidine and also neostigmine have been tried. Recently, dexamethasone has been found to prolong postoperative analgesia, reducing the requirement of the local anaesthetic and also the side effect profile. Hence our study was conducted to analyse the efficacy of dexamethasone as an adjuvant drug to levobupivacaine. After institutional ethical committee approval, CTRI registration and patient consent, a double blinded randomised controlled study was conducted in 50 patients aged 18-65 years of ASA I&II undergoing upper limb surgeries distal to mid-humeral level over a period of 1year. The mean duration of post-operative analgesia in Group D was 1022.2±62.67 minutes and in Group S was 777.40±34.19 minutes (p<0.001). The mean total dose of rescue analgesics required was more in Group S when compared to Group D in the first 24hrs. The onset of sensory and motor block was faster in Group D when compared to Group S. The mean duration of sensory and motor block was significantly longer in Group D than Group S. The addition of dexamethasone to levobupivacaine in SCBP blockade was associated with faster onset as well as prolonged duration of sensory and motor block, prolonged duration of post-operative analgesia and required less rescue analgesics.

Brachial Plexus block either alone or as a part of an anaesthetic sequence is useful as it provides complete relaxation of muscles of upper extremities. Present study was aimed to study additive effects of butorphanol with 0.375% levobupivacaine in supraclavicular brachial plexus block for upper limb surgeries at a tertiary hospital.
Material and Methods: Present study was single-center, prospective, comparative study in patients aged 18–58 years, of both gender, with body mass index (BMI) <25 kg/m2, of American Society of Anesthesiologists (ASA) physical status I to II, scheduled for elective forearm and hand surgeries, Patients fit for surgery, were randomly allocated into two groups using as Group BB (1 mg of butorphanol) & group B (bupivacaine only).
Results: In present study, general characteristics such as age (year), gender (male/female), ASA (I/II), weight (kg), height (cm) & mean duration of surgery (min) were comparable among both groups & difference was not statistically significant. Time taken for procedure (min) & onset of sensory blockade (min) were comparable in both groups and difference was not statistically significant. Butorphanol when added to levobupivacaine in supraclavicular brachial plexus block had early onset of motor block, improves the quality of block, prolonged the duration of sensory and motor blockade as compared to levobupivacaine alone, and difference was statistically significant.  Prolonged the duration of analgesia and late requirement of rescue analgesia as compared to levobupivacaine alone, and difference was statistically significant.
Conclusion: Butorphanol added with 0.375% levobupivacaine in supraclavicular brachial plexus block for upper limb surgeries provides rapid onset of block, better analgesia, good hemodynamic stability and profound and longer analgesia

Regional anaesthesia has been preferred over general anaesthesia in many orthopaedic surgeries due to lack of associated complications in regional blocks. Increasing the duration of local anaesthetic action can obtain the desired effect of prolongation of the postoperative patient comfort. Many adjuvants to local anaesthetics such as epinephrine, clonidine, opioids, dexmedetomidine and also neostigmine have been tried. Recently, dexamethasone has been found to prolong postoperative analgesia, reducing the requirement of the local anaesthetic and also the side effect profile. Hence our study was conducted to analyse the efficacy of dexamethasone as an adjuvant drug to levobupivacaine. After institutional ethical committee approval, CTRI registration and patient consent, a double blinded randomised controlled study was conducted in 50 patients aged 18-65 years of ASA I&II undergoing upper limb surgeries distal to mid-humeral level over a period of 1year. The mean duration of postoperative analgesia in Group D was 1022.2±62.67 minutes and in Group S was 777.40±34.19 minutes (p<0.001). The mean total dose of rescue analgesics required was more in Group S when compared to Group D in the first 24hrs. The onset of sensory and motor block was faster in Group D when compared to Group S. The mean duration of sensory and motor block was significantly longer in Group D than Group S. The addition of dexamethasone to levobupivacaine in SCBP blockade was associated with faster onset as well as prolonged duration of sensory and motor block, prolonged duration of post-operative analgesia and required less rescue analgesics.

Ultrasound guidance in anaesthesia is becoming an important tool in Anaesthesiologists. Sonography helps in addressing a variety of consequences such as patient safety, economic burden, duration of the procedure and success rates associated with invasive anaesthesia procedures. Consent from 50 patients were obtained in their own understandable language. After thorough pre-anaesthetic evaluation and overnight fasting, patients shifted to operation theatre and following monitors are connected. (Pulse oximeter, electrocardiogram, capnograph and non-invasive Blood pressure) Patients were randomly allocated into 2 groups (Group D and Group S) as per computer generated randomization table. The average diastolic blood pressure in both the groups was maintained from the baseline till 24 hours of observation. There was neither clinical nor statistical significant variation found. We did not find any clinical variations in the heart rate, SBP, DBP, MAP, RR of the patients preoperatively, intra and also postoperative period. All the recruited patients had maintained oxygen saturation >95% throughout the surgery.

Levobupivacaine has also been evaluated as a less toxic substitute for bupivacaine and has been found to produce a quantitatively similar neural blockade. So far few data are available concerning the use of levobupivacaine in children. Ropivacaine, a recently introduced bupivacaine analogue drug, is less neurotoxic and cardiotoxic than bupivacaine. Ropivacaine is less lipophilic; hence, it is less likely to penetrate large myelinated motor fibers, resulting in a relatively reduced motor blockade and longer postoperative analgesia and has a greater degree of motor sensory differentiation, which could be useful when motor blockade is not desired. In this randomized, prospective, double blind, single hospital study ninety (90) paediatric patients aged 1 to 10 years undergoing lower abdominal surgery were enrolled. Twenty three patients were excluded as they did not meet the inclusion criteria and seven patients refused to participate.This study was conducted on 60 patients undergoing lower abdominal surgeries. The mean postoperative duration of analgesia was 321.37 ± 24.25 minutes in group L and 309.75 ±23.68 minutes in group R. The difference in the mean duration of analgesia was statistically insignificant (p -value was > 0.05 at all specified intervals).

his study is aimed to compare the effects between 20ml of 0.5% Ropivacaine and 20ml of 0.5% Levobupivacaine in ultrasound guided supraclavicular brachial plexus block for Upper limb surgeries. Methodology: It was a prospective double blinded randomized controlled study in sixty adult patients undergoing upper limb surgeries admitted in Rajah Muthiah Medical college and hospital from November 2020 to November 2022. Result: Significant earlier onset of sensory blockade (p=0.001) and motor blockade (p=0.001), prolonged duration of sensory and motor blockade (p=0.001) was observed in group of patients receiving 0.5% levobupivacaine compared to 0.5% ropivacaine. Intraoperatively throughout the study heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were comparable in both the groups and found no statistically significant difference (p>0.05). The heart rate, systolic and diastolic blood pressure for both the groups were also compared postoperatively and observed no significant statistical difference (p>0.05). No adverse effects were observed in both the groups. Conclusion: 0.5% levobupivacaine used in ultrasound guided supraclavicular brachial plexus block for upper limb surgeries provides rapid onset of sensory and motor blockade and prolonged duration of analgesia compared to 0.5% ropivacaine.

Background: Adductor canal block (ACB) has recently been considered as a promising method for providing analgesia after knee surgeries with sensory blockade. ACB blocks the sensory innervation of the knee via the saphenous nerve ^[1]. ACB preserves quadriceps muscle strength better than Femoral Nerve Block, minimizing weakness during knee extension and thus functional recovery is improved within the first 24 hrs post‑operative period and the risk of developing Deep Vein Thrombosis is reduced ^[1]. Addition of Dexamethasone to local anaesthetics improves the quality and duration of peripheral nerve block ^[2]. We evaluated the effect of adding dexamethasone to levobupivacaine on the duration of postoperative analgesia in patients undergoing knee surgery using ultrasound-guided adductor canal block.
Methods: The study was a prospective double blinded randomized comparative study. Sixty patients scheduled for knee surgery were randomly allocated into two groups to receive adductor canal block. The control group L received 15 mL levobupivacaine 0.25% + 2 mL normal saline, and the dexamethasone group D received 15 mL levobupivacaine 0.25% + 2 mL dexamethasone (8 mg). Measurements included duration of sensory blockade, hemodynamic stability, visual analog score, time to first analgesic requirement and analgesic consumption.
Results: Postoperative analgesia was better in Group D patients. The mean VAS score increased with time and the magnitude of increase was more in the Group L than in group D. Duration of analgesia was significantly prolonged in Group D (14 ± 2.25 hours) when compared to Group L (10.57 ± 1.65 hours) with significant P value (<0.05). There was no significant difference between two groups in terms of age, sex, ASA grading and type of surgery. Both the groups maintained hemodynamic stability, which was statistically insignificant (P value >0.05).

Background and objectives: The provision of adequate analgesia is necessary after any surgery and is all the more important in children. Pain after surgery is inevitable. It has been recognized for some time that management of acute pain, especially postoperative pain, has been consistently and systematically inadequate, situation being worse in children. Bupivacaine has been for long used in caudal for post-operative analgesia but had back drop considerations of toxicity in large doses thus making it necessary to be able to use an alternative drug like Ropivacaine and levobupivacaine with lower toxicity but similar analgesic capability.
Methodology: After careful pre-anaesthetic check-up children posted for elective sub-umbilical surgeries between age groups of 3-8yrs of ASA I & II were randomly divided into 2 equal groups. Group L received levobupivacaine 0.25% 1ml/kg + 2mcg/kg clonidine and Group R received ropivacaine 0.25% 1ml/kg + 2mcg/kg clonidine. Following intrathecal administration of these drugs, intraoperative hemodynamic changes, postoperative pain relieving quality and rescue analgesia were studied. Hemodynamic parameters were monitored in the intraoperative and postoperative period. Incidence of side effects were also noted. Conclusion: we noted that Addition of clonidine as an adjuvant to both the groups were significantly increase in Post-operative analgesic quality with perioperative hemodynamic stability with minimum side effects. Thus making it evident the clonidine as an adjuvant to Ropivacaine and levobupivacaine can be safely used for single shot caudal block in children undergoing elective subumbilical surgeries.

Introduction: After a lower segment caesarean section, local anaesthetic wound infiltration is used as part of multimodal analgesia to lessen pain and opiate use (LSCS). Ketamine extends the effects of analgesia by blocking additional spinal pain pathways.
Aims: To compare the analgesic effectiveness of ketamine and levobupivacaine when injected into subcutaneous wounds.
Materials and Methods: 50 patients receiving under spinal anaesthetic, a randomisedwas done. Both Group A and Group B parturients received surgical wound infiltration with 0.5% levobupivacaine diluted with normal saline at a dose of 2 mg/kg body weight for Group A, and 0.5% levobupivacaine with ketamine at a dose of 1 mg/kg body weight for Group B. We evaluated postoperative pain scores, first rescue analgesia time (FRA), hemodynamic parameters, and overall opioid analgesic use.
Results: Group B had a 1.5-hour longer pain-free duration and shorter time to FRA, along with lower mean VAS scores. Additionally, Group B participants consumed significantly fewer opioids overall and overall pain levels (P = 0.003). 97% of parturients in Group A and just 50% of those in Group B required rescue analgesia. The patient satisfaction score in Group B was considerably higher (P = 0.009). Between the groups, there was no difference in the frequency of nausea and vomiting (P = 0.5234).
Conclusions: Adding ketamine to levobupivacaine for surgical wound infiltration increases patient satisfaction, prolongs the duration of analgesia, and reduces the need for 24-hour opioid use.

Aim: This study is aimed to compare the effects between 20ml of 0.5% Ropivacaine and 20ml
of 0.5% Levobupivacaine in ultrasound guided supraclavicular brachial plexus block for
Upper limb surgeries.
Methodology: It was a prospective double blinded randomized controlled study in sixty adult
patients undergoing upper limb surgeries admitted in Rajah Muthiah Medical college and
hospital from November 2020 to November 2022.
Result: Significant earlier onset of sensory blockade (p=0.001) and motor blockade (p=0.001),
prolonged duration of sensory and motor blockade (p=0.001) was observed in group of
patients receiving 0.5% levobupivacaine compared to 0.5% ropivacaine. Intraoperatively
throughout the study heart rate (HR), systolic blood pressure (SBP) and diastolic blood
pressure (DBP) were comparable in both the groups and found no statistically significant
difference (p>0.05). The heart rate, systolic and diastolic blood pressure for both the groups
were also compared postoperatively and observed no significant statistical difference (p>0.05).
No adverse effects were observed in both the groups.
Conclusion: 0.5% levobupivacaine used in ultrasound guided supraclavicular brachial plexus
block for upper limb surgeries provides rapid onset of sensory and motor blockade and
prolonged duration of analgesia compared to 0.5% ropivacaine

Aim: The purpose of this research is to assess the efficacy of bupivacaine against levobupivacaine in
supraclavicular brachial plexus block.
Methods: The research comprised 100 patients between the ages of 20 and 55 who had upper limb
orthopaedic and soft tissue lesions and weighed more than 61 kilos and had ASA grades I and II. The
first group received 1 ml (100g) dexmedetomidine mixed with 39 ml of 0.5 percentLevobupivacaine.
As an anaesthetic agent, category II received 1 ml of 0.9 percent normal saline and 39 ml of 0.5
percentLevobupivacaine. The heart rate, respiration rate, SBP, DBP, pulse rate, and oxygen saturation
were all monitored and recorded as soon as the patient entered the OT. In the previously secured
intravenous line, ringer lactate was begun. The supraclavicular technique was used to provide brachial
plexus block.
Results: The mean age in categories I and II was 34.25 and 35.87, respectively. Both outcomes were
statistically significant. All research participants in Category I did not need post-operative analgesia,
but all patients in Category II did. In Category I, 28 percent were mildly sleepy, compared to 100
percent in Category I. Both outcomes are statistically significant. In Category I, the average duration
of sensory and motor block was about 4.1 minutes less than in Category II. (5.87 vs. 9.98 minutes)
The onset of motor blockage in Category I was likewise 4.1 minutes sooner than in Category II (8.88
vs 12.96 min). The mean length of sensory block (577 vs 989 min) and motor block (596 vs 988 min)
was 392 minutes shorter in each category. The duration of post-operative analgesia was 404 minutes
shorter in both categories (579 vs 979 min). The findings are all statistically significant.
Conclusion: We believe that in peripheral nerve blocks requiring high amounts of local anaesthetic,
levobupivacaine may be a feasible alternative due to its lower hazardous potential.

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.

Background: Laparoscopic cholecystectomy (LC) has become the gold standard for treatment of benign Gall Bladder disease. Pain after laparoscopic surgery though primarily visceral, often affecting the sub diaphragmatic region and often referred to the right shoulder region, also has a parietal component which occurs at the trocar site. The present study was planned to evaluate the effect of combined port site levobupivacaine administration before and after surgery for patients who underwent Laparoscopic cholecystectomy.
Material & Methods: This was a hospital based prospective randomized double blind comparative study done on 100 patients undergoing elective laparoscopic cholecystectomy surgery at Jawahar Lal Nehru Hospital, Ajmer, after approval from ethical committee. The study population were randomly divided into two groups A (Preincisional) and B (Post incisional) with 50 patients in each group using computer generated tables of random numbers. The primary outcome variable was to compare pain (visual analogue scale [VAS]) score. The intensity of post-operative pain was recorded for all the patients using VAS score at 3, 6, 12, 24 h after surgery (mean of all VAS scores).
Results: Our study showed that mean age of patients in group A was 43.20 years and 41.16 years in group B, which was statistical non-significant (P=0.435). There was significant difference in the mean VAS scores between the two groups up to 12^th hour postoperatively. There was statistically lower VAS score in group A as compared to group B postoperatively up to 12 hour at 24^th postoperative hour there was no significant difference in VAS score in both groups. The mean duration of analgesia was 164.94 ± 27.37 min in group A with a range of 95 to 210 min., while in group B, the mean duration of analgesia was 121.42 ± 14.81 min. with a range of 85 to 145 min, which was statistically longer in Group A as compared to Group B, (p value < 0.0001). Mean number of doses required in group A was 1.70 ± 0.46 and in group B was 2.38 ± 0.49, which was statistically higher in group B (p value <0.0001). In group A total amount of tramadol required in 24 hours was 170.00 ± 46.29 mg in comparison to group B where it was 238.00 ± 49.03 mg (p value <0.0001).
Conclusion: We concluded thatlevobupivacaine can be safely used as local anesthetic infiltration for postoperative pain relief following laparoscopic cholecystectomy surgery.

Introduction: Supraclavicular block is preferred for its rapid onset, reliability and a safetechnique for
surgeries involving the upper limb. Several local anaethetics have
beenusedandproveneffectivewithvariousefficacies.
Aims: To study and compare the efficacy of 0.5% Ropivacaine with 0.5% Levobupivacaine in
supraclavicular brachial plexus block in patients undergoing elective upper limb surgeries.
Materials and methods:
Inourprospectiveclinicalstudy,wecomparedLevobupivacaineandRopivacaineforprovidingsupraclavicularbl
ockin60patients. We demonstrated that a volume of 30 ml of Levobupivacaine and Ropivacinewas
sufficient to provide a satisfactory and a successfulsupraclavicular block withthehelpofultrasoundguidedtechniquekeepinginmindthetoxicdoses.
Results:There were no observable changes in both the groups on comparing the vitalswhichincluded heart
rate, systolic blood pressure, diastolic blood pressure andoxygensaturation. Sensory block onset and
duration in Ropivacaine group was statisticallysignificant.Motor block onset of both were comparable and
did notshowanystatisticalsignificance.. The mean duration of motor blockade were
foundtobesignificantstatistically. The duration of analgesia werefoundtobe statistically significant.
Levobupivacaine providingalonger durationofanalgesia. There were no significant changes in baseline
parameters, heart rate, bloodpressuresandsaturationinboththegroups.
Conclusion: Levobupivacaine would be a better option to choose insupraclavicular brachial plexus
blockwhere prolonged postoperativeanalgesia isrequired.

Background: Spinal anesthesia is a widely used technique providing faster onset with effective and uniformly distributed sensory and motor block. Due to decreased cardiovascular and central nervous system toxicity, levobupivacaine is a good alternative for spinal anesthesia.
Aim: The aim of this study is to evaluate and compare intrathecal plain levobupivacaine and Dexmedetomidine as an adjuvant to 0.5% Levobupivacaine for infra umbilical surgeries with respect to sensory and motor blockade, hemodynamic changes, and adverse effects.
Materials and methods: This is a prospective, randomized double blinded study conducted among 60 patients who were posted under elective infra-umbilical surgery. They were equally divided into Group L: They received intrathecal 0.5% Levobupivacaine 3cc Group LD: They received intrathecal 3 mcg dexmedetomidine with 0.5% Levobupivacaine.
Results: The addition of dexmedetomidine significantly prolonged the duration of sensory and motor block. The addition of dexmedetomidine significantly prolonged the time for rescue analgesia. The addition of intrathecal dexmedetomidine lead to an early onset of sensory block. The incidence of side effects was limited to the occurrence of hypotension and bradycardia in the group that received dexmedetomidine intrathecally.
Conclusion: Intrathecal dexmedetomidine as an adjuvant to spinal anaesthesia is good choice since it produces prolonged sensory and motor block.

Background: When used in conjunction with bupivacaine to block the supraclavicular brachial plexus (SCBP), dexamethasone prolongs the motor and sensory blockade. The effect of dexamethasone (8 mg) when combined with levobupivacaine, on the other hand, has not been well investigated.
Aim: To determine the role of dexamethasone as an adjuvant to levobupivacaine in ultrasound guided SCBP block.
Materials and methods: Comparison of efficacy of levobupivacaine and levobupivacaine with dexamethasone in supraclavicular brachial plexus block was undertaken to compare duration of analgesia, requirement of rescue analgesics and the onset and duration of sensory and motor block among 2 groups. Patients in age group 18 to 60 years belonging to either sex of ASA class 1 or 2 posted for upper limb surgeries were divided into 2 groups of 30 patients each. Group S: 25 ml of 0.5% Levobupivacaine + 2ml Normal Saline Group D: 25 ml of 0.5%Ropivacaine + 2ml (8mg) Dexamethasone.
Results: There was no statistically significant difference in demographic data, duration of surgery, and hemodynamic parameters between the study groups. There was statistically highly significant difference in between the groups in terms of onset and duration of sensory and motor block and duration of analgesia (time to first rescue analgesia) and total number of rescue analgesics used.
Conclusion: Addition of dexamethasone to 0.5% levobupivacaine shortens the onset of sensory and motor block and increases the duration of sensory and motor block as well duration of analgesia in comparison to levobupivacaine alone in Supraclavicular Brachial Plexus Block for upper limb surgeries.

Introduction: Peripheral nerve blocks are the preferred choice of anaesthesia for surgeries involving the extremities of the human body, with fewer complications. Earlier, the most common drug to be used for the brachial plexus block was bupivacaine, but of late, levobupivacaine and Ropivacaine are used as substitutes to counter the toxicity by Bupivacaine.
Materials and methods: 100 patients aged between 18-60 years with ASA I and ASA II undergoing bony surgeries were randomly divided into Group L and Group R. Group L was given 30 ml of 0.5% Levobupivacaine and Group R was given 30 ml of 0.5% Ropivacaine. Results: The onset of the sensory blockade was significantly lesser in Group L (4.51 ± 0.45 minutes) rather than Group R (5.95 ± 1.33 minutes) while there was no significant difference in the onset of the motor blockade (8.13 ± 2.46 minutes in Group L and 8.42 ± 2.51 minutes in Group R). The duration of the sensory blockage was significantly more in Group L (11.13 ± 2.11 hours) than Group R (9.04 ± 1.42 hours) while there was no difference in the duration of the motor blockade. The duration of analgesia was 11.43 ± 2.17 in Group L and 8.23 ± 1.72 hours in Group R, which was statistically significant.
Conclusion: Since the onset is shorter and duration of anesthesia and analgesic is more effective in Levobupivacaine, it can be used as a preferred drug.

Introduction: TAH is associated with significant post-operative pain. Epidural analgesia
with a variety of local anaesthetics and adjuvants is widely used for TAH as it provides both
intra and post-operative analgesia. The aim is to compare the effect of post-operative epidural
analgesia with 0.2% ropivacaine and dexmedetomidine versus 0.125% levobupivacaine and
dexmedetomidine in patients undergoing TAH.
Method: Afterobtaining ethical committee permission and patient consent, 50 women aged
35-65 years of ASA 1&2 were included in the study. We have excluded patients with
hypersensitivity to local anaesthetics, infection at the site of injection. Patients were divided
into 2 groups of 25 each. Group RD-received 10ml of 0.2% ropivacaine and
dexmedetomidine 1 mcg/kg. Group LD-received 10ml of 0.125% levobupivacaine and
dexmedetomidine 1mcg/kg. Using chi-square test and student t-test statistical results were
obtained.
Results: The mean onset of analgesia in Group RD was 11.86min and in Group LD was
8.468min which is statistically significant (P<0.05). Mean duration of analgesia in Group RD
was 210min and in Group LD was 271min which is statistically significant (P<0.05).
Conclusion: We conclude that 0.125% levobupivacaine with dexmedetomidine as adjuvant
was found to have faster onset and prolonged duration of analgesia than 0.2% ropivacaine
with dexmedetomidine.

Aim: To Compare the Effectiveness of Bupivacaine Versus Levobupivacaine in
Supraclavicular Brachial Plexus Block.
Material and methods: This cross sectional comparative study conducted on 100 patients of
ASA I & II status in the age group of 20-58 years given brachial plexus block by
supraclavicular approach for various upper limb surgeries, were included in this study.
Result: There was no statistically significant difference between two groups in
demographic data i.e. age, gender, weight, ASA status. The mean onset time of sensory
block was 11.98 minutes in group B & 10.03 minutes in group L while the mean onset time
of motor block was 13.9 minutes in group B & 12.01 in group L. Mean onset time of
sensory and motor block were significantly shorter in group L than in group B. The mean
duration of sensory block was 878.88±118.55 minutes in group B & 1029.35±139.77
minutes in group L while the mean duration of motor block was 929.55±108.58 minutes in
group B & 1111.11±138.65 minutes in group L Mean duration of sensory and motor block
are significantly longer in group L that in group B. The mean duration of analgesia was
911±118.27 minutes in group B and 1068.69±151.47 minutes in group L . The mean
duration of analgesia was significantly prolonged in group L compared to group B.
Conclusion: We concluded that levobupivacaine has a faster onset of both sensory and
motor blockade as compared to racemic bupivacaine. Also, the duration of both sensory
and motor block is longer with levobupivacaine.

Background: Levobupivacaine is a long acting, amide-type local anaesthetic
that is the S(−) \3- isomer of the racemate bupivacaine. In general, in vitro, in vivo and
human volunteer studies of nerve block indicate that levobupivacaine is as potent as
bupivacaine and produces similar sensory and motor block. Dexmedetomidine is used as
an adjuvant in spinal anesthesia and is associated with prolonged motor and sensory block,
hemodynamic stability, and less requirement of rescue analgesia in 24 h as a result it
facilitates reduction in dose of local anesthetic. Aim of the study: To compare isobaric
levobupivacaine 0.5% versus isobaric levobupivacaine 0.5% with 3 mcg Dexmeditomidine
in spinal anaesthesia. Materials and methods: The present study was conducted in the
Department of Anesthesiology of the medical institution. For the study, we selected a total
of 50 patients in the age group of 20-65 years of physical status American Society of
Anesthesiologists (ASA) Classes I and II admitted for surgeries requiring spinal
anesthesia. An informed written consent was obtained from all the participants after
explaining them the protocol of the study. The patients were randomly grouped into two
groups, Group 1 and Group 2. Group 1 patients received 3 ml (15 mg) of 0.5% isobaric
levobupivacaine + 0.3 ml normal saline, whereas Group 2 patients received 3 ml (15 mg) of
0.5% isobaric levobupivacaine + 0.3 ml (3 μg) dexmedetomidine. Results: It was observed
that the number of male patients in group 1 and 2 was 12 and 14, respectively. The number
of female patients in group 1 and 2 was 13 and 11, respectively. The mean age of patients
in group 1 was 46.28 years and in group 2 was 47.12 years. It was observed that the mean
duration of sensory block in Group 2 was significantly higher than Group 1. The mean
duration of motor block in both the groups was similar and was statistically nonsignificant.
Conclusion: Within the limitations of the present study, it can be concluded
that the duration of sensory block increases with addition of 3 mcg of dexmedetomidine
with Levobupivacaine as compared to plain Levobupivacaine. The results were found to be
statistically significant.