European Journal of Molecular & Clinical Medicine

Postoperativeanalgesia remains a cornerstone in management of patients undergoing inguinal hernia repair. This study evaluates the analgesic efficacy of traditional wound site infiltration and recent ultrasound guided TAP block using VAS score. Sixty patients were divided into two Groups. Patients in Group 1 were given ultrasound guided TAP block with 20ml of 0.25% bupivacaine and patients in Group 2 received wound site infiltration with 20 ml 0.25% bupivacaine as per the discretion of anaesthesiologist. Postoperative parameters like VAS score, time to first rescue analgesia, total analgesic consumption, adverse events and hemodynamic parameters were assessed.
Methods: Sixty patients who met the inclusion criteria posted for elective unilateral inguinal hernia surgeries were divided into two Groups Group1 received ultrasound guided TAP block with 20ml of 0.25% bupivacaine and Group 2 received wound site infiltration with 20 ml 0.25% bupivacaine. Postoperatively patients were shifted to post-operative ward and monitored for post-operative pain using VAS score at various postoperative intervals; 2, 4, 6, 12, 18, 24 hours and secondary parameters such as duration of analgesia, time to first rescue analgesia, total analgesic consumption and adverse events were also recorded.
Results: VAS scores recorded at various post-operative intervals, total analgesic consumption were significantly lower in USG-TAP block Group compared to WSI Group which was significant statistically. The mean time requirement for rescue analgesia was shorter in the WSI Group (3.67h) than the USG-TAP block (6.43h) and was statistically significant.

Laparoscopic surgery has now become the most accepted surgical and safe technique for a number of surgery including cholecystectomy , appendcectomy , etc .Advantages over open procedures include lesser haemorrhoage , better cosmetic results , lesser post operative pain and better results . To compare the analgesic effect of intraperitoneal application of  bupivacaine and bupivacaine with dexmedetomidine in laparoscopic cholecystectomy . To assess the quality of analgesia by visual  analgesia scale score (VAS).
Material and Method: This study was an interventional, prospective, double blind, parallel group, randomised clinical study conducted on patients undergoing laparoscopic cholecystectomy surgeries. Institutional Ethical Committee Approval was obtained and written informed consent was obtained from all the patients before the screening in the study. Total of 162 patients were selected in which 81 were randomly allocated in each group using table of randomisation. Study Duration Period 2 Sep 2020 To 2 March  2021.
Conclusion: Hence our study showed that intraperitoneal instillation of dexmedetomidine 1 µgm/kg in combination with bupivacaine 0.25% in elective laparoscopic cholecystectomy significantly reduces the post-operative pain and significantly reduces the analgesic requirement in post-operative period as compared to bupivacaine 0.25% alone.

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. 

As stated by Hippocrates - “Divine is the task to relieve pain”
Relief of pain during surgery is one of the components of balanced anaesthesia but this pain relief should be extended to the postoperative period also. According to Perkins and co-workers poorly managed acute pain like postoperative pain can lead to the occurrence of chronic pain.
Materials and Method: This clinical study was conducted on 156 adult patients of ASA physical status I to III in the age group of 18-60 years of either sex posted for elective lower abdominal or lower limb surgeries under spinal anaesthesia after taking informed consent at a tertiary hospital Vijayapur.
Results: Statistical tests used: anova, chi square test and tukey test.
Discussion: Spinal anaesthesia is currently wide spread popular anaesthetic technique available today. It has the definitive advantage that profound nerve block can be produced in a large part of the body by the relatively simple injection of a small amount of local anaesthetic.
Conclusion: Acute pain following surgical procedures is unique to the clinical practice of pain medicine. It is one of the few opportunities in which the cause of pain is known before its occurrence, the pain is reliably expected to occur and can be annulled effectively

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.

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

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

There are limited data available on comparing dexmedetomidine and fentanyl as adjuvant to Bupivacaine in brachial plexus block. Considering the low side effect and excellent postoperative analgesic efficacy of two drugs, it is essential to carry out a comparative evaluation of two drugs for their use with bupivacaine as adjuvant in patients undergoing upper limb surgeries which require supraclavicular brachial plexus block. Thus, the present work has been undertaken to study and compare the effect provided by dexmedetomidine and fentanyl as adjuvants to bupivacaine in supraclavicular block.
Material and Methods:  90 patients were divided into three groups; Group C (n=30): 0.5% bupivacaine hydrochloride 30ml, Group D (n=30): 0.5% bupivacaine hydrochloride 30ml and 1mcg/kg dexmedetomidine and Group F (n=30): 0.5% bupivacaine hydrochloride 30ml and 1mcg/kg fentanyl. After completion of injection; parameters (HR, RR, SBP, DBP, MAP, SpO2) were noted. Statistical analysis was performed using SPSS version 22.0 IBM. Parametric data was analysed using student t-test.
Results: Heart rates were similarly maintained in all the three groups across the time points as revealed by the insignificant p value at all the time points (p>0.05). Mean arterial pressure (MAP) was similarly maintained in all the three groups across the time points as revealed by the insignificant p value at all the time points (p>0.05). One incident of bradycardia was noted in Group F which was managed by giving Inj. Atropine 0.6mg; One patient complained of Dry mouth in Group D; One incidence of nausea was seen in Control group and Group F. Other side effects like hypotension, sedation, or itching were not noted in any of the groups in the present study.
Conclusion: The study showed no significant difference in heart rate and mean arterial pressure or any incidence of significant side effects seen with Fentanyl and Dexmeditomidine groups. Thus, we conclude that Dexmedetomidine is better than Fentanyl when added to Bupivacaine or Bupivacaine alone for use in nerve stimulator guided supraclavicular brachial plexus block without any significant complications

Background and Aim: Various adjuvant are being used with local anesthetics for prolongation of intra operative and postoperative analgesia. Dexmedetomidine, a highly selective alpha-2adrenergic agonist, has emerged as a valuable adjunct to regional anesthesia and analgesia. The study was aimed to compare the onset, duration of sensory and motor block, hemodynamic effects, post-operative analgesia, and adverse effects of dexmedetomidine and clonidine with bupivacaine for spinal anesthesia.
Material and Methods: Present study was conducted at GMERS Medical College and Hospital, Vadnagar, Gujarat for the duration of 2 years and 1 month. A total of 80 numbers of patients belonging to American Society of Anesthesiology (ASA) Grades 1 and 2 scheduled for gynecological surgery under subarachnoid block were enrolled after obtaining approval from the Hospital Ethics Committee. The patients were allocated in two groups (40 each). Group I bupivacaine + clonidine (B+C) received 17.5 mg of bupivacaine supplemented 45 mcg clonidine and Group II bupivacaine + dexmedetomidine (B+D) received 17.5 mg bupivacaine supplemented 5 mcg dexmedetomidine. The onset time of sensory and motor level, time to reach peak sensory and motor level, hemodynamic changes and side effects were recorded.
Results: Mean time of onset of sensory block in Group I and Group II were found to be 3.69±0.12 mins and 2.14±0.01 mins respectively (p>0.05). The onset of motor block in Group I was slightly less (3.99±0.44 mins) than Group II (4.24±0.80 mins), however, the difference was insignificant. Duration of sensory and motor block was significantly prolonged in group I as compared to group II (p<0.05) The duration of spinal anesthesia was shorter in group I as compared to group II (p<0.05)
Conclusion: The use of intrathecal dexmedetomidine as an adjuvant to bupivacaine seems to be an attractive alternative to clonidine for long duration gynecological surgical procedures due to its profound intrathecal anesthetic and analgesic properties combined with minimal side effects.

Epidural analgesia remains the gold standard for pain control for abdominal surgical procedures, yet have many potential side effects, risks and limitations. The idea of oblique subcostal transversus abdominis plane block (OSTAPB) and rectus sheath block (RSB) is to anesthetize part of or the entire abdominal wall instead of using intrathecal or epidural techniques, especially in the presence of sepsis and coagulopathy.
Materials and methods: 60 patients scheduled for midline incision abdominal surgeries were randomly assigned to receive ultrasound-guided RSB and OSTAPB blocks with 20ml 0.25% bupivacaine and 40ml 0.25% bupivacaine respectively on each side after induction with general anaesthesia and before start of surgery. Preoperative and intraoperative parameters, plus intraoperative and postoperative cumulative analgesic consumption were recorded. Both groups received intravenous paracetamol 15mg/kg 8 hourly. Postoperative pain severity was assessed using 10cm VAS score and time to request for rescue analgesia, total analgesic consumption in 24 h were recorded.
Results: Patients in the OSTAPB group had more stable hemodynamics and consumed statistically significant less opioid in comparison to RSB group either intraoperatively or postoperatively. Mean VAS scores were statistically significant less in OSTAPB group than in the RSB group at 0, 2, 6, 12, and 24 h postoperatively.  More patients’ satisfaction was reported in the OSTAPB Group.
Conclusion: Ultrasound-guided RSB and OSTAPB block is effective pain management technique for midline laparotomies in scenarios where epidural is contraindicated, has failed or in case of unexpected change in surgical plan and in patients with compromised physiology

Each patient was randomly assigned to one of the two groups of 30 patients each using random table. Group A Patients who received instillation of 20cc of 0.5% Bupivacaine diluted to 40cc with NS intraperitoneally, a total of 40cc. Group B patients who received instillation of 20cc Bupivacaine 0.5% diluted till 40cc with NS with Dexmedetomidine 50mcgs intraperitoneally, a total of 40cc. The patient was blind to the drug injected. All patients underwent thorough medical evaluation and routine lab investigations a day prior to surgery Result; In the present study mean age of Bupivacaine group was 26 and Bupivacaine with Dexmedetomidine study group was 25.65.There was statistically significant difference between two groups of patients in terms of pulse rate and , Systolic BP all the time.The mean VAS as per data, the gradual increase of the VAS scores is comparable, and showed statistical significance between two groups. Comparisons of pain between two groups by Visual Analogue Scale scores were statistically significant at all time point except 6,8 and 24 hour.This study also showed that Bupivacaine provided adequate analgesia for the first  1 to 2 hours when compared to Bupivacaine+Dexmed, which provided adequate analgesia for about 4 to 6 hours.  Conclusion: We concluded that the administration of the intraperitoneal local anaesthetic agent, Bupivacaine in combination with dexmedetomidine can effectively reduce the need for prescribing postoperative analgesic drugs as well as decrease postoperative pain severity in minimal surgery..

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: Ropivacaine, a newer long acting amide local anaesthetic and it has lesser side effects compared to Bupivacaine and is increasingly replacing Bupivacaine because of its similar analgesic profile and lesser cardiotoxicity. Tramadol hydrochloride is a weak centrally acting analgesic commonly used as adjuvant with local anaesthetic agents in epidural analgesia. Aims and objectives: The aim of this study was to compare the hemodynamic changes of 0.125% Bupivacaine with that of 0.125% Ropivacaine along with tramadol in patients undergoing intra abdominal surgery for post-operative analgesia. Material and Methods: Total 60 patients were taken scheduled for intra operative surgery ranging from 18-55 years in ASA grade I and II. They were randomly allocated to two groups of 30 each. Group R (n = 30) received an Epidural loading dose of 10ml 0.125% of Ropivacaine with 50mg tramadol. Group B (n =30) received an Epidural loading dose of 10ml 0.125% Bupivacaine with 50mg tramadol. Patients were assessed post-operatively every 15 min for heart rate, blood pressure, SPO2 for first hour and then after every 30 min till patient complained of pain. Result: Hemodynamically, patients in both the groups, were equally stable. Group-R (412 ± 46.56 min) was having much longer duration of post-operative analgesia as compared to Group-B (348 ± 48.31 min, p < 0.001). Conclusion: Ropivacaine and Bupivacaine shows a similar hemodynamic profile. Thus, Ropivacaine can be used as an alternative to Bupivacaine for postoperative pain relief through the epidural route in patients undergoing intra abdominal surgeries ,as a safe and effective agent

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.

Background: Benign prostatic hyperplasia (BPH) is the most frequent cause of lower urinary tract symptoms (LUTS) in the aging male. The present study compared intrathecal dexmedetomidine with low-dose bupivacaine spinal anaesthesia versus a higher dose of bupivacaine in patients undergoing transurethral resection of the prostate (TURP).
Materials & Methods: 60 male patients undergoing transurethral resection of the prostatewere divided into 2 groups of 30 each. Group I received 7.5 mg of 0.5% hyperbaric bupivacaine hydrochloride and group II received 3 µg of dexmedetomidine hydrochloride along with 6 mg of 0.5% hyperbaric bupivacaine hydrochloride. Parameters such as regression time from peak sensory block level, assessment of the motor block scales, haemodynamic alterations were recorded.
Results: Time to reach T10 sensory block was 12.6 minutes in group I and 10.2 minutes in group II. Modified Bromage score at the end of surgery 1 was seen in 7 in group I, 2 in 8 in group I and 17 in group II, 3 seen 15 in group I and 13 in group II. VAS score at 1 hours was 3.4 and 2.6, at 2 hours was 2.1 and 2.0, at 3 hours was 1.9 and 1.5 and at 4 hours was 1.1 and 1.3. The difference was significant (P< 0.05). Common side effects werenausea seen in 4 in group I and 3 in group II, vomiting 3 in group I and 2 in group II, pruritis 3 in group I and 1 in group II and hypotension 1 in group I and 2 in group II.
Conclusion: Authors found that addition of 3 µg of dexmedetomidine added to 6 mg bupivacaine resulted prolonged perioperative analgesia and a faster onset and longer duration of sensory and motor block.

Aim: The aim of the study is to compare post-operative analgesic efficacy of 0.25% bupivacaine vs 0.25% bupivacaine with dexmedetomidine in transversus abdominis plane block for postoperative caesarean section.
Methodology: Prospective randomized double blinded experimental study was conducted among 60 patients posted for elective caesarean section surgery and were divided into two equal groups. Group B patients received 20ml of 0.25% Bupivacaine and Group BD patients received 20ml of 0.25% Bupivacaine with 50 mcg Dexmedetomidine. Visual Analogue Score was used to determine the pain at rest during postoperative period. The time of requirement of rescue analgesia during postoperative period was also assessed.
Results: The demographic variables such as age and sex were comparable between the two groups.VAS at rest was significantly reduced in group BD (p<0.05). Duration of analgesia was significantly prolonged in group BD when compared to group B with significant P value <0.05. Rescue analgesic consumption in 24 hours during postoperative period was significantly decreased in group BD (p<0.05). Intraoperatively the heart rate, systolic and diastolic bp was comparable between both the groups. Postoperatively there was a significant fall in heart rate systolic and diastolic bp in the group BD when compared to group B with a P value <0.05.
Conclusion: In this study we observed that Dexmedetomidine, in combination with bupivacaine when given for TAP block provided excellent postoperative analgesia, extending upto more than 12 hours. Dexmedetomidine seems to decrease postoperative analgesic consumption and improve pain scores.

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

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.

Introduction: Femur fractures cause moderate to severe pain which requires effective analgesia both preoperatively and postoperatively, poor pain management can have serious physiological and psychological consequences.
Aim: To compare the postoperative analgesic efficacy between 0.25% Bupivacaine and 0.2% Ropivacaine in ultrasound guided fascia iliaca compartment block for femur surgeries under epidural anaesthesia.
Materials and Methodology: This is a randomized clinical study conducted at a tertiary care centre, after receiving approval from institute’s ethical committee. 60 patients posted for femur surgeries under epidural anesthesia were divided into groups of 30 each. Postoperatively ultrasound guided fascia iliaca block using 0.25% bupivacaine 20 ml for group B and 0.2% Ropivacaine 20 ml was given to group R and are compared. The time from fascia iliaca compartment block to first requirement of analgesia for both the groups calculated.
Results: Demographic characteristics and BMI are statistically similar between both the groups. The mean time for duration of analgesia for bupivacaine group was 307.83±34.43 minutes and that of Ropivacaine group was 262.67±31.39 minutes. So, the mean duration of post-operative analgesia of the Bupivacaine group was more than that of Ropivacaine group which was statistically significant. Both the groups maintained hemodynamic stability.
Conclusion: We observed that the postoperative analgesia was definitely of a longer duration with the Bupivacaine group when compared to Ropivacaine group. So, it is concluded that 0.25% Bupivacaine is better in providing prolonged satisfactory postoperative analgesia as compared to 0.2% Ropivacaine when both are used as postoperative analgesia.

Background: To compare the efficacy standards and clinical status of two α-2 agonists dexmedetomidine and clonidine as adjuvant to bupivacaine in undergoing surgical procedures of lower limb and infraumbilical region. To estimate adjuvants analgesic property that provides superior anaesthetizing properties with sedation, haemodynamic stability in neuraxial anaesthesia.

Introduction: The goal for postoperative pain management is to reduce or eliminate pain and discomfort with a minimum of side effects. Post-operative epidural analgesia provides better static and dynamic pain relief. Ropivacaine is less neuro and cardiotoxic when compared to Bupivacaine with minimal motor blockade thus facilitating early post-operative mobilization.
Aims and Objectives: To Compare Lumbar Epidural Analgesia using 0.25% Bupivacaine (10ml) and 0.2% Ropivacaine (10ml) for post-operative analgesia in abdominal surgeries.
Materials and Methods: A Randomized Comparative Study was conducted on Sixty (60) adult patients of either sex divided in to two equal groups with age group 20-65 years with physical status ASA I, II undergoing abdominal surgeries. At the end of surgery when the patient complained of pain Group B received 10ml of 0.25% bupivacaine and Group R received 10ml of 0.2% ropivacaine as post-operative analgesia.
Results: Both the group B (236.40 ± 29.55 minutes) and group R (244 ± 27.95 minutes) produced almost same duration of post-operative analgesia, but hemodynamic instability was seen with Group B (53.3% reported hypotension and 13.3% reported nausea) along with delay in recovery of motor activity.
Discussion: Group B shows statistical significance with Group R in (HR, SBP, DBP) in first 60 minutes required vasopressor. Group B shows statistical similarity with Group R (P value >0.05) in (HR, SBP, DBP) after 60 minutes, RR, SPO2, onset and duration of analgesia, VAS score, Patient satisfaction score. Group R has less complications than Group B, hence proves statistically significant (P value <0.05).
Conclusion: Post-operative analgesia with 0.2% Ropivacaine provides excellent pain relief with hemodynamic stability and early post-operative ambulation

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.

Introduction: The effective intrapartum analgesia greatly minimizes pain, stress, and anxiety which cause release of stress hormones as well as beta-endorphins. This this present study is followed to evaluate the effect of intrathecal labour analgesia on the progress of labour was compared between fentanyl 25μg alone and fentanyl 20μg plus bupivacaine 2.5mg. Materials and Methodology: Patients in the group SA (n = 33) were administered with an intrathecal injection of 0.5% hyperbaric bupivacaine 2.5 mg (0.5 mL) and fentanyl 25 µg (0.5 mL), volume made to 1.5 mL with normal saline. And the matching group C (n = 33) who refused to give consent for neuraxial analgesia. The two groups were evaluated with regards to the progress of labour, maternal hemodynamic variations, foetal heart rate, and neonatal outcome during labour in parturient undergoing normal vaginal delivery. Results: Parturient in group SA has gained excellent pain relief throughout their labour and VAS score remained less than 4 till delivery as compared to group C, in which VAS score was more than 7 at all time. There were no observed significant changes in FHR when compared to the baseline in both the groups and none had observed with the interventions of foetal compromise. The mode of delivery in all parturient in the study group was mostly vaginal delivery without any instrumental delivery. The parturient who required caesarean section due to other indication were excluded from the study. Conclusion: A a single dose of intrathecal fentanyl 25 μg and bupivacaine 25 mg which were given in the active phase of first stage of labour had rapid onset with satisfactory pain relief and minimal motor block, which completely regressed at the time of second stage of labour.

Background: Supraclavicular brachial plexus block is a commonly employed regional nerve block technique for upper extremity surgery. Various adjuvants were added to local anaesthetics in brachial plexus block to achieve rapid onset and prolonged block. To compare dexamethasone and dexmedetomidine as an adjuvant to local anaesthetic agent in supraclavicular brachial plexus block with respect to onset and duration of sensory and motor block and duration of blockade.
Material and Methods:Forty ASA I and II patients scheduled for elective upper limb surgeries under supraclavicular brachial plexus block were divided into two equal groups in a double- blinded fashion. Group one was given 0.25% Bupivacaine 2 milligram/kg as local anaesthetic and Dexmedetomidine 1microgram/kg as adjuvant. Group two was given 0.25% Bupivacaine 2 milligram/kg and Dexamethasone 100microgram/kg as adjuvant. Onset and duration of sensory and motor blockade and hemodynamic stability were recorded. All patients were observed for any side effects and complications. All data were recorded and statistical analysis was done.
Results: Sensory block and motor block onset was earlier in dexmedetomidine group.The duration of blockade was also prolonged in dexmedetomidine group when compared with dexamethasone group and is not associated with any major side-effect.
Conclusion: Dexmedetomidine is a better adjuvant than dexamethasone in supraclavicular brachial plexus block.

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- The Transversus Abdominis Plane (TAP) Block is a method used for regional anaesthesia. It offers analgesia during lower abdominal surgery, especially when parietal wall pain is a significant source of discomfort. Through the local anaesthetic deposition between the Transversus Abdominis muscle and internal oblique muscle, it permits sensory blockage of the lower abdominal wall's skin and muscles. In a hospital-based, prospective observational study we assessed the effectiveness of unilateral TAP Block with bupivacaine for postoperative analgesia in hernia repair.
Material & Methods - The following procedure was used on 100 patients having elective unilateral inguinal hernioplasty surgery: TAP Block with bupivacaine (n = 50 in the study group) and without TAP Block (n = 50 in the control group). At the conclusion of the spinal anesthesia-induced surgery, the study group underwent a unilateral TAP Block on the surgical side using 20 ml of 0.25% bupivacaine. In the post-anesthesia care unit, each patient was evaluated 30 minutes, 2, 4, 6, 12, 18, and 24 hours after surgery. The amount of time needed to administer the first dosage of rescue analgesia, the vas score, and the total amount of diclofenac used were evaluated in each group, and comparisons were made using a student t-test.
Result: The difference between the mean analgesia duration in the study group and control group—669.66± 346 min 220.33 ± 139.24 minutes, respectively—was shown to be statistically significant. The VAS score in the control group was consistently higher than in the study group. Diclofenac was consumed in a total dose of 95 mg in the study group and 202.5 mg in the control group, indicating a substantial decrease in diclofenac consumption in the study group.
Conclusions- When utilised in patients undergoing inguinal hernioplasty, TAP Block with 0.25% bupivacaine offered powerful and longer duration of analgesia, with little any need for diclofenac. There were no side effects linked to TAP Block or the medications being tested

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

Introduction: The regional anaesthesia for cataract surgery is associated with lesser respiratory and hemodynamic events and quick recovery of function than general anaesthesia.

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.

Background : Laparoscopic [LC] surgeries or minimally invasive surgeries are associated
with lesser parietal pain and haemorrhage, compared to the open surgeries. However visceral
pain persists. The effect of volume and concentration on intra-peritoneal instillation of local
anaesthetics for pain relief has not been studied . In this study we have compared the intraperitoneal
instillation of local anaesthetic with transversus abdominis plane block (TAP).
This study is aimed at assessing the superiority of effect of volume of local anaesthetic
instilled intra-peritoneally versus TAP block on post-operative pain relief in laparoscopic
cholecystectomy.

Background: Caudal blocks have been shown to reliably block dermatomes below the level of the umbilicus (T10–S5) in children <20 kg (∼6 yr of age).  Caudal epidural anaesthesia involves accessing the epidural space through the sacrococcygeal ligament via the sacral hiatus at the base of the sacrum. The aim of this study was to compare the effects of ropivacaine and bupivacaine for caudal anaesthesia in children undergoing lower abdominal surgery.
Methods: After the hospital ethics committee approval, 60 (ASA I–II) children scheduled for lower abdominal surgery were included in this study. The group A (n=30) patients received ropivacaine 0.25% and group B (n = 30) patients received bupivacaine 0.25% via the caudal route. In this study we assessed demographic and clinical characteristics, AIIMS pain score at 1, 2, 4, 8, 12, 16 and 24 hours after operation and level of residual motor block (Modified Bromage Scale) immediately after surgery and at 1, 2 and 3 hours post operatively.
Results: There were no statistically significant differences in AIIMS pain scores between groups A and B at all postoperative time points – 1hr, 2hr, 4hr, 8hr, 12hr, 16hr and 24hr (P < 0.00001). The quality and duration of analgesia were comparable in both the groups. However, degree of motor block was significantly less in the ropivacaine group. After 3 hours there was no significant difference in the level of residual motor block.
Conclusion: The single shot caudal epidural block with 1ml/kg ropivacaine 0.25% is a safe and effective, long lasting dose for postoperative analgesia in paediatric lower abdominal surgery, producing less duration of motor block than bupivacaine 0.25%.

The development of breast cancer in many women appears to be related to female reproductive hormones, particularly endogenous estrogens. Early age at menarche, nulliparity or late age at first full-term pregnancy, and late age at menopause increase the risk of developing breast cancer. In postmenopausal women, obesity and postmenopausal hormone replacement therapy (HRT), both of which are positively correlated with plasma estrogen levels and plasma estradiol levels, are associated with increased breast cancer risk. Most hormonal risk factors have a relative risk (RR) of ≤2 for breast cancer development. The elective Modified Radical Mastectomy procedure was done in standard fashion. Patients in group A (Study group) received intraoperatively instillation of 0.5% bupivacaine into operative bed at the end of surgery. Patients in group B (Placebo group) received intraoperative instillation of normal saline into the operative bed at the end of surgery position. Approval from the ethical committee of the institution was obtained. All the patients were explained about the basis of the study and informed consent were obtained. Patients who received bupivacaine had longer postoperative analgesia when compared with normal saline group.

Background:Transversus abdominis plane (TAP) block is a well-established analgesic
technique for postoperative analgesia in abdominal surgeries.In our study, we
compared the analgesic efficacy of adjuvant fentanyl and tramadol with Bupivacaine in
TAP block following percutaneous nephrolithotomy.
Methods:In this randomized, prospective, controlled study, 90 patients of ASA grade I
and II were divided into three groups; Group A, Group B, and Group C. Surgical
procedure was done under spinal anesthesia.At the end of surgery, we introduced TAP
block unilaterally in the triangle of petit by feeling two pop technique. Group A
received 28 ml of 0.25% bupivacaine with 50 μg of Fentanyl;1 ml normal saline was
added to make total 30 ml, Group B received 28 ml of 0.25% bupivacaine with 100 mg
of tramadol (2ml), and Group C received 28 ml of 0.25% bupivacaine with 2 ml of
normal saline. The primary outcome wasduration of analgesia (time to first rescue
analgesia) and the secondary outcomes were total dose of rescue analgesics and visual
analog scale (VAS) score recorded at 0,2,6,4,8,12, and 24 hr. If VAS score >4 or patient
complained of pain, then injection diclofenac 75mg intravenous was given as rescue
analgesic.
Results:Duration of analgesia was higher with fentanyl than tramadol & normal saline.
It was 7.01±0.176 hrs., 4.89±0.713 hrs. and 3.01±0.125 hrs. respectively with fentanyl,
tramadol, and normal saline. The total dose of rescue analgesic was lower with fentanyl
than tramadol and higher with normal saline. VAS score was also lower with fentanyl in
comparison to tramadol and normal saline.
Conclusion:Postoperatively many adjuvants were added in TAP block to improve the
quality of analgesia but fentanyl prolonged the postoperative analgesia effectively in
comparison to tramadol or plain TAP block.

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: Pain has already been accepted as the sixth vital sign. Hence, attenuation of pain and alleviation of human suffering is of paramount importance in respect to the service provided by anaesthesiologists, for whom the patients submit a virtual suicidal note in the form of expressed consent. Hence, the importance of the study is self-explanatory.
Objective: The purpose of this study was to clinically evaluate the efficacy of post-operative analgesia with epidural Bupivacaine with Butorphanol, Bupivacaine with Fentanyl and Bupivacaine with Nalbuphine.
Material & Method: 75 patients belonging to ASA Ι and ΙΙ, undergoing lower abdominal surgeries were divided into three groups.
Group A: 0.125% bupivacaine + 2 mg butorphanol.
Group B: 0.125% bupivacaine + 100 mcg. Fentanyl.
Group C: 0.125% bupivacaine + 10 mg Nalbuphine Under all aseptic conditions patients were given epidural block with loss of resistance technique.
Results & Conclusion: Conclusions are drawn from the Study: Opioid analgesics with local anesthetics are extremely safe, effective and reliable method of postoperative pain relief. Fentanyl produces faster onset of analgesia with fewer adverse effects like sedation, pruritus, and nausea and vomiting than butorphanol and nalbuphine when given epidurally along with 0.125% bupivacaine. Butorphanol administered epidurally has advantage of longer duration of analgesia than fentanyl or epidural nalbuphine with side effects like nausea vomiting and sedation.

Aim: To evaluate the efficacy of the combination of intrathecal bupivacaine 0.5% heavy + fentanyl (0.5 microgram/kg) versus intrathecal bupivacaine 0.5% heavy + buprenorphine (2 microgram/kg) in lower abdominal and lower limb surgeries.
Materials and Methods: A total of 80 patients who underwent lower abdominal and lower limb surgeries were taken up for the study. Patients were randomised into two groups each. Patients allotted with odd numbers were in GROUP F: Bupivacaine +Fentanyl group (n=40) and patients allotted with even numbers were in GROUP B: Bupivacaine + Buprenorphine group (n=40). Group F received 3ml, 0.5% hyperbaric bupivacaine + Fentanyl (0.5mcg/Kg), Group B received 3ml, 0.5% hyperbaric bupivacaine + Buprenorphine (2mcg/Kg).
Results: In the current study, onset of analgesia was significantly earlier due to the addition of buprenorphine. This may be attributed to high lipid solubility and highest affinity for opiate receptors of buprenorphine. Both the groups had the same mean time to achieve motor blockade. Both groups maintained hemodynamic stability which was statistically insignificant. The mean duration of effective analgesia in Group A and group B found significant statistically (p<0.01).
Conclusion: We observed that anaesthesia was superior when buprenorphine is mixed with bupivacaine (0.5%) as compared to bupivacaine with fentanyl. Addition of buprenorphine to bupivacaine 0.5% augments the sensory blockade of local anaesthetics without affecting the sympathetic activity. Thus, it is concluded that intrathecal buprenorphine is suitable drug for post-operative analgesia for caesarean section.

Introduction: Pain is the fifth vital sign and a critical focus of the anaesthesiologist. Pain
is perhaps elaborated as an unpleasant sensory and emotional experience associated
with actual or potential tissue damage. Acute post operative pain is a complex
physiological reaction to tissue-injury, visceral distension or disease. It is manifested by
autonomic, psychological and behavioural responses that result in patient specific
unpleasant, unwanted sensory and subjective emotional experience. Postoperative pain
leads to delayed mobilization and its associated complications. With the development of
an expanding awareness of the epidemiology and pathophysiology of pain, more
attention is focused on the multimodal management of pain to improve the quality of
pain relief, augment functionality, leading to early mobilization, and reduce
physiological and emotional morbidity. Hence the present study was done at our
tertiary care centre to compare the effectiveness of intrathecal neostigmine (50 mcg)
combined with 0.5 % bupivacaine (Hyperbaric) with 0.5 % bupivacaine (Hyperbaric)
alone in spinal anaesthesia for infra umbilical surgeries.

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.

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.

Caesarean sections are routinely done under spinal anaesthesia using 0.5% hyperbaric bupivacaine that has a long duration of action. As most of the caesarean sections are of short duration, we decided to compare 1% 2-chloroprocaine with routinely used bupivacaine as chloroprocaine has rapid onset of action, producing an excellent sensory and motor blockade. After ethical committee clearance and informed written consent, 70 uncomplicated singleton parturients of ASA I and II posted for elective caesarean section were randomised into chloroprocaine (CP) and bupivacaine (B) group of 35 each.
Onset of sensory block in group CP was 1.71±0.62min and in group B was 2.31±0.63min. Onset of motor block in group CP was 2.54±0.88min and in group B was 2.66±0.76min. Mean time for maximum sensory block in group CP was 12.77±3.52min and in group B was 22.34±6.46min and time for maximum motor block in group CP was 9.14±2.23min and in group B was 10.86±2.18min. Two segment regression time in group CP was 39.34±4.46min and in group B was 63.14±4.7min. Mean duration of sensory block in group CP was 2.08±0.25hr and in group B was 3.60±0.27hr and duration of motor block in group CP was 1.07±0.14hr and in group B was 3.42±0.41hr. VAS scores in first 6hrs were lesser in group CP than group B. Onset, maximum time, duration of sensory and motor block were lower in group CP than group B. hemodynamic parameters were comparable between the groups with no side effects.

For decades, lignocaine was the local anaesthetic of choice for spinal anaesthesia in ambulatory surgeries. Its advantages are rapid onset of action and good motor block manifested as good muscle relaxation. Its use has become limited because of transient neurologic symptoms and cauda equina syndrome following intrathecal injection. After obtaining the approval of scientific, ethics committee and written informed consent, a total of 100 patients undergoing elective lower limb surgeries under spinal anaesthesia were selected. Patients were explained before operative procedure. Pre-anaesthetic check- up was carried out preoperatively with a detailed history, general physical examination and systemic examination. Airway assessment and spinal column examination was done. In the present study it was observed that there was a statistically difference in the bromage score between groups, score 2 was significantly higher in group II, score 3 was significantly higher in group I p < 0.05. In the present study it was observed that Mean time (in minutes) to pass urine was significantly lower in group I than compared to group II p <0.05.

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.

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.

Low back pain is the most common problem among chronic pain disorders in middle aged population. Epidural Steroid Injection (ESI) is one of the most commonly performed non-surgical interventions 1. Objective of study is to compare the efficacy of epidural steroid injection with & without Bupivacaine for low backache patients.
Materials and Method: Two groups of 12 selected patients with chronic low backache were randomized for midline Inter laminar Epidural injection with 80 mg Methylprednisolone acetate with saline and Methylprednisolone acetate 80mg with 0.25% Bupivacaine. All patients received 3 injections at intervals of 2 weeks. They were assessed for degree and duration of analgesia (VAS) and any adverse effects.
Results: Onset of pain relief was less in adjuvant group when compared to non-adjuvant group after ESI. VAS at the end of 6 weeks in both groups was almost same in both groups. There were no significant adverse effects.
Conclusion: Epidural Steroid Injections significantly reduce radicular pain more with Bupivacaine.

Background: The aim of the study was to compare multi-modal approach with Tramadol suppository
and Ultrasound guided Transversus Abdominis Plane (TAP) Block with Bupivacaine versus Tramadol
suppository alone in providing adequate post-operative analgesia after Caesarean section.
Method: 158 patients, aged between 18 to 40 years with ASA physical status I-II scheduled for elective
caesarean surgery, were enrolled in this prospective randomized comparative study. 79 patients (of Group
A) were given Ultrasound guided Transversus Abdominis Plane Block with Bupivacaine and Tramadol
suppository as post-operative analgesia. The remaining patients were given only tramadol suppository as
post-operative analgesic (Group B). They were observed for 12 hours or till the patient requested for
rescue analgesic. Pain (VAS score), satisfaction (Likert scale), sedation (Four-point sedation scale),
nausea & vomiting (PONV Impact scale) and adverse effects at 3hours, 6hours, 9hours and 12hours postoperatively
were observed and compared in both the study groups.
Results: Both groups were comparable in demographic data. There was a statistically significant
difference between the VAS scores and satisfaction scores with a p < 0.001 between the two groups. No
statistically significant differences in the sedation, PONV or adverse effects were found between the two
groups. In our study, Group A patients who received ultrasound guided TAP block remained painless for
longer period (23hours) than Group B (6.5hours).
Conclusion: In conclusion, our study suggests that Ultrasound guided TAP block significantly improved
postoperative analgesia in women undergoing Caesarean delivery patients.

Spinal anesthesia can be performed with a wide range of local anesthetic drugs. using local anesthetics alone is associated with a relatively short duration of action.1 Postoperative pain control is a major problem with spinal anesthesia using local anesthetics alone, and thus early analgesic intervention is needed in the postoperative period. Bupivacaine is the local anesthetic most commonly used, although lidocaine, tetracaine, procaine, ropivacaine, levobupivacaine, and prilocaine may also be used. After institutional ethical committee approval, 90 patients aged between 18-60 years undergoing lower abdominal and lower limb surgeries were selected. A detailed history, complete physical examination, and investigations were done for all patients. Informed consent was taken. The study population was divided into 3 groups with 30 patients in each group. The study has demonstrated that increasing the dose of buprenorphine with 0.5% bupivacaine in spinal anesthesia significantly decreases the time of onset of sensory and motor block and prolongs the duration of sensory, motor blockade. The requirement of postoperative rescue analgesia is also decreased as the dose increased.

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.

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: Stress factors in the operation room and block level mismatch with
surgical area may contribute to discomfort, anxiety and restlessness in patients under
spinal anaesthesia. Sedation is a valuable tool to provide general comfort for the patient.
It usually provides freedom from specific discomfort and can impose some amount of
amnesia for the block procedure and surgical procedure. Thus, legal use of sedation can
make these surgeries under spinal anaesthesia more comfortable for the patient, the
surgeon and the anaesthetist. Therefore, it can enhance the patient's acceptance of
regional anaesthetic technique. Spinal anaesthesia itself can impart some sedative
effects.Spinal subarachnoid block is one of the most versatile regional anaesthetic
techniques available these days. Regional anaesthesia usually offers several advantages
over general anaesthesia—blunts stress response to surgery, decreases intraoperative
blood loss, lowers the incidence of postoperative thromboembolic events and provides
analgesia in early postoperative period. Subarachnoid block provides profound
anaesthesia for patients undergoing infraumbilical surgery.

Background and Objectives: Patients undergoing forearm surgeries have benefited considerably with the widespread use of brachial plexus block instead of general anaesthesia. This study was conducted to investigate the efficacy of 0.75% Ropivacaine in supraclavicular brachial plexus block and to compare the results with 0.5% bupivacaine, which is already established as local anaesthetic for regional anaesthesia.
Methods: Sixty patients of ASA-I and II consenting adult patients undergoing elective upper limb surgeries were randomly divided into Group A and Group B. Group A received 30 ml of 0.5% Bupivacaine and Group B received 0.75% Ropivacaine in supraclavicular block after authenticating the position of brachial plexus with nerve stimulator. Patients were monitored for peak onset and duration of sensory and motor blockade and post-operative analgesia using visual analogue scale. Patients were also observed for any complications during the surgery and in the postoperative period. Sensory and motor block peak and duration of analgesia were evaluated statistically using unpaired t-test and p-value <0.05 was considered significant.
Results: There were no significant differences between the study groups with respect to pattern of changes in Heart rate, Systolic blood pressure, Diastolic blood pressure, Mean arterial pressure perioperatively.
Peak sensory blockade was attained faster in Group B (Ropivacaine) i.e. 13.10 ±2.5 minutes compared to Group A (Bupivacaine) i.e. 23.33 ±3.1 minutes which is statistically significant. Duration of sensory blockade was also longer in Group B (Ropivacaine) i.e. 720.66 ±38.09 minutes compared to Group A (Bupivacaine) i.e. 672.66 ±105.95 minutes and is statistically significant. Onset of Motor blockade was faster in Group B (Ropivacaine) i.e. 18.03 ±2.4 minutes compared to Group A (Bupivacaine) i.e. 24.76±3.1 minutes which is statistically significant. Duration of Motor blockade in Group A (Bupivacaine) was 637.100 ±88.72 minutes compared to Group B (Ropivacaine) i.e. 646.17 ±38.07 minutes and is statistically
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not significant. Also, the time for demand of rescue analgesics was prolonged in Group B (Ropivacaine) i.e. 752.66 ±40.33 minutes compared to Group A (Bupivacaine) i.e. 694.56 ±106.14 minutes and this difference is statistically significant.
Conclusion: Ropivacaine 0.75% has an added advantage over Bupivacaine 0.5% for Supraclavicular Brachial Plexus block in terms of early onset of sensory and motor blockade, prolonged duration of sensory blockade, and prolonged duration of analgesia leading to lesser requirement of rescue analgesic. The side effects and complications rate are almost negligible in both groups. Thus Ropivacaine even at higher concentrations of 0.75% and 30 ml volume has proven to be an absolutely safe local anaesthetic. So on the basis of our study we conclude that Ropivacaine 0.75% is an excellent choice for local anaesthetic, which provides better and safer regional anaesthesia.

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.

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.

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.

Background and Objectives: Adjuncts to local anaesthetics for brachial plexus block enhances the
quality and duration of analgesia. The purpose of this study was to compare the effects of
dexmedetomidine, when added as adjuvant to bupivacaine, in respect to onset, duration of sensory and
motor block along with duration of analgesia.
Materials and Methods: After informed consent, 60 ASA I and II patients scheduled for
elective/emergency upper limb surgeries under supraclavicular brachial plexus block (under ultrasound
guidance) was randomized were divided into two equal groups-Group A & B. Group A-received
bupivacaine 28 ml (0.25%) & dexmedetomidine 1μg/kg, and Group B-received bupivacaine 28 ml
(0.25%) & 2ml normal saline. Onset and duration of sensory and motor block, duration of analgesia were
studied in both the groups.
Results: Both groups were comparable with regard to age, sex distribution & duration of surgery. There
was no statistically significant difference. Onset of sensory and motor blockade was 9.2±1.6min
and12.8±1.6mins, respectively in group A, while it was 17.7±2.6min and 23.5±1.7min respectively in
Group B, which (p value˂0.001) is statistically significant. Duration of sensory block and motor block
was 648±49.1min 600.2±45.9min, respectively, in group A, while it was 250.5±26.8min and
206.0±19.0min respectively, in group B, which (p value˂0.001) is statistically significant. The duration
of analgesia in group A was 720.8±44.2 min, while in group B, it was 268.9± 23.1min which (p
value˂0.001), is also significant. There were no adverse events noted in either group. All patients were
haemodynamically stable.
Conclusion: Dexmedetomidine when added to bupivacaine in supraclavicular brachial plexus block had
faster onset, greater duration of sensory and motor block and also longer the duration of analgesia, than
in bupivacaine alone.

Background: Caudal epidural anaesthesia blocks dermatomes below the level of the umbilicus  in children.
Objectives:This study intends to compareropivacaine and bupivacaine for caudal anaesthesia in children undergoing lower abdominal surgery.
Materials and methods: After the hospital ethics committee approval, 60 (ASA I–II) children scheduled for lower abdominal surgery were included in this study. Group A (n=30) patients received ropivacaine 0.25% and group B (n = 30) patients received bupivacaine 0.25% via the caudal route. We assessed the demographic and clinical characteristics, AIIMS pain score at 1, 2, 4, 8, 12, 16 and 24 hours after operation and level of residual motor block (Bromage Scale)immediately after surgery and at 1, 2 and 3 hours post operatively.Data analysis was performed using one way ANOVA test.P value less than 0.05 was considered significant.
Results and conclusion: There were no statistically significant differences in AIIMS pain scores between groups A and B at all postoperative time points –1hr, 2hr, 4hr, 8hr, 12hr, 16hr and 24hr(P < 0.00001). The quality and duration of analgesia were comparable in both the groups. However, degree of motor block was significantly less in the ropivacaine group. After 3 hours there was no significant difference in the level of residual motor block.
The single shot caudal epidural block with 1ml/kg ropivacaine 0.25% is a safe and effective, long lasting dose for postoperative analgesia in paediatric lower abdominal surgery, producing less duration of motor block than bupivacaine 0.25%.

The lipophilic portion is essential for anaesthetic activity and therapeutically useful local anaesthetics require a delicate balance between lipid solubility and water solubility. Addition of a butyl group to the Piperidine nitrogen of Mepivacaine results in bupivacaine, which is 35 times more lipid soluble and has a potency and duration of action three to four times that of Mepivacaine. Inclusion criteria were American Society of Anaesthesiologists (ASA) physical status I or II, either sex, age 18-60 years, presenting for lower limb surgeries. Exclusion criteria were patient allergic to drug, heart block/dysrhythmia. Hundred slips were made in such a manner that fifty slips had Group 1 written on it and the other fifty had Group 2. In the present study it was observed that there was no statistically significant difference in distribution of patients based on ASA grade in between the two groups p >0.05. In the present study it was observed that there was there no statistically significant difference in adverse events in between group.

Background: The supraclavicular approach to brachial plexus block is the most common peripheral nerve block technique used for upper limb surgeries. Aim of the present study was to evaluate and compare the efficacy of clonidine and dexmedetomidine as an adjuvant to 0.25% bupivacaine in peripheral nerve stimulator guided supraclavicular brachial plexus block in upper limb surgery.
Method: Total 80 patients of ASA grade I and II, age between 25-55 years were enrolled in the study and divided into two groups of 40 each. Group C received 39ml bupivacaine 0.25% (2.5mg/ml) + 1ml clonidine (1µg/ml) and group D received 39ml bupivacaine 0.25% (2.5mg/ml) + 1ml dexmedetomidine (1µg/ml). Parameters were observed include hemodynamic stability, onset time and duration of sensory and motor blockade, duration of analgesia and complications.
Results: Onset of sensory (2.32±1.16min) and motor blockade (5.55±1.50min) was earlier in dexmedetomidine group compared to clonidine group (sensory= 6.52±0.71min and motor= 11.65±1.05min), (p<0.0001). Duration of sensory blockade was 427.75±19.14 minutes in dexmedetomidine group and 226.0±11.72 minutes with clonidine group. Duration of motor blockade was 486.50±28.96 minutes with dexmedetomidine group and 275.25±17.53 minutes with clonidine group. However, the duration of analgesia was 588.25±28.27 minutes with dexmedetomidine group and 341.00±27.34 minutes with clonidine group. Hemodynamic parameters and side effects were comparable between the two drugs.
Conclusion: Dexmedetomidine shortens the onset, prolongs the duration of sensory and motor block, and also provides longer postoperative analgesia as compared with clonidine when used as an adjuvant to bupivacaine in peripheral nerve stimulator guided supraclavicular brachial plexus block.

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.

Background and Aims: Postoperative pain remains the most important cause of morbidity. Thus, a good postoperative analgesia is required but at the same time any untoward complication is to be avoided as patient is in a ward setting which is not a continuous monitoring setting always. Epidural local anaesthetics with good safety profile remain a safe modality in such settings. Our aim is to compare the efficacy, haemodynamics and side effects of Epidural 0.2%Ropivacaine versus 0.2%Bupivacaine for post-operative analgesia in abdominal surgeries.  
Materials and Methods: A comparative study of 80 patients undergoing elective abdominal surgeries were allocated into two groups using Computer generated randomization. Postoperatively, one group received epidural Bupivacaine 0.2%, upto10cc and other received ropivacaine 0.2% 10cc. Pre-emptive epidural analgesia in the form of Bupivacaine/Ropivacaine administered at the time of closure and duration of analgesia was taken from time of extubation till analgesic is asked for the first-time post operatively.  Rescue analgesia administered in the form of epidural Bupivacaine or Ropivacaine in the respective groups. Assessment done by a blinded anesthesiologist. Statistical analysis done using SPSS software version 20 and Epi Info 7.2.1.
Result: Though both the drugs maintained a comparable hemodynamic profile, there was better patient comfort at rest in ropivacaine group with lower VAS scores and lesser demand for rescue analgesia. Significantly higher number of adverse effects were found in bupivacaine group (n=36) as compared to ropivacaine group (n=6), specifically, fall in blood pressure and motor deficit.
Conclusion- Ropivacaine provided better post-operative analgesia as patients required lesser amount of rescue analgesia as well as mean time was comparatively longer for the first top up in comparison to Bupivacaine. Ropivacaine was also found to have a better safety profile alongwith distinct motor sensory differentiation

Lower abdominal surgeries are usually performed under subarachnoid block, also called spinal anesthesia. The drug which is routinely used for spinal anesthesia is 0.5% hyperbaric Bupivacaine. Addition of adjuvants to the hyperbaric Bupivacaine helps in prolonging the duration of anesthesia and provides better and prolonged post-operative analgesia.
Materials and Methods: This study was done on 100 ASA 1 & 2 patients between 18 and 70 years who underwent various lower abdominal surgeries at our hospital. Patients were divided into two groups, Group I were given 0.5% hyperbaric Bupivacaine and Group II were given 0.5% hyperbaric Bupivacaine along with 60 mcg Buprenorphine in the intrathecal space.
Results: The onset of sensory blockade was significantly earlier in patients in group I, while the duration of analgesia was significantly longer in group II, 426 ± 41.17 minutes as compared to 203.49 ± 41.35 minutes in group I. More than 80% patients in group II had mild post-operative pain only after 8 hours, whereas patients in group I started having moderate to severe pain after 4 hours. About 15% patients in group II experienced nausea, vomiting and drowsiness.
Conclusion: Buprenorphine is an effective adjuvant to provide prolonged post-operative analgesia with minimal hemodynamic changes and minor side effects

Background:Aim: To evaluate and compare the following factors in two groups –
intrathecal dexmedetomidine and intrathecal buprenorphine as an adjuvant to 0.5%
hyperbaric bupivacaine for lower abdominal surgeries and lower limb surgeries.
Materials and Methods: A clinical study was undertaken to compare the effects of
intrathecal Buprenorphine and dexmedetomidine as additives to 0.5 % hyperbaric
bupivacaine for spinal anaesthesia. This prospective, randomized, Double blind study
was conducted on 60 adult patients of ASA physical status 1 and 2 in the age group of
18 to 60 years, posted for elective lower abdominal surgeries at Osmania Medical
college Hospital, Hyderabad from the period 2017 – 2020. Patients were randomly
allocated into two groups namely, Group BB and Group BD of 30 each. Patients in
Group BB received 60mcg of Buprenorphine with 0.5% bupivacaine 15mg
intrathecally. Patients in Group BD received 5mcg of Dexmedetomidine with 0.5%
bupivacaine 15mg intrathecally. After connecting monitors, the required preloading
done to all patients. Subarachnoid block was carried out under aseptic precautions.
Pulse rate, respiratory rate, arterial blood pressure and oxygen saturation were
recorded at 0, 2, 5 minutes and thereafter every 10 minutes up to 90 minutes
intraoperatively.
Results: The following parameters were observed - onset and duration of sensory block
and motor block, time for sensory regression to S1, degree of sedation, hemodynamic
stability and any side effects associated with these drugs. Collected data were analysed
using appropriate statistics. Demographic datas were not statistically significant. The
onsets of sensory and motor blockades were not statistically significant. The duration of
sensory blockade was prolonged in dexmedetomidine group (51%) compared to
buprenorphine group. The Motor blockade, sensory regression to S1 were also got
prolonged in Dexmedetomidine group Hemodynamic parameters were comparable
between the groups. In our study The onsets of sensory and motor blockades were not
statistically significance between the groups. The duration of both sensory and motor
blockades were prolonged in dexmedetomidine group compared to buprenorphine
group with the best statistical significance. Both groups had stable and comparable
hemo dynamics during the study. Compared to buprenorphine, intrathecal
administration of dexmedetomidine as additive to hyperbaric bupivacaine was
associated with fewer side effects.
Conclusion: Our study concludes that dexmedetomidine as an adjuvant to intrathecal
bupivacaine prolongs both sensory and motor block duration with fewer side effects
compared to buprenophine.

Background:Brachial plexus block is a regional technique commonly employed for upper limb
surgeries. The present study was conducted to assess effectiveness of bupivacaine versus
levobupivacaine in supraclavicular brachial plexus block.
Materials & Methods:70 patients of ASA I & II status were given brachial plexus block by
supraclavicular approach for various upper limb surgeries of both genders. Group I patients
received bupivacaine and group B received levobupivacaine. Onset and duration of sensory
and motor block was recorded. Duration of analgesia was considered as the time taken to
reach an NRS score of 3.
Results: ASA grade I was seen in 25 in group I and 18 in group II and II in 10 in group I and
17 in group II. The mean age was 35.4 years in group I and 35.1 years in group II and weight
was 61.2 Kgs in group I and 62.7 Kgs in group II. The mean onset of sensory block was 12.8
minutes in group I and 10.1 minutes in group II, onset of motor block was 14.9 minutes in
group I and 11.3 minutes in group II, duration of sensory block (minutes) was 812.8 minutes
in group I and 1024.6 minutes in group II, duration of motor block (minutes) was 926.2
minutes in group I and 1156.4 minutes in group II and duration of analgesia (minutes) was
910.2 minutes in group I and 1058.0 minutes in group II. The difference was significant (P<
0.05).
Conclusion: Levobupivacaine has a faster onset of both sensory and motor blockade as
compared to bupivacaine.

The brachial plexus is enveloped by a fascial sheath, formed by prevertebral and scalene
fascia, extending from the intervertebral foramina to the upper arm. The foramina of a sheath,
at any anatomical point, will allow for the spread of local anaesthetics and subsequent
blockade. Each approach to the brachial plexus impacts specific anatomical areas of the upper
extremity. Patients were kept Nil per orally for 6 hours before the time of surgery and on the
previous night premedicated with Diazepam 5 mg and Ranitidine 150mg. 60 patients ASA I
and ASA II were randomly allocated with sealed envelope method into two different groups
of 30 each. Both observer and participant were blinded. GROUP A- received (n=30) 25 ml of
0.5% bupivacaine, GROUP B-received (n=30) 25 ml of 0.5% ropivacaine. There was no
statistically significant difference in heart rate between both groups (p>0.05). There is no
significant difference of heart rate clinically.

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.

Introduction: Adequate pain control remains a major challenge after ambulatory surgery. Midazolam as adjunct to local anaesthetics in caudal epidural analgesia has been found effective with minimal adverse effects.
Objective: The study was carried out to evaluate the analgesic efficacy of caudal bupivacaine and midazolam in children undergoing genitourinary surgeryfor post operative analgesia and to study the side effects and complications of bupivacaine and midazolam.
Subjects and methods: Sixty children, aged2-12 were randomly selected from routine cases of pediatric genitourinary surgery in NSCB Medical college and Hospital, Jabalpur.Group B receive 0.25% bupivacaine 0.5ml/kg [n=30] and group BM receive combination of 0.25% bupivacaine 0.5ml/kg with 50 microgm/kg midazolam[n=30].Throughout the study period heart rate,arterial BP, respiratory rate were monitored. Postoperative pain was assessed by MODIFIED TODDLER PRESCHOOLER POST OPERATIVE PAIN SCALE [TPPPS].Rescue analgesia was given when pain score was 4 or more than 4. Sedation was evaluated by four point sedation score.
Results: Lowest pain score were observed in BM group. The mean duration of postoperative analgesia in group  B was 7.6+1.5hrs and in group BM was 10.43+0.95 hrs’ which was statistically significant[p<0.05]. There was no significant changes in HR,BP and respiratory rate in both groups. The incidence of nausea and vomiting were equal in both groups. No respiratory depression,motor paralysis or urinary retention in both groups during the period of study.
Conclusion- Caudal administration of bupivacaine , midazolam mixture prolongs postoperative analgesia compare to bupivacaine alone without causing any adverse effects and complications.