European Journal of Molecular & Clinical Medicine

Delivery by caesarean section has become very common nowadays.Lower segment caesarean sections (LSCS) are now commonly performed using spinal anaesthesia. In parturients, hypotension is aggravated by compression of the inferior vena cava by gravid uterus. Its incidence has been reported as high as 40-70% and affects 90% women. For reducing the severity of maternal hypotension, many pharmacological and non-pharmacological methods are employed.
Glycopyrrolate,an anticholinergic drug with a quaternary amine structure that limits its ability to cross the blood-brain barrier and placenta and therefore has no effect on the variability of foetal heart rate (FHR) and maternal heart rate (HR).During spinal anaesthesia glycopyrrolate is expected to attenuate hemodynamic changes which makes it a popular choice for obstetric patients.

Background: Femur fracture is a common orthopaedic injury that causes a lot of pain and distress to the patients as the periosteum is more sensitive to pain. Proper positioning while giving neuraxial block is important but pain due to overriding of fractured bone ends makes it difficult. Over the years various techniques, drugs and blocks have been studied to reduce this discomfort and make patients more comfortable during positioning. Our study compares efficacy of Fascia Iliaca Compartment Block & intravenous Ketorolac during positioning for subarachnoid block in femur fracture patients.
Method: Prospective double blinded randomized control trial, n=60 patients; computer-based allocation into Group FICB (n=30)- Fascia Iliaca Compartment Block, landmark technique with 20 ml of 0.25% bupivacaine; Group KETO (n=30)- 0.5 mg/kg Inj Ketorolac (max 30mg) in 100 ml normal saline; 15 minutes prior to subarachnoid block; aged between 18-65 years, ASA class I and II, for elective femur fracture surgeries. VAS was studied till positioning for subarachnoid block and patient positioning, patient satisfaction & time to give subarachnoid block were also noted. The comparison was studied using the Chi-square test or Fisher's exact
test as appropriate, with the P value reported at the 80% confidence interval. P<0.05 was
considered statistically significant.

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.

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

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

Background: Dexmedetomidine and midazolam both affects duration of spinal
analgesia by different mechanisms, and yet, no studies are available to compare them
for postoperative analgesia after neuraxial administration. We investigated the addition
of dexmedetomidine or midazolam to intrathecal bupivacaine on the duration of
effective analgesia.
Materials and Methods: The patient posted for elective procedure under spinal
anaesthesia were randomly allocated in to three group of 20 patient and each group.
Group D- Patient in the group receiving 3 ml of 0.5% hyperbaric Bupivacaine with
5mcg Dexmedetomidine the total volume is 3.5ml. Group M - Patient in the group
receiving 3 ml of 0.5% hyperbaric Bupivacaine with 1mg of Midazolam, the total
volume is 3.5 ml. Group B-: Patient in the group receiving 3 ml of 0.5% hyperbaric
Bupivacaine with 0.5 ml of normal saline, the total volume is 3.5 ml. The groups were
compared to the regression time of sensory block, duration of effective sedation score,
and side effects.
Results: The mean duration of sensory and motor block was quite prolonged in group D
patients The results were, statistically highly significant (P<0.0l) There
is significant difference between all the three groups in group D the sensory duration
block is 226 minutes while in group M is 158.7 minutes, In group B this Is 134.8 minutes
which is much less than the above groups. The motor block in group D 202.35 minutes,
in group M is 110.5 minutes and in group B is 96.8 minutes.
Conclusion: Dexmedetomidine (5mcg) when used as an adjunct to 3 ml of 0.5%
hyperbaric bupivacaine and prolongs the duration of effective analgesia in the
immediate postoperative period without any significant hemodynamic instability in
comparison to 1 mg midazolam.

Background: Choice of anaesthesia for surgery below the umbilicus is Subarachnoid block
with Bupivacaine traditionally. Dexmedetomidine is being used with Ropivacaine to avoid
side effects of Bupivacaine. The objective of this study is to compare the groups (group 1-
only Ropivacaine and group 2- Ropivacaine with Dexmedetomidine) with respect to
duration of sensory block and motor block, sedation, and complications.
Material and Methods: This is a prospective observational study and 30 patients in each
group were included. Duration of sensory block and motor block, scale of sedation and
complications were looked for. Patients with bradycardia, AV block, using beta blockers,
calcium channel blockers or anti-arrhythmic and hepatic or renal dysfunction were
excluded. Mean and standard deviation for continuous variables, frequencies and
percentages for categorial variables were determined. Chi-Square test, Paired T test,
Independent T test or Unpaired Test, and Wilcoxon Sum Rank Test were done.
Results: Mean age and weight of the group-1 were 38.80±4.2years and 62.23±5.43 kg and
that of group-2 were 39.67±5.9 years and 63.45±6.23 kg respectively. Mean duration of
sensory and motor blockade of the group-1 were 189±18.2 minutes and 158±18.77 minutes
respectively and that of group-2 were 230±19.7 minutes and 189±21.34 minutes
respectively (p<0.001). Ramsay sedation scores in the group with only Ropivacaine was 1.7
± 0.3 while in Dexmedetomidine group was 2.4±0.3 (p<0.001). 13 patients experienced
hypotension, 5 were from only Ropivacaine group and 8 were from Dexmedetomidine
group(p<0.001). 12 patients experienced bradycardia among which 4 were from only
Ropivacaine group and 8 from Dexmedetomidine group(p<0.001).
Conclusion: Intravenous dexmedetomidine in patients getting 0.75% isobaric ropivacaine
for subarachnoid block, increases time to two dermatomal regression of sensory blockade,
duration of sensory block, duration of motor block and provides good sedation.