European Journal of Molecular & Clinical Medicine

Systemic local anesthetic toxicity is rare but can be fatal because of relative resistance of local anesthetic–induced cardiac arrest to standard resuscitative measures.
Aim: To observe Lidocaine induced systemic toxicity when it is used by its various methods of administration and review treatment and management strategies available for lidocaine toxicity.
Method: Prospective , observational study conducted on 120 patients, between the age group of 20-60 years ( of either sex ) of ASA grade 1-2, undergoing surgical procedures in which lidocaine (0.25-4%) was  administered by different modes at various  associated hospitals of GMC Srinagar.
Results:  In the present study, out of 120 patients, 7 patients developed systemic symptoms following lidocaine administration by different routes. Patients were categorised into three groups- epidural group, brachial plexus blockade group and local infiltration group (40 patients in each group). 4 patients developed symptoms following epidural administration and 3 patients following brachial plexus blockade and none with local infiltration. Systemic manifestations were more when lidocaine was used for epidural anesthesia followed by brachial plexus blockade and least with local infiltration. Conclusion: We concluded that the dose and route of administration of lidocaine are statistically significant factors in considering systemic manifestation. The treatment of systemic toxicity is primarily supportive with oxygenation, fluid administration and administration of benzodiazepines.CNS toxicity is either self limiting or quite amenable to treatment with benzodiazepines. Cardiac toxicity may require resuscitation with fluids but the prognosis after return to spontaneous circulation is often very good.
 

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

Background: 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.

Background: A vast majority of prolapsed inter-vertebral disc (PIVD) occur at L4-L5 and L5-S1 level causing L5 and S1 radiculopathy. Lumbar epidural steroid injection (LESI) forms an important part of modern spine care, in cases not responding to conservative management for more than 3 months. Present study was aimed to study epidural methylprednisolone injection in treatment of prolapsed inter-vertebral disc (PIVD) cases.
Material and Methods: Present study was hospital based, prospective, observational study, conducted patients aged 18 to 65 years suffering from mechanical LBP with radiation due to PIVD at L4-L5 and L5-S1 (diagnosed with MRI) with symptom duration of less than 1year, symptom severity of ≥6 cm VAS score for pain, and not responding to conservative management for 3 months, received epidural steroid injection of methylprednisolone (80 mg).
Results: In present study, out of 55 enrolled patients, 42 completed follow-up. Majority were females (54.76 %), left side affected (52.38 %), Housewife (42.86 %) & labourers (26.19 %). Mean age was 38.32 ± 9.18 years, mean BMI was 27.89 ± 4.12 kg/m², average duration of pain was 13.33± 4.16 weeks. L4-L5 (61.9 %) were commonly involved as compared to L5-S1 (38.1 %). As per MRI Grading, Grade 2 (66.67 %) were more than Grade 3 (33.33 %) cases. We noted a significant improvement in Oswestry Disability Index Score (ODI) and the Visual Analogue Scale (VAS) as compared to baseline & at 6-month follow-up values, difference was highly significant (< 0.001).
Conclusion: Epidural use of methyl prednisone is safe and efficacious treatment modality in management of low back pain and radicular pain due to a prolapsed lumbar intervertebral disc.

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%.

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.

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

Introduction: Patients who receive epidural opioids have fewer respiratory issues and can be deployed sooner in the postoperative phase than those who get standard, intermittent IV/IM dosing.The present study was done to compare the postoperative analgesia between tramadol and Buprenorphine through an epidural technique in patients undergoing lower abdominal surgeries, along with their onset, duration of analgesia, and side effects.
Materials and Methods: This study was a prospective comparative randomized studyOur study comprised 60 patients who came in for elective lower abdomen surgery and were randomly divided into two groups of 50 individuals each..Group T received 50 mg of Inj.Tramadol hydrochloride and Group B received 100 micrograms of Inj.Buprenorphine hydrochloride through epidural route (epidural catheterization done).Both groups of patients were monitored for 24 hours after surgery. In the postoperative phase, the VAS(VISUAL ANALOG SCORE) score for pain severity, onset and duration of analgesia, and side effects was monitored.
ResultsThe onset of analgesia in Group T was quicker, but the duration of analgesia was shorter than in Group B. Group T had a mean onset of analgesia of 9.65±4.25 minutes, whereas Group B had a mean onset of 14.85± 4.75 minutes. The mean duration of postoperative analgesia in Group T was 345.12±78.65minutes, while it was 595.45±88.42minutes in Group B, with a P-value of 0.02which was significant. Throughout the study, all of the patients were hemodynamically stable, and no severe side effects such as respiratory depression were detected. However, Group B had a higher incidence of nausea, vomiting, and pruritus than Group T.
Conclusion: At the end of the study, It was observed that epidural Buprenorphine gives a substantially longer and higher quality of analgesia than epidural TramadolNausea, vomiting, and pruritus were the most common adverse effects associated with injectable buprenorphine, which may be alleviated by antiemetics and antihistaminics, respectively.

Introduction: Patients who receive epidural opioids have fewer respiratory issues and can be deployed sooner in the postoperative phase than those who get standard, intermittent IV/IM dosing.The present study was done to compare the postoperative analgesia between tramadol and Buprenorphine through an epidural technique in patients undergoing lower abdominal surgeries, along with their onset, duration of analgesia, and side effects.
Materials and Methods: This study was a prospective comparative randomized studyOur study comprised 60 patients who came in for elective lower abdomen surgery and were randomly divided into two groups of 50 individuals each..Group T received 50 mg of Inj. Tramadol hydrochloride and Group B received 100 micrograms of Inj.Buprenorphine hydrochloride through epidural route (epidural catheterization done).Both groups of patients were monitored for 24 hours after surgery. In the postoperative phase, the VAS(VISUAL ANALOG SCORE) score for pain severity, onset and duration of analgesia, and side effects was monitored.
ResultsThe onset of analgesia in Group T was quicker, but the duration of analgesia was shorter than in Group B. Group T had a mean onset of analgesia of 9.65±4.25 minutes, whereas Group B had a mean onset of 14.85± 4.75 minutes. The mean duration of postoperative analgesia in Group T was 345.12±78.65minutes, while it was 595.45±88.42minutes in Group B, with a P-value of 0.02which was significant. Throughout the study, all of the patients were hemodynamically stable, and no severe side effects such as respiratory depression were detected. However, Group B had a higher incidence of nausea, vomiting, and pruritus than Group T.
Conclusion: At the end of the study, It was observed that epidural Buprenorphine gives a substantially longer and higher quality of analgesia than epidural TramadolNausea, vomiting, and pruritus were the most common adverse effects associated with injectable buprenorphine, which may be alleviated by antiemetics and antihistaminics, respectively.

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