European Journal of Molecular & Clinical Medicine

Background: Intrathecal opioids are the gold standard for the treatment of post-operative pain with Buprenorphine adjudged as the most effective due its potent and prolonged effects. However, over the years it is losing popularity due to dose dependant side effects such as pruritus, nausea, vomiting and the most feared risk of delayed respiratory depression. Hence the search for an agent which can provide potent postoperative analgesia as comparable to morphine without its side effects still continues.
Aim & Objective: study intrathecal Dexmedetomidine 10mcg and Buprenorphine 75mcg used as adjuvant to 0.5% hyperbaric Bupivacaine to study- The onset of sensory block., Time of achieving highest level of sensory block. The onset of motor block. The Hemodynamic Effects. The Adverse Effects. Methods: Randomized clinical trial, Study setting:  Anaesthesia Department of tertiary care centre. Study duration: from April 2021 to March 2022 Study population: All patients with cataract requiring surgery admitted in tertiary care center. Sample size: 100. Results:  Dexmedetomidine group- 4 (8%) patients were less than 20 years of age, 34 (68%) patients were between 20-40 years of age, 12 (24%) patients were between 41-58 years of age. Buprenorphine group- 1(2%) patient was less than 20 years of age ,34(68%) were between 20-40 years of age, 15(30%) were between 41-58 years of age. 47(94%) patients in Dexmedetomidine group were males and 3(6%) were females.38(76%) patients in Buprenorphine group were males and 12(24%) were females. Dexmedetomidine group 47(94%) patients were ASA 1 grade whereas 3(6%) patients were ASA 2 grade. Buprenorphine group 43(86%) patients were ASA 1 grade whereas 7(14%) patients were ASA 2 grade. Dexmedetomidine group was earlier with mean 3.06 ± 0.45 min whereas 3.46 ± 0.59 min in buprenorphine group, P value 0.0002492 which was significant as it was less than 0.05. so onset of sensory block was significantly earlier in Dexmedetomidine group than Buprenorphine group. No significant difference was seen in the distribution of maximum sensory level among patients in both the group as observed p value is 0.532 which was >0.05. From 10 min onwards, Hollmen score was 3 among both group which denotes no perception of pinprick 15min after giving spinal anaesthesia. Conclusions: Time of onset of sensory block and motor block was earlier in Dexmedetomidine group   than the Buprenorphine group. Duration of sensory block and motor block was prolonged in Dexmedetomidine group than the Buprenorphine group. Two segment regression of sensory level was significantly later among Dexmedetomidine group than Buprenorphine group.

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:Postoperative analgesia after cesarean section poses unique clinical challenges
to anesthesiologist. Intrathecal buprenorphine is a promising drug for postoperative analgesia.
Aims: The aim of this study was to compare the efficacy of two doses of buprenorphine (45
μg and 60 μg) as an adjuvant to hyperbaric bupivacaine for postoperative analgesia in
caesarean section.
Materials and methods: This was a prospective, randomized, double-blind controlled study.
Ninety ASA physical status Class II parturients posted for elective caesarean section. The
computer-generated simple random sampling procedure was used to allocate the subjects into
three Groups A, B, C of 30 each.
Results: Addition of buprenorphine to intrathecal bupivacaine prolonged the duration and
quality of postoperative analgesia without producing any major side effect. The maximum
duration of analgesia and hence decreased analgesic requirement were obtained with 60 μg
buprenorphine. Addition of buprenorphine did not have any adverse outcome on the baby as
assessed by Apgar score.
Conclusion:Addition of buprenorphine to hyperbaric bupivacaine provides postoperative
analgesia after cesarean section without significant maternal and neonatal side effects.

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.

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.

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

Bupivacaine hydrochloride is 2-piperidenecarboxamide-1-butyl-N-(2, 6 dimethyl phenyl) monochloride, a monohydrate is a white crystalline powder that is freely soluble in 95% ethanol, soluble in water, and slightly soluble in chloroform or acetone. Local anesthetics mainly work on the cell membrane of the axon. The considerable transient rise in sodium ion permeability that's also required for impulse transmission is inhibited. Depolarization in response to the stimulus is thereby blocked, and the resting membrane potential is preserved. A pre-anesthetic check-up was done one day before the surgery. Patients were evaluated for any systemic diseases and laboratory investigations were recorded. The procedure of SAB was explained to the patients and written consent was obtained. The preparation of patients included a period of overnight fasting. Hemodynamics during the operative period was similar in the 30 mcg group and 60 mcg, but for the 90 mcg group incidence of hypotension and respiratory depression was observed for a few cases.