Online ISSN: 2515-8260

Keywords : adjuvant


Clinical Comparative Study Between Caudal Levobupivacaine-Clonidine and Ropivacaine- Clonidine for Post-Operative Analgesia in Paediatric Subumbilical Surgery

Kumar Akash, Garima Gaurav

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 7541-7547

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

A COMPARATIVE STUDY OF TWO DIFFERENT ROUTES OF DEXMEDETOMIDINE ADMINISTRATION ON THE EFFICACY OF SUBARACHNOID BLOCK

Dr. Renuka R, Dr. Kayitha Sharanya, Dr. Nusrat Anjum, Dr. Dileep S, Dr.Vaishnavi Narendra Lakkappa

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 4, Pages 3050-3059

Background: Dexmedetomidine has emerged as a wonder drug in regional anesthesia practice owing to its co-analgesic properties. However, there is a lack of literature for comparison of intrathecal with intravenous routes of dexmedetomidine administration on the effectiveness of subarachnoid block.
Methods: Prospective, randomized, double-blind study was carried out in 40 patients aged 18-60 years with ASA I and ASA II physical status scheduled for elective infraumbilical surgery under subarachnoid block. Participants were randomly divided into two groups. Subarachnoid block was administered with 3ml of hyperbaric Bupivacaine in both groups. Patients in Group 1 received intrathecal 5µg dexmedetomidine and intravenous infusion of normal saline during surgery. Patients in Group 2 received intravenous bolus dexmedetomidine infusion of 0.5 µg /kg followed by maintenance infusion of 0.5 µg/kg/hr. Block characteristics, Ramsay Sedation score and hemodynamic variables were recorded for all patients.
Results: The duration of motor block, the dermatomal level achieved and duration of analgesia was higher in group 1 compared to group 2. The groups were similar with respect to onset time of sensory and motor block, sedation score and hemodynamic variables. There were no significant side effects in either of the groups.
Conclusions: Dexmedetomidine by either intrathecal or intravenous route is an attractive adjuvant for infraumbilical surgical procedures performed under subarachnoid block. In cases where the requirement is to prolong duration of intraoperative anesthesia and postoperative analgesia intrathecal route is desirable. Whereas, in daycare surgeries where the requirement is only to intensify the block in the intraoperative period with early postoperative ambulation intravenous route is preferable.