Online ISSN: 2515-8260

Keywords : Ropivacaine


Effects of adding dexmedetomidine to ropivacaine for paravertebral block in breast cancer surgery

Dr. Killu Bhagya Lakshmi, Dr. Venkata Krishna Gollapalli, Dr. Venkata Ramesh Pativada

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 210-218

Background: Effective pain control after surgery is an important part of taking care of someone who has had surgery. A paravertebral block (PVB) is becoming more popular for breast surgery and is thought to be the best method for anaesthesia and pain relief after surgery. Several local and regional anaesthetic techniques were looked at to see if they could reduce post-surgery pain after breast surgery. The thoracic PVB technique looks promising because it reduces post-surgery pain, reduces opioid use, reduces side effects like drowsiness and the risk of breathing problems, and saves money. The goal of this study was to find out how well dexmedetomidine works with ropivacaine as a paravertebral block in breast cancer surgery.
Material and Methods: Randomly, 100 women having breast surgery were split into two groups, Group PR and Group PRD. For thoracic paravertebral block, Group PR got 0.5% ropivacaine (0.3 ml/kg) with 1 ml normal saline, while Group PRD got the same amount of ropivacaine with 1 mcg/ml of dexmedetomidine. The groups were watched to see how well the block worked, how the hemodynamic parameters changed at different times, when the sensory block started, how long it lasted and if there were any complications during or after the surgery.
Results: When added to ropivacaine in TPVB as an adjuvant, dexmedetomidine gives good pain relief during and after surgery and reduces the need for painkillers after surgery. There were no problems with the technique or the way the blood flowed and there were no bad effects from the dexmedetomidine.
Conclusion: TPVB with ropivacaine and dexmedetomidine as an add-on can be a better choice for good pain relief and stable blood flow during breast surgery without complications or side effects.

Comparison of Lidocaine Plus Ropivacaine with Lidocaine Plus Bupivacaine for Peribulbar Anaesthesia During Phacoemulsification Cataract Surgery: A Double-Blinded Randomized Study

Vishnu Kumar Garg; Sunil Chauhan; Jigyasa Shahani; Mangilal Deganwa; PS Lamba

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 6, Pages 1374-1380

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

A comparative study of dexmedetomidine and dexamethasone as adjuvants to ropivacaine in supraclavicular brachial plexus block

B Vani Prapurna, V Sudharani, S Kiran Kumar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 54-60

Background: Enhancing the duration of sensory and motor blockade of regional anaesthesia is often desirable for prolonged surgeries and also provides pain relief in the immediate postoperative period. We performed a prospective, randomised, study to evaluate the effect of Dexmedetomidine and Dexamethasone as adjuvants to Ropivacaine in supraclavicular approach of brachial plexus block.
Study design: The study was a controlled, randomised, double-blinded, prospective study.
Methods: Sixty ASA physical status 1 and 2 patients undergoing elective hand, forearm and elbow surgeries under brachial plexus block were randomly divided to receive either 8 mg Dexamethasone + 30ml 0.5% Ropivacaine or 1 mcg/kg Dexmedetomidine + 30 ml 0.5% Ropivacaine. The block was performed using a nerve stimulator. Onset and duration of sensory and motor blockade and total duration of analgesia were measured. Vitals were recorded at 3, 5,10,15,30 and 45 minutes. Two sample ‘t’ test of difference between two means was used to analyse the differences between various parameters that were used in the cases. Categorical data was assessed by Chi square test and Fishers exact test. P value of < 0.05 was considered significant.
Results: The onset of sensory block and onset of motor block both were found to be sooner with Dexmedetomidine than Dexamethasone. The duration of sensory block and motor blockade and duration of analgesia was longer with Dexmedetomidine than Dexamethasone.
Conclusion: Both Dexmedetomidine and Dexamethasone enhanced the onset and duration of blockade but, the effect was found to be more pronounced with Dexmedetomidine.
 

SIMULTANEOUS USE OF DEXMEDETOMIDINE AND CLONIDINE AS POTENT ADJUVANT TO ROPIVACAINE FOR EPIDURAL ANESTHESIA IN LOWER LIMB AND LOWER ABDOMINAL SURGERIES; A COMPARATIVE STUDY

M. Prashanth, Shepuri Swetha

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 31-38

Background: The potential and duration of analgesia can be increased by adding a suitable alpha 2 adrenergic agonists as adjuvants to ropivacaine during elective lower limb surgical procedures under epidural anaesthesia. Still there is a scope for research on the effects of clonidine and dexmedetomidine as potent adjuvants in epidural local anesthetics. The aim of our study is to compare the effect of clonidine and dexmedetomidine when used as an adjuvant to epidural ropivacaine in lower abdominal and lower limb surgeries.
Materials and Methods: Patients were randomized into fourgroups Group R (n=30) patients received 10ml of 1% isobaric ropivacaine alone, Group RC (n=30) patients received 10ml of 1% isobaric ropivacaine with clonidine 1μg/kg, Group RD (n=30) patients received 10ml of 1% isobaric ropivacaine with Dexmedetomidine 1μg/kg, Group RCD (n=30) patients received 10ml of 1% isobaric ropivacaine with 0.5μg/kg Dexmedetomidine and 0.5μg/kg of clonidine. Onsetofsensory analgesia using colds wab, onset of motor blockade using Bromage scale, time to 2 dermatome regression of sensory level, time to first demand for analgesia, sedationusing Ramsaysedation scale, intra operative hemodynamic parameters and complication swere assessed.
Results: The impressive and practically applicable results were obtained in Group RCD with respect to Results: The impressive and practically applicable results were obtained in Group RCD with respect to time for onset of analgesia (29 ± 3.9 sec), maximum sensory level (T 4.12 ± 1.1), time to peak sensory level (3.49 ± 1.2 min), time for two segment sensory regression (150 ± 12.3min), time taken for sensory regression to s1 (372.5 ± 17.1), duration of analgesia (439.3 ± 64.6 min), regression to Bromage 0 (41±11.3), onset to Bromage 3 (390 ± 32.9 min) and vas score (3.10±0.50).
Conclusion: The study results strongly conclude the use of 0.5μg/kg Dexmedetomidine and 0.5μg/kg of clonidine as aneffective adjuvant to10ml of 1% isobaric ropivacaine forepiduralanesthesia in lower limb and lower abdominal surgeries.

A comparative study of local anaesthetics ropivacaine and bupivacaine for caudal epidural anaesthesia in children undergoing lower abdominal surgery

Dr. Marie Ninu, Dr. Jagadish Basumatary, Dr. Ashim Saikia, Dr. Sangeeta Deka

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1863-1871

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%.

A RANDOMIZED CONTROL STUDY TO EVALUATE EFFICACY OF MAGNESIUM SULPHATE AS AN ADDITIVE TO ROPIVACAINE IN SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK

Supriya Aggarwal, Naveen Kumar Singh, Prateek Agrawal, Vidushi Sharma

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 2184-2191

INTRODUCTION
Ropivacaine is an aminoamide local anaesthetic that is less cardiac and central nervous system (CNS) toxic than other long acting local anaesthetics like bupivacaine. Local anaesthetics alone for supraclavicular brachial plexus block provide good operative conditions but have shorter duration of postoperative analgesia.
MATERIAL AND METHODS
This prospective study was conducted in the Department of Anaesthesia at KD Medical College, Hospital and Research from November 2021to April 2022.After obtaining permission from institutional ethics committee, written informed consent was taken from the participants. Eighty adult patients were randomly allocated to two equal groups (n = 40 in each group) using computer-generated random number list.Patients with the American Society of Anaesthesiologists (ASA) physical status I and II, aged between 25 and 55 years of both sexes undergoing elective orthopaedic surgeries of elbow, forearm, and hand under supraclavicular brachial plexus block were enrolled in the study.  The onset and duration of sensory and motor block, the perioperative vitals and requirement of post operative rescue analgesic were compared by us.
 
RESULTS
In group A 50% of patients achieved grade IV quality of block in comparison to 45% in group B which was not significant (p>0.05). 31 patients required rescue analgesic (intramuscular diclofenac sodium injection) in group A compared to 27 patients in group B.
Conclusion
We conclude that addition of 150 mg magnesium sulphate to ropivacaine 0.50% solution in supraclavicular brachial plexus block prolongs the duration of sensory and motor blockade and reduces the requirement of rescue analgesic in postoperative period with no significant adverse effects.

A comparative study of ropivacaine and bupivacaine for caudal epidural anaesthesia in children undergoing lower abdominal surgery

Dr. Marie Ninu, Dr. Jagadish Basumatary, Dr. Sangeeta Deka .

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 5330-5339

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%.

Study to assess the effectiveness of Ropivacaine versus Ropivacaine plus Fentanyl combination in Brachial Plexus block by supraclavicular approach

Dr. Padmalatha Seelam, Dr. Manoj Patruni, Dr. Vengamamba Thummala, Dr. Vadlamudi Rajesh Kumar, Dr. Nalli Venkata Krishna Mallik

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1597-1607

Introduction: One of the primary aims of anesthesia is to relieve the patient's pain and
agony, thereby the surgical procedures can be conducted without any discomfort. Relief of
intraoperative and postoperative pain has gained importance in recent years, considering the
central, peripheral and immunological stress response to tissue injury. Any expertise acquired
in this field should be extended into the postoperative period, which is the period of severe,
intolerable pain requiring attention. So there is need of extended analgesia without any side
effects in the process of achieving this goal. “Regional anaesthesia” is the term first used by
Harvey Cushing in 1901 to describe pain relief by nerve block 1. Regional nerve blocks are
based on the concept that pain stimulus conveyed by nerve fibers, which are amenable to
interruption anywhere along their pathway 2. Brachial plexus block is a valuable and safe
alternative to general anesthesia in upper limb surgeries. Interrupting the acute pain which
can help in limiting the development of chronic pain syndromes 3, 4. The effects of opioids on
regional blockade is controversial. So the present study is being undertaken to evaluate
Fentanyl as an adjuvant to Ropivacaine in supraclavicular brachial plexus block.
Methodology: Hospital based Prospective randomized single blinded study. Conducted on
eighty patients of ASA I and II posted for upper limb surgeries under supraclavicular block.
Patients were divided randomly by means of random number table generated by computer
into two groups as A and B. Each group consisting of 40 patients. Prior to the study
Institutional Ethical committee approval and consent from the patients were taken. The study
was conducted in the Department of Anesthesiology, at Katuri medical college &Hospital,
Guntur from January 2016 to October 2017.

Ropivacaine a better alternative to bupivacaine: A comparative study of 0.75% ropivacaine vs 0.5% bupivacaine for analgesic efficacy under supraclavicular brachial plexus block

Dr. Divya Chandra, Dr. JP Tiwari, Dr. Sritam Mohanty, Dr. Yogesh Kumar Yadav

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2115-2126

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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Volume ISSN 2515-8260 09, Issue 02, 2022
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.

Intrathecal 0.75% ropivacaine with fentanyl and 0.5% bupivacaine with fentanyl for lower limb surgeries: Changes in blood pressure

Dr. Arjun Nair, Dr. Pramod Kohli, Dr. Sachin Kumar, Dr. Maitree Pandey, Dr. Prashantha Kumar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2427-2432

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.

The onset and duration of sensory and motor block between intrathecal 0.75% ropivacaine with fentanyl and 0.5% bupivacaine with fentanyl for lower limb surgeries

Dr. Arjun Nair, Dr. Pramod Kohli, Dr. Sachin Kumar, Dr. Maitree Pandey, Dr. Prashantha Kumar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2433-2440

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.

COMPARISON OF EFFICACY OF 0.5% LEVOBUPIVACAINE AND 0.5% ROPIVACAINE IN ULTRASOUND GUIDED BRACHIAL PLEXUS BLOCK BY SUPRACLAVICULAR APPROACH IN UPPERLIMB ELECTIVE PROCEDURES: A COMPARATIVE, CLINICAL STUDY

Dr. D. Jyothirmayee, Dr. S. Manasa ,Dr. P. Nikhitha, Dr. Gayathri Dakshinamurthy

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 10319-10328

Introduction: Supraclavicular block is preferred for its rapid onset, reliability and a safetechnique for
surgeries involving the upper limb. Several local anaethetics have
beenusedandproveneffectivewithvariousefficacies.
Aims: To study and compare the efficacy of 0.5% Ropivacaine with 0.5% Levobupivacaine in
supraclavicular brachial plexus block in patients undergoing elective upper limb surgeries.
Materials and methods:
Inourprospectiveclinicalstudy,wecomparedLevobupivacaineandRopivacaineforprovidingsupraclavicularbl
ockin60patients. We demonstrated that a volume of 30 ml of Levobupivacaine and Ropivacinewas
sufficient to provide a satisfactory and a successfulsupraclavicular block withthehelpofultrasoundguidedtechniquekeepinginmindthetoxicdoses.
Results:There were no observable changes in both the groups on comparing the vitalswhichincluded heart
rate, systolic blood pressure, diastolic blood pressure andoxygensaturation. Sensory block onset and
duration in Ropivacaine group was statisticallysignificant.Motor block onset of both were comparable and
did notshowanystatisticalsignificance.. The mean duration of motor blockade were
foundtobesignificantstatistically. The duration of analgesia werefoundtobe statistically significant.
Levobupivacaine providingalonger durationofanalgesia. There were no significant changes in baseline
parameters, heart rate, bloodpressuresandsaturationinboththegroups.
Conclusion: Levobupivacaine would be a better option to choose insupraclavicular brachial plexus
blockwhere prolonged postoperativeanalgesia isrequired.

EVALUATION OF EPIDURAL ROPIVACAINE FOR LOWER ABDOMINAL SURGERIES-A CLINICAL STUDY

Dr P. Nikhitha, Dr D. Jyothirmayee, Dr S. Manasa .

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 782-792

Background: Different adjuvants are coadministered with local anesthetics to improve the speed of onset and duration of analgesia, and to reduce the dose, the selection of which is often left to the choice of an anesthesiologist.
Aims: Aim of the study is to evaluate the efficacy &safety of 0.75% Ropivacaine in epidural anaesthesia for lower abdominal surgeries.
Materials and methods: In the present clinical study, 0.75% preservative free ropivacaine is used through epidural route for patients undergoing elective lower abdominal surgeries belonging to ASA grade I and II with in the age group of 20 to 60 years.
We observed the time of onset , highest cephalad spread, two segment regression from highest cephalad spread and total duration of sensory block as well as degree of motor blockade and it's duration, haemodynamic changes, duration of post operative analgesia and side effects , if any.
Results: With 0.75% preservative free ropivacaine, the mean onset time of sensory block for S1, L1, T10, andT6 dermatomal levels are 22.9+/-5.01 mins, 8.48+/- 3.18 mins, 13.4+/-3.88 mins and 29.5+/-3.33 mins respectively. The maximum cephalad spread is T5 dermatomal level and mean time to reach maximum cephalad spread is 29.77+/-4.94 minutes.
The mean duration of sensory blockade and motor blockade are 406.25 +/- 23.22 minutes and 263.58 +/- 21.19 minutes respectively. The motor blockade time is far less than the sensory blockade. Only 6.66% of the total patients achieved the Modified Bromage scale3.
In our present study, the mean total duration of postoperative analgesia is 246.67+/- 42.86 minutes. There are not many changes in the haemodynamics and incidence of side effects and requirement of vasoactive drugs were minimal.
Conclusions: 0.75% ropivacaine has a longer duration of sensory blockade and the duration of motor blockade is for less than the sensory blockade, their by providing post operative analgesia for nearly more than four hours. It appears to be an ideal and safe local anaesthetic for these surgeries.

Intravenous Regional Anaesthesia: Comparison of Ropivacaine and Ropivacaine Dexamethasone Combination

Arvinpreet Kour, Ajaydeep Singh, Ritu Gupta

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 1332-1338

Background: Intravenous regional anaesthaesia(IVRA), also known as Biers Block is a
technique of producing surgical anaesthesia by intravenous injection of a local
anesthetic into a limb whose circulation has been interrupted by a
tourniquet.Ropivacaine is a safer alternative among available local anaesthetics with
analgesic duration 4-8 hrs. Dexamethasone is a long-acting synthetic corticosteroid and
is beneficial anti-inflammatory agent for the management of acute surgical pain.This
study was done with the aim to comparethe effectiveness as well the onset and duration
of sensory block, motor block and analgesia between ropivacaine alone and ropivacainedexamethasone
in regional anaesthesia.
Methods: 50 adult patients of ASA grade I & II in the age group of 20-50 years were
randomized into two groups of 25 patients, scheduled for ambulatory hand surgery
andwere administered intravenous( IV)Ropivacaine (0.2%) 40 ml and IV
Ropivacaine(0.2%)40ml plus 8mg Dexamethasone after inflating the proximal cuff of
tourniquet and assessment was done with pin prick and visual analogue scale
(VAS)score.
Results:This study showed, the duration as well as the recovery of sensory block was
prolonged on adding dexamethasone. In group receiving dexamethasone as an adjuvant
to ropivacaine the duration of analgesia was prolongedas well as the total analgesic
consumption was reduced. Conclusion: IVRA is a safer technique and addition of
dexamethasone to ropivacaine increases the analgesic efficacy as well the duration of
sensory block which decreases pain scores and attributes to early recovery as well as
short hospital stay.

A comparative study of levobupivacaine and ropivacaine as supraclavicular brachial plexus block in patients undergoing upper limb surgery

Sirisha T, Varaprasada Rao T

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1193-1200

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.

To evaluate the effect of local infiltration of Ropivacaine 0.75 % and clonidine in post operative pain management of total knee arthroplasty

Dr. Amit Gavali, Dr. Hemant S Dambale, Dr. Nitin D Waghchoure, Dr. Shrikant M Upasani

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 2804-2808

Introduction: Pain is constant companion for human. There is perhaps nothing as dreaded as pain. Pain is the ultimate teacher. It alerts the body to disease. Depending upon the intensity and duration, it impacts quality of life. Pain after total knee arthroplasty (TKA) is a big concern in orthopaedics. Although opioids and continuous epidural analgesia remains the major option for the postoperative pain management of TKA, they have undesirable side effects like sedation, nausea and hypotension.  Epidural catheterization is skilful and technically demanding procedure with close monitoring. Infiltration of local anesthetic solution minimizes pain at the source superiorly. It has short learning curve, no systemic side effects, no infection, level of motor block is none, early mobilization and cost effective. There is not much study done on combination of Ropivacaine and Clonidine as a LIA.
Material and Methods: A prospective study was carried out among 30 cases undergoing total knee surgery at a tertiary care hospital. During pre-anaesthetic check up detailed assessment of airway, respiratory and cardiovascular system was carried out. Basic laboratory data were reviewed. Informed consent was taken. All patients were kept nil per oral for 8 hours and were pre-medicated with Tab Ranitidine 150mg, Tab Diazepam 5mg orally 12 hours before surgery. Patients were taught the visual analog pain scale (VAS) (0 = no pain, 10 = worst imaginable pain), and VAS was measured preoperatively at rest and on movement of the knee to be operated.
Results: We observed that; mean age was 62.7+9.9 years. Out of 30, 70% were female and 30% were males. Pain control with Ropivacaine and clonidine has been very effective in 1st 24 hours in total knee replacement surgery.
Conclusion: From this study s we concluded that, with the use of local infiltrative anesthesia i.e combination of Ropivacaine & clonidine, requirement of opioid has been decreased. Effects on cardiovascular system like tachycardia, hypertension has also been decreased. It also benefited patient by early mobilization.

Comparison of Analgesic Effect of a Single Dose of PerineuralRopivacaine With and Without Dexamethasone on Ultrasound-Guided Femoral Nerve Block After Total Knee Arthroplasty

Dr. Rajmohan Rao Tumulu, Dr. Dilshad Kauser, Dr. Sunil Kumar Swain, Pranay Kumar Tumulu, Tanisha Garg, Mohammed Amer Mohiuddin

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 4696-4701

Background:
Postoperative pain after total knee replacement surgery is an unpleasant memory for the patients.
Different techniques have been tried to elevate the post-operative pain. A femoral nerve block
with local anaesthetics is considered to bethe gold standard for postoperative pain.But the painfree
period after the femoral nerve block lasts for a few hours only.Several adjuvants have been
triedwith local anaestheticsto prolong analgesics’ duration and avoid the adverse effects of
NSAIDsandopioid use.
Objective:
In this study, we have used dexamethasone as an adjuvant withropivacaine to prolong the
duration of analgesia effect, in a single dose of perineural femoral nerve block after total knee
arthroplasty.
Methods:
It was a prospective, randomized, controlled study, sixty patients were randomly assigned to one
of two groups:Group R or Group RD. In Group R, 40 mL of 0.375% ropivacaine was used, and
in Group RD 8 mg of dexamethasone was used as an adjuvant to 40 mL of 0.375%
ropivacaine.The primary endpoint was to check the duration of analgesia after the femoral nerve
block and the secondary endpoint was to check the amount of rescue analgesic consumed in the
first 24 hours, postoperatively.A visualanalogue scale (VAS) score was used to access the pain
with 1 being the least pain and 10 being the highest. The adverse reactions to the drugs were also
noted in both groups.

A comparative study between 0.2% ropivacaine with dexmedetomidine and 0.125% levobupivacaine with dexmedetomidine for post-operative epidural analgesia in patients undergoing total abdominal hysterectomy

Dr. T. Anusha,Dr. Kiran Kumar Suggala, Dr. Tejaswi T

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 1, Pages 701-710

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.

Effect of ropivacaine and bupivacaine on heart rate for supraclavicular brachial plexus

Dr. Shivakumara K C, Dr. Vishal

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 1, Pages 212-216

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.

Evaluation of The Efficacy of Dexmedetomidine And Dexamethasone When Used As Adjuvant To Ropivacaine In Supraclavicular Brachial Plexus Block for Upper Limb Surgeries

Dr Abhilash Dash; Dr Rabi Narayan Dhar; Dr Ramakanta Mohanty; Dr Sidharth Sraban Routray; Dr Soumyakant Mallick

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 6, Pages 1166-1173

We have done this trialin order to correlate analgesic dexmedetomidine (DXM) &dexamethasone (DX) efficacyin form of an additive for supraclavicular brachial plexus(SCBP)‘s ropivacaine blockage for upper extremity surgery. This is trial in which, 18–65 yrs 70 ASA status type one and two individuals suffering from disease, posted for upper extremity surgery was splitrandomly within couple of categories. Class DXMgot 2 mlof normal saline containing dexmedetomidine (1mcg/kg) with 0.5%ropivacaine(30 ml) and Class DXgot 2 ml(8 mg) of dexamethasone with 0.5%ropivacaine(30 ml). SCBP block was performed under ultrasonography(USG). The primary outcome was time of 1st analgesic request and no of analgesic request in 1st 24hrs. Secondary endresult of the trial were Motor block& sensory were secondary trial end result onset & time & incidence associated with drug’sside effects. Time for request of 1st rescue analgesia was 720.50±67.87min in Class DXM and 591.83±52.25min in Class DX. Total rescue analgesia required within post -operative for 1 dayinto DXM Class is less in comparison to DX Class. The mean of onset time of motor block& sensory into Class DXM is lesser in comparison to Class DX, which is statistically important. In Class DXM mean of duration of sensory block was 656.50± 50.58min, which was significantly longer than Class DX where duration was 534.10± 62.43min. Mean of motor block duration was 611.83± 45.3min in Class DXM and 470.83± 59.40min in Class DX (p<0.001). Dexmedetomidine provided prolonged relief from suffering after utilizing it in form of an additive to SCBP portion’s ropivacaine when compared to dexamethasone