European Journal of Cardiovascular Medicine

Background: Transversus abdominis plane block is a regional anaesthesia technique. It provides analgesia after abdominal surgery particularly where parietal wall pain forms major component of pain. It allows sensory blockade of lower abdominal wall skin and muscles via local anaesthetic deposition above transverses abdominus muscle. We evaluated the efficacy of TAP block with Ropivacaine and Bupivacaine for post operative analgesia in abdominal surgery, a double blind, prospective randomized controlled trial

Pain is defined as "an unpleasant sensory and emotional experience associated with existing or potential tissue damage or described in terms of such damage" by the updated taxonomy committee of the International Association for the Study of Pain (IASP).

Introduction: Pain during and after surgery results in intense changes in hemodynamics, increased metabolic and endocrine stress hormone production, and increased myocardial oxygen demand and consumption. Some patients require bothopioid and non-opioid analgesics within the first 24 hours followingsurgery. Pre-emptive analgesia is theintroducing of analgesic management beforeonset of noxious stimuli, which helps to prevent pain potentiation. It provide spain relief priorto surgery and throughout the perioperative period. Bilateral superficial cervical plexus block (BSCPB) is a technique where local anaesthetic mixtureis injected based on anatomical landmarks. It reduces the intraoperative analgesic requirements when administered before surgery. By decreasing analgesic requirements, the block produces tableintra operative vital sin comparison to general anaesthesia alone [3] Therefore, this study involved administering bilateral superficial cervical plexus blocks for thyroid surgeries in addition to general anaesthesia, along with assessment of intra- and post-operative hemodynamics, evaluation of postoperative eanalgesia, and detection of adverse effects. Materials and Methods: This randomized study was carried out in the Department of Anaesthesia, MGM Medical College and MY Hospital, Indore, among 60 consented patients aged 18 – 60 years belonging to ASA grade I/II and posted for elective thyroid surgeries under general anaesthesia, allocated into 2 groups of 30 each: Group A (without SCPB) and Group B (with SCPB), using a proforma, pre-anaesthetic evaluation, investigations followed by induction of anaesthesia and performing of SCPB. Data was collected, compiled and analysed using SPSS 22.0 (trial version). Result: Majority Group A (36.67%) and Group B (40%) participants belonged to 31-40 years and 18-30 years age group, respectively and were females (Group A=90%; Group B=83.3%). Most were classified as ASA grade I (63.3%). The HR, SBP, DBP and MAP in Group A intra-operatively, was found to be significantly higher than Group B (p-value-0.000). Post-operatively, it was observed that the HR and SBP was significantly higher in Group A at all the time intervals till 24 hours after the procedure (p-value=0.000). The DBP was higher initially in the post-operative period in Group A (p-value=0.000), however, 24 hours later, it was found to be comparable with Group B(p-value>0.05). Similar was the case with MAP, which was higher in Group A in the initial post-operative period, decreased gradually and 24 hours later, was comparable with Group B(p-value>0.05). Statistically significant difference was also observed between both the groups (p-value<0.05) with respect to VAS score. Requirement of first rescue analgesia was earlier in Group A (p-value<0.000). Post-operative complication were experienced more in Group A. Conclusion: It was concluded that BSCB block with injection Ropivacaine 0.75% and injection Fentanyl 25 mcg was effective in blunting hemodynamic stress response to pain and provided stable hemodynamics throughout the surgery. It also reduced the dose and requirement of opioid analgesics after the surgery.

Introduction: The effective management of pain during and after lower limb orthopaedic surgeries is crucial for optimizing patient comfort and postoperative outcomes. Epidural analgesia, often employed in this context, relies on the adjunctive use of medications to enhance pain control. Among the numerous options available, two commonly used adjuvants are dexmedetomidine and fentanyl. This study aims to provide a comparative analysis of the efficacy and safety of these two medications when incorporated into epidural analgesia protocols for lower limb orthopaedic surgeries. By exploring their respective benefits and potential drawbacks, this research seeks to contribute valuable insights to the field of perioperative pain management, ultimately aiding clinicians in making informed decisions regarding the choice of adjuvants in orthopaedic surgical settings. Materials and Methods:  The present study included 120 patients who underwent lower limb orthopaedic surgery and were of both sexes, aged 20 years to 56 years, and of physical status I and II according to the American Society of Anaesthesiologists (ASA). Sixty patients each were randomly assigned to the two groups Group 1 [ropivacaine + dexmedetomidine (RD)] and Group 2 [ropivacaine + fentanyl (RF)]. Epidurally, 15 ml of 0.75% ropivacaine injection was given to both groups, along with 1 g/kg of dexmedetomidine for Group 1 and 1 g/kg of fentanyl for Group 2. Various block characteristics, such as the time to the first onset of analgesia at T10, the maximum sensory analgesic level, the duration of the motor blockade, the duration of the two segmental dermatomal regressions, and the duration of the first rescue analgesic, were also noted along with cardio-respiratory parameters and sedation scores. Data was rigorously gathered at the conclusion of the study and analyzed using Fisher's exact test, Chi-square test, and ANOVA with post-hoc significance. Statistical significance was set at 0.05 (if the P-value ≤ 0.05, it is significant). Results: The demographic profile of patients was comparable in both groups. The onset of sensory analgesia at T10 (7.65±1.93 minutes vs 9.76±2.19 minutes) and establishment of complete motor blockade (19.42±4.11 minutes vs 21.65±5.37 minutes) was significantly earlier in Group 1 [ropivacaine + dexmedetomidine (RD)].  Postoperative analgesia was prolonged significantly in Group 1 [ropivacaine + dexmedetomidine (RD)] (362.13±20.87 minutes) and consequently low dose consumption of local anaesthetic (74.56±9.82 mg vs 108.65±14.69 mg) during epidural top‑ups postoperatively. Sedation scores were much better in Group 1 [ropivacaine + dexmedetomidine (RD)] and highly significant in statistical comparison. The incidence of nausea and vomiting was significantly higher in Group 2 [ropivacaine + fentanyl (RF)] , while the incidence of dry mouth was significantly higher in Group 1 [ropivacaine + dexmedetomidine (RD)].  Conclusion: As an epidural adjuvant, dexmedetomidine appears to be preferable to fentanyl because it offers comparable stable hemodynamics, early onset and establishment of sensory anaesthesia, prolonged postoperative analgesia, lower post-operative local anaesthetics consumption for epidural analgesia, and significantly higher sedation levels.

Introduction: Brachial plexus block is the cornerstone of anaesthesia and analgesia in the management of upper limb surgeries. Different approaches to this block can be used and compared for efficacy and safety using the same volume of local anaesthetics. AIM: To compare the efficacy of supraclavicular block, interscalene block and combination of supraclavicular and low interscalene block in upper limb orthopaedic surgeries. Materials and Methods: 60 patients of ASA Grade I, II & III of age group 18-65 years of either sex undergoing orthopaedic upper limb surgeries under regional anaesthesia were randomly divided into 3 groups of 20 patients each. In Group SR, supraclavicular block was given using 20ml of Ropivacaine 0.5% with 0.05mg of Dexmedetomidine, In Group IR, Interscalene block was given using 20ml of Ropivacaine 0.5% + 0.05mg of Dexmedetomidine and in Group ISR, a combination of low interscalene and supraclavicular block using 20 ml of Ropivacaine 0.5% + 0.05 mg Dexmedetomidine (10 ml in low interscalene and 10 ml in supraclavicular block) was administered. Results: The demographic profile was comparable in the three groups. The mean time of onset of sensory block was earlier in group ISR (5.77± 1.51 mins) than in SR group (12.77± 2.55 mins) and IR group (7.52 ± 1.50 mins). The mean time of onset of motor block was also significantly shorter in the combination group ISR (7.91± 1.45 mins) than in SR (16.94 ± 3.03 mins) and IR group (11.82 ± 2.81 mins). The mean duration of sensory block (893.56±20.10 mins), as well as motor block (782.50±33.17 mins) in group ISR, was significantly prolonged than the other two groups. Conclusion: The combination of supraclavicular and low interscalene block is more efficacious than supraclavicular and interscalene blocks alone in terms of onset and duration of block without any significant side effects.

Background: Supraclavicularbrachialplexus blockis used for providing pain relief in upper limb surgeries and has manyadvantagesovergeneralanaesthesia.Alpha-2-adrenergicagonists are chosen with local anaesthetics for their sedative,analgesicand antihypertensive properties. Aim : To  evaluate  the  effects  of  clonidine  and  dexmedetomidine  in  combination  with  ropivacaine  on  peripheral  nerves  during  brachial  plexus  block. Methods :The present study was prospective  comparative  observational  study. A total of 58patients admitted in orthopaedics ward scheduled for upper limb surgeries fulfilling the requisite criteria were included in the study.  Study was conducted from August 2022toSeptember2022 in the Department of orthopaedics, Burdwan Medical College, Burdwan, West Bengal, India. Statistical data were analysed by using Microsoft Excel and SPSS V.20 software. Results :The mean age of the patients was 31.5 ± 4.2 years in Group C and 33.1 ± 3.9 years in Group D. There were 22 males (37.93%) and 7 (12.07%) females in Group C and 19 males (32.76%) and 10 females (17.24%) in Group D. Group D showed less time for the onset of sensory and motor blocks and more time in duration for sensory and motor blocks. The duration of analgesia was longer in Group D. Comparison of complications showed that, bradycardia and hypotension were found more in Group C than Group D. The vital parameters were comparable in both the groups. Conclusion :Dexmedetomidine prolongs the duration of sensory and motor block and enhances the quality of block as compared with clonidine when used as an adjuvant to ropivacaine in supraclavicular brachial plexus block.

Aims: to compare the effectiveness of epidural Ropivacaine with epidural Levobupivacaine for anaesthesia in lower abdominal and lower limb surgeries. Materials and methods: It is a Hospital based prospective study in 100 patients admitted between age 18-60 years, ASA grade 1 and 2 in Patients undergoing Lower abdominal and Lower limb surgeries  Results: In  the  present  study,  the  mean  age, gender, weight, height, ASA-1 and 2, onset of sensory block, onset of motor block of  the  Levobupivacaine  group  and ropivacaine group was not statistically significant. No  significant  difference observed between the two groups with relation to Highest level of sensory block  achieved. There is significant difference between the two groups, with group L producing a deeper motor blockade (0.02). Mean Duration of Motor block in Group R was 282.98 ± 11.23 and in Group L was 280.54 ± 4.61. This observation was not statistically significant (p=0.64). Mean duration of sensory  analgesia in Group R was significantly prolonged than Group L. This observation was statistically significant (p=0.02).  Both the study groups were hemodynamically stable with relation to pulse rate at 0, 5, 15, 30,  60mins,  2, 6, 12 hours. Higher sedation score was observed in Ropivacaine group compared to Levobupivacaine group. Conclusion: Levobupivacaine can be used as a better alternative to Ropivacaine for epidural anaesthesia in lower abdominal and lower limb surgeries

Background- Effective pain relief and minimum motor block are the necessary constituents of an ideal epidural block. Fentanyl is a lipophilic opioid most commonly used as an adjuvant to local anaesthetic. Ropivacaine is an alternative to bupivacaine, with greater sensitivity for sensory fibres than motor fibres, thus producing less motor blockade than bupivacaine. This study assessed the analgesic effect of very low dose fentanyl (1mcg/ml) as an adjuvant to either ropivacaine or bupivacaine. without compromising its beneficial effects and avoiding the undesired side effects. AIM- To study the effect of fentanyl as an adjuvant to bupivacaine and ropivacaine in epidural analgesia for laboringparturient. Method- 44 nulliparous labouring parturients of ASA I & II at term with singleton pregnancy of vertex presentation without any obstetric complication were randomly allocated into two groups of 22 each. Group B received bupivacaine 0.125% with fentanyl 1 mcg/ml bolus dose till VAS<3. Similarly, Group R received ropivacaine 0.125% with fentanyl 1 mcg/ml. Analgesia was maintained with intermittent bolus of study solution. Analgesic efficacy was measured in terms of duration of analgesia, onset of analgesia, highest level of sensory block, motor block, side effects if any; obstetric and neonatal outcomes were also recorded. Results- There was no significant difference between the two groups in terms of duration of analgesia, level of sensory block achieved, time required to achieve level of sensory block, motor block or side effect profile. There were minimal side effects and neonatal outcomes were good. Obstetric outcomes and maternal satisfaction level was also comparable between the two groups. Conclusion- Fentanyl when used in a low dose of 1 mcg/ml with equal concentration of two local anaesthetic bupivacaine and ropivacaine provides good analgesia in all stages of labour avoiding the side effects of opioids.

Background:    The standard procedure for patients undergoing mastectomy surgery is general anaesthesia along with post operative analgesia, such as opioids, paracetamol and, nsaids [1]. Some additional approach is must to undertake post operative analgesia. Our aim of the study is to compare the efficacy of bupivacaine and ropivacaine in PECS block for providing analgesia in postoperative period of mastectomy patients by assessing VAS score and other parameters. Methods: The study was conducted at Srinivas Institute Of Medical Sciences And Research Centre, Mangalore, it is a randomised prospective study with 60 patients meeting inclusion criteria. In all patients following parameters like VAS score, pulse rate, blood pressure was recorded and evaluated. Results: This study shows that there was significantly less post operative pain in the R Group (0.2% Ropivacaine) compared to the B Group (0.25% Bupivacaine) as seen from the significant difference in VAS score. Conclusion: The results of our study is supportive in proving that 0.2% Ropivacaine is superior to 0.25% Bupivacaine for post-operative analgesia using PECS block and TTP block for breast cancer surgery. It should be considered as an adjuvant therapy multimodal analgesic technique to general anaesthesia

Background: Spinal anaesthesia is the most commonly performed technique in parturients undergoing Lower Segment Caesarean section (LSCS). This randomized double-blinded study compared the hemodynamic effects of levobupivacaine and ropivacaine in parturient with pre-eclampsia undergoing emergency LSCS. AIM: The commonest side effect of subarachnoid block is hypotension and bradycardia and so to counter that, there has been developments of newer amide group of local anaesthetics. Both hyperbaric levobupivacaine and hyperbaric ropivacaine, have shown better hemodynamic effects as compared to conventional hyperbaric bupivacaine. So, in this study we shall further compare hyperbaric levobupivacaine and hyperbaric ropivacaine and consider its outcome in parturients with pre-eclampsia undergoing emergency Lower Segment Caesarean section (LSCS). Material And Methods: Eighty parturients with pre-eclampsia scheduled for emergency LSCS were randomized into Group L and Group R of 40 parturients each. Group L parturients received 1.4ml of 0.5% hyperbaric levobupivacaine while Group R parturients received 1.4 ml of 0.75% hyperbaric ropivacaine with fentanyl 0.4 ml (50 mcg/ml) as an adjuvant in both groups was injected intrathecally at L2-L3 interspinous space. Primary objective was to compare perioperative hemodynamic changes. Secondary aim was to compare onset and duration of sensory and motor block, duration of analgesia and quality of motor block. Results: Group L provides better hemodynamic stability and postoperative analgesia as compared to Group R. Conclusion: Ropivacaine and levobupivacaine are the newest drugs utilized for neuraxial blockade and they have demonstrated a superior pharmacological safety profile. Levobupivacaine emerges as the more favorable option when considering cardio stability and hemodynamic stability in parturients with deranged hemodynamics.

Background- Levobupivacaine and ropivacaine, both relatively new amide local anesthetic agents, have been developed to overcome the problems associated with bupivacaine toxicity. This study was conducted to compare clinical efficacy and characteristics of 0.5% hyperbaric levobupivacaine with 0.75% hyperbaric ropivacaine for subarachnoid block in lower limb orthopaedic surgeries. Methods- This was a prospective randomized double-blind study conducted among 60 patients scheduled for elective lower limb orthopaedic surgeries under spinal anaesthesia. The patients were randomly allocated into two groups Group L and Group R. Group L (n = 30) received 3ml of 0.5% hyperbaric levobupivacaine and Group R received 3 ml of 0.75% hyperbaric ropivacaine. Onset and duration of sensory and motor blockade, hemodynamic parameters, patient satisfaction score and adverse effects were recorded. The data was analysed using SPSS version 24.0 with appropriate tests and a P<0.05 was considered significant. Results-The distribution of patients was comparable with respect to age, sex, ASA grades and duration of surgery (P>0.05). Mean time to reach highest sensory level was significantly higher in Group L (19.2±1.4 min) than Group-R (17.9±1.2 min) (P<0.05). The mean time of two segment regression from highest sensory level blockade was less in group R (Group R 65.7±3.3 min Group L 72.4±5.1 min; P<0.05). However, the time of regression from highest sensory level to S1 was significantly less in Group L (Group L 180.8±7.3 min; Group R 188.4±3.7 min; P<0.05). Mean time of onset of motor blockade (Bromage scale 3) was 19.2±1.3 min in group L and 19±1.2 in group R and the difference was not statistically significant (p = 0.484). Patients in hyperbaric ropivacaine group had a significantly faster recovery from motor blockade recorded as mean regression to motor blockade (Bromage scale 0) (Group R 119.5±6 min vs Group L 128.8±7 min; P< 0.05). Both drugs were also found to be safe and comparable in terms of impact on hemodynamic parameter and no complication was observed. Conclusion- Hyperbaric levobupivacaine and hyperbaric ropivacaine are reliable in term of efficacy and safety for subarachnoid block in lower limb surgery. However, hyperbaric ropivacaine is a better alternative than hyperbaric levobupivacaine in patients where early mobilisation is required as it offers a faster recovery from motor blockade.

Introduction: Total knee replacement (TKR) is commonly performed surgeries associated with high degree postoperative pain, prolonged immobilization. Postoperative analgesia with Ultrasound guided (USG) Adductor canal block(ACB) using Ropivacaine with or without Nalbuphine is reported to give good analgesia without compromising on the motility of patients. Nalbuphine is a derivative of 14-hydroxymorphine which is a strong analgesic with mixed k agonist and μ antagonist. The combination of Ropivacaine with Nalbuphine for ACB may offer improved postoperative pain management compared to Ropivacaine alone. Materials and Methods: Thirty American Society of Anesthesiologists (ASA) class I and II patients, ranging in age from eighteen to sixty, were chosen as candidates for elective total knee replacement procedures in a randomized clinical trial. Once TKR surgery was done, Adductor canal block was performed using ultrasound guidance. 30 patients were randomly allocated into two groups of 15 each by computer generated randomized number. Group R recieved19ml of ropivacaine (0.375%) +1ml normal saline. Group RN received 19ml solution of Ropivacaine (0.375%) with 1ml (10mg) Nalbuphine. Results: it was observed that time of postoperative analgesia has 398.67 minutes in group RN and 306.67 minutes in group R. P value is 0.000 (‘p’ < 0.05). this is statistically significant. Conclusion: we concluded that the addition of Nalbuphine as an adjuvant to Ropivacaine after unilateral total knee replacement using ultrasound guided Adductor canal block prolongs the duration of postoperative analgesia.

Background and Aims: Pure enantiomers of Bupivacaine such as Levobupivacaine and Ropivacaine (amides) have been established in routine practice due to their reduced detrimental impact on the cardiovascular and nervous systems. The effects of these drugs were compared in our study in patients undergoing surgeries under subarachnoid block. Materials and Methodology: Seventy patients assessed under American Society of Anaesthesiologists, Grade I and II of both genders between 18-65 years of age, scheduled for both elective and emergency surgeries under the subarachnoid block of duration more than or equal to one hour were included, randomized into two groups. Thirty-five people received 0.5% Isobaric Inj. Levobupivacaine 3.5 ml with Inj. Buprenorphine 0.2 ml (60µg) and thirty-five people received 0.75% Isobaric Inj. Ropivacaine 3.5ml with Inj. Buprenorphine 0.2 ml (60µg). Comparison between both groups with regards to age, sex, weight, onset of sensory and motor blockade, duration of sensory and motor blockade, hemodynamic responses, visual analog score ≥ 3, and the side effects were analyzed. Results: The sensory blockade onset was accelerated in the levobupivacaine subset (7.37 ± 3.59) than in the ropivacaine group (9.66 ± 3.56) and was significant statistically. The mean motor blockade onset was longer in the Ropivacaine subset at 8.49 ± 2.95 minutes compared to the Levobupivacaine group at 6.51 ± 2.36 minutes showed a P value of 0.003 and was significant statistically. The two-segment regression time and the motor blockade duration were longer in the levobupivacaine group (192.86 ± 49.5 and 141.43 ± 35.33) than in the ropivacaine group (163.71 ± 36.63 and 111.43 ± 31.36). The need for postoperative analgesia was faster in the Ropivacaine group than in the Levobupivacaine group. There was no remarkable statistical variation (P value > 0.05) in the hemodynamic parameters at different follow-up periods between both groups. Conclusion: Levobupivacaine has a faster onset and duration of the sensory blockade and motor blockade, and a delayed requirement of post-operative rescue analgesia compared to Ropivacaine without any significant differences in hemodynamic parameters and side effects.

Background: Combined femoral and sciatic nerve blocks are crucial for lower limb orthopedic surgeries. This study compared the efficacy of 0.5% Bupivacaine and 0.5% Ropivacaine in these blocks, focusing on onset time, duration, hemodynamic stability, and postoperative analgesia. Methods: In this cross-sectional study, 60 ASA I-II patients undergoing elective lower limb below-knee orthopedic surgeries were randomized into two groups of 30 each. Group A received 0.5% Bupivacaine (3mg/kg), while Group B received 0.5% Ropivacaine (3mg/kg). Sensory and motor blockades were assessed using Modified Hollmen's and Bromage scales. Postoperative pain was evaluated using VAS scores for 24 hours. Hemodynamic parameters and time to first rescue analgesia were recorded. Results: The study found no significant difference in the onset of sensory block for both femoral and sciatic nerves between the two groups. However, the duration of sensory block was significantly longer in Group A (890.07±11.36 min) compared to Group B (834.50±10.20 min, p<0.001). Group A also demonstrated a significantly faster onset of motor block (21.43±0.77 min vs 22.60±0.69 min, p<0.001) and a longer duration of motor block (242.67±6.39 min vs 192.83±4.86 min, p<0.001). Hemodynamic parameters remained generally stable in both groups, with only minor differences at specific time points. VAS pain scores showed similar progression in both groups, with no significant differences. The time to first rescue analgesia was not significantly different between the groups (Group A: 14.08±1.95 hours, Group B: 13.49±1.71 hours, p=0.222). Conclusion: While both 0.5% Bupivacaine and 0.5% Ropivacaine provided effective anesthesia and postoperative analgesia, Bupivacaine demonstrated superior performance in terms of block duration for both sensory and motor components. Bupivacaine may be preferred for longer procedures or when extended postoperative analgesia is desired, while Ropivacaine could be favored when shorter duration of motor block is preferred. The choice between these agents should be tailored to specific surgical and patient requirements.

BACKGROUND: Transversus abdominis plane (TAP) block in cesarean section is carried out by local anesthetics such as bupivacaine or ropivacaine with a limited duration of analgesia. This double-blind, randomized controlled trial aimed to compare bilateral ultrasound-guided TAP block with bupivacaine and levobupivacaine for analgesia after cesarean delivery performed under spinal anesthesia. Aims: The aim of this study was to compare the duration of postoperative analgesia between levobupivacaine (0.25%) versus bupivacaine (0.25%) alone in the bilateral TAP block after lower segment cesarean section (LSCS). Materials and methods: In this prospective randomized double-blind interventional study, 100 parturients undergoing elective LSCS were included in the study. Patients were randomly divided to receive either 20-ml levobupivacaine 0.25% (Group A; n = 50) or 20-mL bupivacaine (0.25%) bilaterally (Group B; n = 50) in TAP block in a double-blind fashion. The total duration of analgesia, patient satisfaction, total requirement of analgesics in the first 24 h, and the side effects sedation, hypotension, and bradycardia were observed. Statistical analysis: Statistical tests were conducted using SPSS. P < 0.05 was considered as statistically significant. Results: A total of 100 patients were analyzed. Duration of analgesia was significantly longer in Group B (10.94 ± 0.56 h) compared to Group A (6.16 ± 0.81 h) (P < 0.001). Mean consumption of tramadol was 134.77 ± 14.90 mg and 78.89 ± 28.77 mg in Groups A and B (P < 0.001), respectively. All patients in Group B were extremely satisfied while those in Group A were satisfied (P < 0.01). None of the patients experienced any side effect like hypotension or bradycardia. sedaion were comparable in both the groups. Conclusion: 0.25% bupivacaine in TAP block bilaterally for cesarean section significantly increases the duration of postoperative analgesia, decreases postoperative rescue analgesic requirement, and increases maternal comfort compared to 0.25% ml of levobupivacaine.

Introduction: The history of spinal anesthetic begins in 1898, when Professor August Karl Gustav Bier successfully administered it to his friend Hildebrandt. This signaled the start of its application in medicine. Technological developments in anesthesia and surgery have contributed to the growth of day care surgery in recent decades1. Rapid anesthetic onset and offset, efficient postoperative pain management, and an early return of bladder control and mobility—all while minimizing side effects—are the optimal outcomes1. Despite the previous preference for general anesthesia with short-acting drugs, regional anesthesia—especially spinal anesthesia—has become the preferred technique due to its benefits. Material And Method:  The present study was conducted in the Government General Hospital, Nizamabad, Telangana, India. A randomized study was conducted on 100 patients belonging to ASA grade I & II of either sex and ages between 25-50 years posted for different perianal surgeries. After clearance of the Institutional Ethical Committee and written informed consent, 100 selected patients were divided randomly into two groups of 50 each based on a computer-generated randomization table. A detailed pre-anesthetic evaluation including history, thorough general and systemic examination, and all relevant investigations were done. Result: The study was conducted at a single center, which may limit the generalizability of the findings to a broader population. The sample size of 100 patients may not be sufficient to detect small differences between the two groups, potentially limiting the statistical power of the study. The examiner was not blinded to the type of treatment, which could introduce bias in the assessment of outcomes. The study duration of 12 months may not capture long-term outcomes or complications associated with the interventions. Conclusion: In conclusion, this study comparing Hyperbaric Ropivacaine to Hyperbaric Bupivacaine for peri-anal surgeries in ASA grade I and II patients revealed significant differences between the two groups. The intra-thecal 0.75% Hyperbaric Ropivacaine has provided clinically effective surgical anaesthesia for perianal surgeries with rapid return of motor function [101.8 mins vs 147.2 mins], less hemodynamic alterations and better safety profile when compared to Hyperbaric Bupivacaine.

Background: Brachial plexus block is most common peripheral nerve block technique for upper limb surgeries. Present study was aimed to know the efficacy of magnesium sulphate as an adjuvant to Ropivacaine in interscalene brachial plexus block using peripheral nerve stimulator. Material and Methods: Present study was hospital based, randomized, double blinded, clinical trial conducted in patients of age group 18-55 years, ASA grade I and II, posted for above elbow surgeries under peripheral nerve stimulator guided interscalene brachial plexus block. Patients were randomly allocated to Group A {Ropivacaine 0.5% (5mg/ml) with Normal saline} and group B {Injection Ropivacaine 0.5% (5mg/ml) with 0.3ml Magnesium sulphate (150mg)}.  Results: Mean onset time of sensory blockade was earlier in group A, mean onset time of motor blockade was earlier in group A, difference was statistically significant. Mean duration of sensory blockade was less in group A & Mean duration of motor blockade was less in group A, difference was statistically significant. The mean VAS score of Group A at 12hours is 3.95 ± 0.136 and group B is 2.00 ± 0.000, which was statistically significant. Mean VAS score of Group A at 24hours is 4.95 ± 0.316 and group B is 3.00 ± 0.000, which was statistically significant. In Group A, mean duration of postoperative analgesia was 345 ± 57.24 min i.e., 5.75± 0.954 hours and in Group B it was 457.8 ± 35.16 min i.e., 7.63 ± 0.586 hours.  In group A none of the patients had intraoperative complications whereas, two patients in group B suffered from vomiting, which was statistically significant (P value <0.001) Conclusion: Addition of 150 mg magnesium sulphate to 0.5% ropivacaine in interscalene brachial plexus block significantly prolongs the duration of sensory and motor blockade and significantly reduces the requirement of rescue analgesic.

Background: The combination of Ropivacaine and Dexmedetomidine has been suggested to enhance the efficacy of epidural anesthesia. This study aims to compare the effects of Ropivacaine alone with Ropivacaine and Dexmedetomidine for postoperative analgesia in lower abdominal surgeries. Methods: This randomized controlled trial included 122 adult patients scheduled for elective lower abdominal surgeries. Participants were randomly assigned into two groups: Group R (Ropivacaine 0.75%) and Group RD (Ropivacaine 0.75% with Dexmedetomidine). Onset and duration of sensory and motor blockades, sedation scores, and hemodynamic parameters were assessed. Statistical analyses were performed using t-tests and chi-square tests, with p<0.05 considered significant. Results: The onset of sensory and motor blockades was significantly faster in Group RD compared to Group R (6.1±2.5 vs. 11.1±3.1 minutes, p=0.009; 10±2.5 vs. 17±3.1 minutes, p=0.005, respectively). The duration of sensory and motor blocks was significantly prolonged in Group RD (349±52 vs. 196±12.5 minutes, p=0.007; 240±12 vs. 150±34 minutes, p=0.002, respectively). Group RD exhibited more intense motor blockade (Bromage 4: 34.4% vs. 0%, p=0.002) and higher sedation scores (p=0.004). Hemodynamic parameters were comparable between the groups, with no significant side effects observed. Conclusion : Dexmedetomidine, when added to Ropivacaine for epidural anesthesia, enhances the onset, intensity, and duration of sensory and motor blockades and provides better sedation scores without compromising safety. This combination is effective and safe for lower abdominal and lower limb surgeries.

Background and Aims: Literature is sparse comparing the intrathecal use of hyperbaric ropivacaine and levobupivacaine for lower limb procedures. To take advantage of stereoselectivity, ropivacaine and levo-(S)-bupivacaine were developed. Both are less cardiotoxic than bupivacaine. This study was undertaken with the aim of comparing the block characteristics following intra-thecal administration of hyperbaric levobupivacaine (0.5%) with hyperbaric ropivacaine (0.75%) for lower limb orthopedic surgeries under sub-arachnoid block. Material and Methods: This randomised, comparative study was undertaken in a tertiary care, teaching hospital after taking necessary approvals (IRB and IEC), in consenting adult patients fulfilling the inclusion and exclusion criteria, posted for elective lower limb orthopaedic surgeries under subarachnoid block. After standard sample size calculation, a total of 80 patients were enrolled and randomised into two groups (40 patients in each group). Group L received 3 ml of preservative-free, 0.5 percent hyperbaric Levobupivacaine with 20 microgram fentanyl; and Group R received 3 ml of 0.75% hyperbaric Ropivacaine (preservative free) with 20 mcg fentanyl, intra-thecally. The vital parameters, onset of motor and sensory blockade as well as duration of motor and sensory blockade were noted at regular intervals, tabulated and subjected to statistical analysis. Results: As regards to demographic variables, both the groups were comparable. In terms of onset of motor block (minutes), there was a significant difference between the two groups (p = 0.001), with onset of motor block (minutes) being higher for Levobupivacaine. Ropivacaine had a faster onset of motor block as compared to levobupivacaine. Between the two groups, there was a substantial variation in the number of hours that the motor block lasted (p = 0.001), with the duration of motor block (hours) being longer in the levobupivacaine group. Levobupivacaine produced longer lasting motor block than ropivacaine. In terms of onset of sensory block (minutes), there was a significant difference between the 2 groups (t = -8.746, p = 0.001). Ropivacaine had a faster onset of sensory block as compared with levobupivacaine. The duration of sensory block (hours) varied significantly across the 2 groups (p = 0.001), with the Group L (levobupivacainegroup) having longer duration of sensory block (hours). Ropivacaine had a lesser duration of sensory blockade as compared with levobupivacaine. Participants in the group Group L (levobupivacaine group) had a higher proportion of MAP fall >10% from baseline as compared to Group R (Ropivacaine). Conclusions: In demographically similar group of patients, intra-thecal ropivacaine showed earlier onset of both sensory and motor block than levobupivacaine. Duration of both sensory and motor blocks was longer with levobupivacaine than ropivacaine. Hemodynamic parameters (HR, SBP, DBP, ECG, SpO2) remained similar and stable with both the drugs, although the systolic BP fall was more with levobupivacaine than ropivacaine. Level of block achieved with both the drugs in the used doses were similar in our study.

Background: Effective pain management is a crucial aspect of postoperative care for minimally invasive surgeries, such as laparoscopic nephrectomy. Regional anesthesia techniques like the transmuscular quadratus lumborum block (TMQLB) and thoracic paravertebral block (TPVB) have gained attention as part of multimodal analgesia strategies aimed at minimizing opioid use and enhancing recovery. While TPVB is a well-established technique, TMQLB has emerged as a promising alternative due to its ease of administration and potential for broader sensory coverage. This study aimed to compare the analgesic efficacy, opioid-sparing effects, and postoperative recovery outcomes of TMQLB and TPVB in patients undergoing laparoscopic nephrectomy through a prospective randomized controlled trial. Materials and Methods: This prospective, randomized, double-blind, single-center study was conducted to compare the analgesic efficacy and recovery outcomes of transmuscular quadratus lumborum block (TMQLB) and thoracic paravertebral block (TPVB) in laparoscopic nephrectomy patients. A total of 68 participants, aged 17–80 years and classified as ASA I–III, were enrolled and randomized into two groups. All blocks were performed under ultrasound guidance using 0.5% ropivacaine at a dose of 0.4 ml/kg. The primary outcome was 48-hour postoperative cumulative morphine consumption, while secondary outcomes included sensory block dermatomes, intraoperative hemodynamic changes, Numerical Rating Scale (NRS) pain scores, postoperative recovery data, and quality of recovery scores. Data analysis was performed using GraphPad software, with a significance threshold of p < 0.05. Results: A total of 68 patients were randomized into two groups (n=34 each), with 30 patients per group included in the final analysis. Both groups had similar baseline characteristics. Postoperative cumulative morphine consumption was significantly lower in the TPVB group at all time points (p < 0.05), though pain scores were comparable. The postoperative pain NRS at rest and on movement, incidences of side effects, anesthesia-related satisfaction, and quality of recovery scores were similar between the two groups (all P > 0.05). The TMQLB group achieved a broader sensory block (p = 0.002). Intraoperative hemodynamics were stable, with no significant differences between groups. The TMQLB group required more sevoflurane and fentanyl. Postoperative recovery, including gas passing, urination, mobilization, and length of stay, showed no significant differences. Complication rates and quality of recovery were similar, with high patient satisfaction in both groups. Conclusion: The present study demonstrated that transmuscular quadratus lumborum block (TMQLB) provides a comparable postoperative analgesic effect to T10-level thoracic paravertebral block (TPVB), as reflected by similar 48-hour cumulative morphine consumption in patients undergoing laparoscopic partial nephrectomy. TMQLB shows promise as a viable alternative to TPVB in select surgical settings and patient populations, warranting further research to explore its potential applications and benefits.

Background: This study aimed to evaluate the effectiveness of a low dose of hyperbaric ropivacaine administered with and without fentanyl via intrathecal injection in elderly patients undergoing mesh hernioplasty. Method: Eighty patients were randomly assigned to two groups of 40. Group RP received 2ml of 15mg hyperbaric Ropivacaine (0.75%) combined with 0.2ml normal saline (total volume of 2.2ml), while Group RF received 2ml of 15mg hyperbaric Ropivacaine (0.75%)  with 10ug of fentanyl (also total 2.2ml), both administered intrathecally. The onset, duration, quality of sensory-motor block, and any side effects were recorded for both groups. Results: The onset of sensory-motor block was significantly early in the RF group compared to the RS group (p<0.05). In terms of peak sensory dermatome level, 80% of patients in the RF group reached T8, compared to 65% in the RS group. Additionally, the duration of sensory-motor block was significantly longer with prolonged postoperative analgesia in the RF group (p<0.05), with better overall anesthesia quality reported. Both groups maintained hemodynamic stability with no difference in side effect between both group. Conclusion: The findings of our study strongly support the use of a low dose of hyperbaric ropivacaine combined with fentanyl for spinal anesthesia in elderly patients undergoing mesh hernioplasty. This combination offers rapid onset, superior quality of anesthesia, and a lack of side effects, reinforcing its effectiveness in elderly patients.

Background: Intrathecal administration of local anaesthetic drug for spinal anaesthesia can achieve adequate sensory and motor blockade required for lower limb orthopaedic surgeries. However, the traditionally used drug bupivacaine has been associated with severe cardiovascular and CNS toxicity. Newer long-acting local anaesthetics, levobupivacaine and ropivacaine due to their three-dimensional structure seem to have lesser toxic effects on the central nervous system and the cardiovascular system. Through our study we intend to clinically compare the efficacy of 0.75% hyperbaric ropivacaine and 0.5% hyperbaric levobupivacaine in spinal anaesthesia. Materials and methods:  A prospective, randomized, double blinded, clinical, parallel arm study was conducted including a total of 70 patients posted for lower limb orthopaedic surgery. The patients were randomly divided into 2 groups of 35 patients each. Group A received 15 mg 0.5% (3ml) hyperbariclevobupivacaine for spinal anaesthesia. Group B received 22.5 mg 0.75% (3ml) hyperbaricropivacaine for spinal anaesthesia. The total duration of analgesia along with time taken for onset and regression of sensory block and motor block was recorded and statistical analysis was performed. The two groups were also compared based on peri-operative hemodynamic parameters and adverse effects encountered. Results & conclusion: The findings in the 2 groups were comparable regarding duration of analgesia, the maximum dermatomal height of sensory block and the time required to achieve maximum dermatomal height. However, hyperbaric 0.75% ropivacaine was found to produce faster onset as well as regression of sensory and motor block compared to hyperbaric 0.5% levobupivacaine.

Background: Regional anaesthesia and in particular brachial plexus block, is very useful for patients undergoing upper limb surgeries. It offers sympathetic blockade, better postoperative analgesia and fewer side-effects compared to general anaesthesia. Supraclavicular approach provides a denser block to upper arm elbow and forearm. Aim: The present study aimed to evaluate the effect of adding Dexamethasone to 0.75% Ropivacaine for supraclavicular block with consideration to the onset and duration of sensory and motor blockade, hemodynamic variables, postoperative analgesia and complications. Materials and methods: A prospective observational comparative study was conducted in 60 ASA I & II patients undergoing upper limb surgeries. They were divided into two groups of 30 each. Group (R) received Ropivacaine (0.75%) 28 ml+ Inj. Normal Saline 2ml. Group (RD) received ropivacaine (0.75%) 28 ml+ Inj. Dexamethasone 2ml (8mg).Demographic data, hemodynamic variables, onset and duration of sensory and motor blockade, total rescue analgesics consummation, post-operative VAS, side effects and patient satisfaction were recorded. Results: Demographic, haemodynamic and surgical characteristics were similar in both the groups. The mean onset of sensory and motor block were similar in both the groups. The mean duration of sensory and motor blockage were longer in group RD (P<0.05) and Post operative analgesia and total rescue analgesics were higher in group RD compared to group R. Both these data were highly significant statistically. Conclusion: Ropivacaine (0. 75%) with Dexamethasone can be safely used in supraclavicular brachial plexus block and it has prolonged duration of anaesthesia as well as prolonged post-operative pain relief in comparison with Ropivacaine alone without any side effects.

Background: Brachial plexus anaesthesia has been an indispensable tool in the anaesthesiologist’s armamentarium. Clinical studies have shown that levobupivacaine and ropivacaine have fewer adverse effects on the cardiovascular and central nervous system making them more advantageous in regional anaesthesia techniques. Less information is available regarding their comparable clinical data. Only a few studies have compared levobupivacaine and ropivacaine for brachial plexus blocks; hence, this study was aimed to compare the analgesic effectiveness and nerve block characteristics of ropivacaine and levobupivacaine in supraclavicular brachial plexus blocks in upper limb surgeries. Methods: Patients with American Society of Anaesthesiologists physical status I or II coming for elective upper limb surgeries were included in the study. Total numbers of 62 patients were randomly allocated into two groups, group A and group B. Group A received 25 mL of 0.75% ropivacaine, and group B received 25 mL of 0.5% levobupivacaine. The duration of analgesia, onset of block, duration of sensory, and motor blockade were studied and compared. Results: The mean duration of analgesia in group ropivacaine was 8.33 hours and in group levobupivacaine was 10.23 hours which was statistically significant. Ropivacaine had a faster sensory onset compared to levobupivacaine (5.22 vs. 6.88 minutes). The duration of sensory and motor blockade was longer with levobupivacaine than ropivacaine (sensory-8.64 vs. 10.29 hours, motor-8.32 vs. 9.8 hours). Conclusion: Levobupivacaine had longer duration of analgesia. The sensory and motor blockade was also longer with levobupivacaine.

Background: Selection of appropriate local anesthetic agents plays a crucial role in optimizing patient comfort, procedural success, and postoperative outcomes in pain management. Lidocaine, bupivacaine, and ropivacaine are widely used, each with distinct pharmacological profiles. Objective: To compare the efficacy, duration of analgesia, onset time, adverse effects, and patient satisfaction of three anesthetic agents—lidocaine, bupivacaine, and ropivacaine—in patients undergoing pain management procedures. Methods: A randomized clinical trial was conducted on 90 patients divided into three groups (n=30 each). Group A received lidocaine 2%, Group B bupivacaine 0.5%, and Group C ropivacaine 0.75%. Parameters assessed included onset of action, duration of analgesia, adverse effects, and satisfaction scores. Results: Lidocaine exhibited the fastest onset (2.2 ± 0.4 minutes) but the shortest duration (2.9 ± 0.6 hours). Bupivacaine had intermediate duration (6.4 ± 1.2 hours), while ropivacaine showed the longest analgesia (7.3 ± 1.0 hours) with minimal adverse events. Patient satisfaction was highest with ropivacaine (4.6 ± 0.5). Conclusion: Ropivacaine provided superior outcomes in terms of prolonged analgesia and safety, suggesting it may be preferred for extended pain relief in clinical practice.

Introduction: Ropivacaine, being less lipophilic than bupivacaine leads to a reduced motor blockade allowing for sensory-motor differentiation. This makes ropivacaine particularly useful in situations where lesser muscle relaxation is desired. Various adjuvants have been used to prolong the duration of analgesia. Dexmedetomidine, a newer α2 agonist is currently gaining attention for its sedative, anxiolytic, and analgesic properties. Aim: This prospective, randomised, double blinded study was done to determine the efficacy of lower concentration of ropivacaine (0.2%) in providing adequate blockade and to determine the effects of adding dexmedetomidine to 0.2% ropivacaine for enhancing the analgesic properties. Methods: This study was done on 60 patients undergoing elective below elbow surgeries. Patients were randomly allocated into two groups: Group RN received 40ml of 0.2% ropivacaine with 1ml of normal saline and Group RD received 40ml of 0.2% ropivacaine with 1mcg/kg dexmedetomidine. The time for onset of sensory, motor blockade, duration of sensory and motor blockade, hemodynamic variability and side effects were recorded. Results: There was no statistical difference in the time for onset of sensory blockade between the groups. Onset of motor blockade was significantly faster in group RD (5.4 +/- 2.4 minutes) than that of group RN. The duration of sensory blockade was significantly longer in group RD (1440+/- 360 minutes) than that of group RN with P value <0.01. There was no significant difference in the duration of motor blockade between the two groups. Total duration of analgesia was longer with group RD (894 minutes). Minimal variations in hemodynamic parameters observed without any side effects. Conclusion: We conclude that 0.2% ropivacaine is sufficient to provide adequate anesthesia for below elbow surgeries and profound prolongation of analgesia was obtained on addition of perineural dexmedetomidine to 0.2% ropivacaine.

Introduction: Ropivacaine, a pure S (-) enantiomer of bupivacaine has a better safety profile due to its reduced neurotoxicity and cardiotoxicity. Various adjuvants like opioids, clonidine, dexamethasone etc have been used to improve the quality of blockade. Dexmedetomidine is a selective alpha-2 agonist and has been used widely in recent studies. Nalbuphine, a mixed opioid receptor agonist-antagonist, provides analgesia through κ-receptor activation and mitigates side effects such as respiratory depression, pruritus, nausea, and vomiting by antagonizing μ-receptors. Very few studies have compared intrathecal dexmedetomidine and nalbuphine as adjuvants to hyperbaric ropivacaine. Aim: This prospective, randomised, double blinded study was done to determine and compare the effects of adding dexmedetomidine or nalbuphine to 0.75% hyperbaric ropivacaine in patients undergoing infraumbilical surgeries. Methods: This study was done on 80 patients undergoing elective infraumbilical surgeries. Patients were randomly allocated into two groups: Group RD recieved 3.2ml of 0.75% hyperbaric ropivacaine along with 10 μg of Inj. Dexmedetomidine (0.1ml of dexmedetomidine reconstituted with 0.2ml normal saline) while Group RN received 1mg of inj. Nalbuphine (0.1 ml of nalbuphine reconstituted with 0.2ml normal saline) along with 3.2ml of 0.75% hyperbaric ropivacaine The time for onset of sensory, motor blockade, duration of sensory and motor blockade, hemodynamic variability and side effects were recorded. Results: Onset of sensory and motor blockade was significantly faster in group RD (7.93 and 4.2 minutes respectively) than that of group RN. The duration of sensory and motor blockade was significantly longer in group RD (647.38 and 524.88 minutes) than that of group RN with P value <0.01. Also, the highest level of sensory blockade was T4 in 12.8% and T6 in 87.5% individuals with dexmedetomidine. Both the groups showed hemodynamic stability with no side-effects. Conclusion: We conclude that dexmedetomidine, as an adjuvant to hyperbaric ropivacaine, provided superior blockade and analgesia compared to nalbuphine

Background: Effective postoperative pain control enhances recovery and patient satisfaction. The Transverse Abdominis Plane (TAP) block is an established regional anesthesia technique for abdominal surgeries. This study compares the efficacy of 0.25% Bupivacaine and 0.5% Ropivacaine in TAP blocks for postoperative analgesia. Aim: To evaluate the effectiveness of 0.25% Bupivacaine versus 0.5% Ropivacaine in TAP block in terms of duration of analgesia, time to first rescue analgesia, pain intensity, hemodynamic stability, and complications. Materials and Methods: This was a prospective, randomized, single-blinded controlled trial involving 60 patients (ASA I–II) undergoing elective abdominal surgeries under general anesthesia. Patients were randomly allocated into two groups: Group B (Bupivacaine, n=30) and Group R (Ropivacaine, n=30), receiving 15 ml of the respective drug bilaterally in the TAP block. Postoperative pain was assessed using the Visual Analog Scale (VAS) and rescue analgesia was administered when VAS >3. Results: Ropivacaine provided significantly longer analgesia (725.33 ± 18.89 min vs. 408 ± 14.10 min; p=0.001) and delayed time to first rescue analgesia (735.33 ± 18.89 min vs. 417.67 ± 15.01 min; p=0.001). VAS scores were consistently lower in the Ropivacaine group at key time intervals. Hemodynamic parameters remained stable in both groups. No complications were reported. Conclusion: 0.5% Ropivacaine is superior to 0.25% Bupivacaine for TAP block in providing prolonged postoperative analgesia with better pain control and no additional complications.

Background: Pediatric lower abdominal surgeries often necessitate effective intraoperative and postoperative pain control. Opioid-based analgesia, though effective, is associated with adverse effects. Caudal anesthesia, a regional technique, may offer effective analgesia and reduce the need for systemic opioids. Aim: To evaluate the effect of caudal anesthesia on intraoperative opioid (fentanyl) requirements and hemodynamic parameters in pediatric patients undergoing lower abdominal surgeries. Methods: This prospective study enrolled 60 pediatric patients aged 1–10 years, undergoing elective lower abdominal surgeries. Patients were randomized into two groups: Group 1 received caudal anesthesia using ropivacaine 0.5 ml/kg, while Group 2 received no caudal block. All patients were administered fentanyl at induction and additionally intraoperatively as required. Hemodynamic parameters and total fentanyl consumption were recorded and analyzed. Results: Group 1 showed significantly reduced intraoperative fentanyl requirements compared to Group 2 (mean 0.8 ± 0.3 mcg/kg vs. 2.2 ± 0.4 mcg/kg, p<0.001). Hemodynamic stability was superior in Group 1 with fewer fluctuations in heart rate and blood pressure. Conclusion: Caudal anesthesia with ropivacaine significantly reduces intraoperative opioid consumption and maintains better hemodynamic stability in pediatric patients undergoing lower abdominal surgeries.