European Journal of Cardiovascular Medicine

Introduction:   Spinal anaesthesia (or spinal anesthesia), also called spinal block, subarachnoid block, intradural block and intrathecal block is a form of neuraxial regional anaesthesia involving the injection of a local anaesthetic or opioid into the subarachnoid space, generally through a fine needle, usually 9 cm (3.5 in) long. It is a safe and effective form of anesthesia usually performed by anesthesiologists that can be used as an alternative to general anesthesia commonly in surgeries involving the lower extremities and surgeries below the umbilicus. Epidural anesthesia is a technique that may be used as a primary surgical anesthetic or as a resource for postoperative pain management. It is safe and relatively easy to learn and perform. Material and methods: This are a prospective study was conducted in the Department of Anesthesia at Khaja Bandanawaz Institute of Medical Sciences, Kalaburgi over a period of 1 year. Spinal anaesthesia was given under all sterilised precaution, 3 ml of 0.5% bupivacaine heavy using a 25-gauge Quincke’s spinal needle through the L3-L4 intervertebral space in the sitting posture. Before giving the local anaesthesia, each patient throughout the technique asked to report verbally any time if he feels distress. Results: Duration to perform the procedure was significantly longer with epidural than spinal block. Intraoperative fluid requirement was statistically higher in Spinal than Epidural (p<0.0001). Duration of Surgery was significantly shorter in Spinal as compared to Epidural (p=0.0019). Systolic and mean blood pressure showed statistically significant reduction in Spinal as compared to Epidural (p<0.001). Duration of ambulation was significantly shorter in Epidural as compared to Spinal (p<0.001). Conclusion: Epidural anaesthesia can be a safe alternative to spinal anaesthesia for elective inguinal hernia repair.

Background: Postoperative pain is the major cause of fear and anxiety leading to prolonged hospital admission and delayed discharge rates in hospitalized patients. So, to make the patient pain free, multimodal analgesia has been used since long time. Opioids as an adjunct to epidural local anaesthetics by many people, but opioid free analgesia is a major concern in recent times to avoid its respiratory depressant and other adverse effects. Objective: studying non opioid drugs namely α2 agonist dexmedetomidine and magnesium sulphate as an adjunct to epidural bupivacaine and to compare their hemodynamic, sedative and analgesic effects. Methods: A randomized double blinded study was conducted in 60 patients of either sex belonging to ASA class I and II scheduled for elective lower abdominal and lower limb surgeries under epidural anaesthesia. They were divided randomly into two groups (n = 30). After epidural block, test dose was given with 3 ml 2% lignocaine with adrenaline. Both the groups received 15ml 0.5% bupivacaine, group MB received 50mg magnesium sulphate and group DB received 25µg dexmedetomidine. Onset and duration of sensory blockade, motor blockade; time required for first rescue analgesia; Ramsey sedation score; cardiorespiratory parameters and adverse events were recorded. Result:   Onset of sensory and motor blockade was rapid: duration of sensory and motor blockade; and the time for rescue analgesic was prolonged with higher sedation in group DB. Cardiorespiratory parameters and adverse effects were comparable between the two groups. Conclusion: Addition of dexmedetomidine to epidural bupivacaine can be advantageous with increased duration of sensory and motor blockade with arousable sedation, acceptable side effects and better patient comfort compared to addition of magnesium sulphate.

Background: Epidural analgesia is widely regarded as the preferred method for pain management, facilitating early mobilization following orthopedic surgery and promoting enhanced bowel function. Methods: A total of 50 patients were randomly allocated into two groups of equal size, both of which were scheduled to undergo elective lower limb surgery. Group A was administered a dosage of 1 µg/kg of fentanyl, while Group B received a dosage of 1 mg/kg of tramadol. In both cases, the medications were diluted to a volume of 10 ml using 0.9% normal saline. Following the surgical procedure, patients underwent a comprehensive evaluation that included the assessment of various parameters such as the visual analogue scale (VAS) for pain, sedation score, respiratory rate, haemodynamic stability, onset of analgesic effect, quality and duration of pain relief, frequency of epidural doses, and the occurrence of any adverse effects. Results: The mean duration of analgesia onset in group A and group B was found to be 12.47± 2.51 minutes and 6.15±1.75 minutes, respectively (p < 0.001). The mean duration of analgesia in group A was 8.06±1.25 hours, while in group B it was 5.4±0.97 hours (p <0.001). Throughout the study, it was observed that the Visual Analog Scale (VAS) scores were consistently lower in group A. The mean visual analog scale (VAS) score was found to be statistically significant at p < 0.05 up to 24 hours, but at 48 hours, the p-value was greater than 0.05. In Group B, five individuals experienced symptoms of vomiting, while four individuals reported experiencing nausea. In Group A, two individuals reported symptoms of vomiting, two individuals reported experiencing nausea, and four patients experienced episodes of purities. Conclusion: Based on our research, it can be inferred that fentanyl exhibits a prompt onset and superior analgesic efficacy. Additional frequent top-ups were necessary when administering fentanyl

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.

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:  Levobupivacaine is an optical isomer of bupivacaine of the amide class and is linked to a decreased risk of toxicity than either the dextro-enantiomer itself or the racemic bupivacaine Levobupivacaine slows the transmission of the action potential in neurons that regulate sensory Aim: The present study aims at finding suitable adjuvant to Levobupivacaine for controlling of post-operative pain under epidural technique in surgical intensive care units of Nalanda Medical College and Hospital, Patna, Bihar, India  Methods: This was a Randomized double blinded controlled trial conducted at Department of Anaesthesia & Intensive Care, for the period of 24 months. However, this study was restricted only to the elective lower limb orthopaedic surgeries. Total number of patients seen at our Institute during the study period was 60 with 30 patients in each group. 60 healthy patients of ASA physical status I and II who undergone lower limb orthopaedic surgery were included in our study. After completion of the surgical procedure patients were shifted to post-operative care unit. They were divided into two groups -Group I and Group II and postoperative analgesia were maintained with the study drug according to the drug schedule: Group I: Received 10 ml injection of Levobupivacaine .125% with .5 mcg/kg Dexmedetomidine via epidural route. Group II: Received 10 ml injection of Levobupivacaine .125% with 1 mcg/kg Fentanyl via epidural route. Results: Observation showed that dexmedetomidine was better adjuvant to levobupivacaine as compared to fentanyl group. Number of top-ups required were significantly greater in fentanyl group in 24 hours. At the end of 24 hours majority of patients with Dexmedetomidine were pain free and satisfied with postoperative analgesia. Degree of complications (respiratory depression, nausea & vomiting) were observed more with the Fentanyl group in comparison to Dexmedetomidine group. Conclusion: In this randomised controlled trial, dexmedetomidine was found to be superior than fentanyl with better post-operative analgesia and less requirement of additional analgesics, less respiratory depression, less incidence of nausea or vomiting, urinary retention and low level of sedation. However, patients in fentanyl were more haemodynamically stable as compared to dexmedetomidine group. In this clinical trial, it can be concluded that the use of dexmedetomidine as an adjuvant to the local anaesthetic agent during epidural block hastens the onset of sensory and motor blockade, provides a longer duration of analgesia, decreases the total analgesic requirement, and is not associated with nausea like fentanyl and tramadol, which cause clinically significant and unmanageable side effects.

Background: Dexmedetomidine acts on the rostral ventrolateral medulla (RVLM, cardiovascular regulatory centre), downregulating the neuronal activity of the RVLM. It is highly lipid soluble, has a strong meningeal penetration, and is easily absorbed by the brain and spinal cord after being administered via the epidural route. In order to assess and compare the haemodynamic profiles of bupivacaine alone and in conjunction with modest doses of dexmedetomidine, a prospective research study was conducted on patients undergoing orthopaedic surgery. Methods: This was a prospective randomized study carried out over a period of 18 months involving 60 patients aged 20-55 years of ASA grade I & II scheduled for elective. Group D patients were administered 18 ml of 0.5% isobaric bupivacaine with 0.5 µg/kg dexmedetomidine. Group P patients were administered 18 ml of 0.5% isobaric bupivacaine with normal saline, volume made equivalent to that of dexmedetomidine. HR, RR, SBP, DBP, MAP, and SpO2 were recorded intra-operatively every 5 minutes for the first 60 minutes, then every 15 minutes till the end of surgery, and thereafter every 30 minutes till the time for rescue analgesia. Sedation score was assessed periodically. Results: Both groups were comparable with regards to age, weight, height distribution and ASA grading. There was no statistically significant difference in oxygen saturation levels of both groups. From 25 minutes after induction till 300 minutes, the mean heart rate in group D was lower than in group P. This difference was statistically significant (p<0.05). The mean systolic, diastolic and mean blood pressures were significantly lower in the D group compared to the P group at various study points. Conclusion: The addition of dexmedetomidine, an alpha-2 agonist, to the local anesthetic solution for the conduct of a lumbar epidural block in the dose of 0.5 mcg/kg provides a stable hemodynamic milieu during elective lower limb surgeries with good block characteristics, improved sedation scores and enhanced postoperative analgesia.

Introduction: The determination of the landmarks by the clinician enables the sacral hiatus to be ascertained and may increase the success rate of Caudal Epidural Block. The reliability and success of caudal epidural anaesthesia depends upon anatomical variations of sacral hiatus. The present study was conducted to find out different morphological features and anatomical variations of sacrum and sacral hiatus. Methods: An observational study was conducted on 70 adult sacra of unknown sex obtained from Department of Anatomy, Government Medical College, Machilipatnam, Andhra Pradesh. Vernier callipers was used to take the measurements on the intact parts of normal bone. Results: An inverted ‘U’ shape was the predominant shape of the sacrum observed in the present study. The level of apex of hiatus was observed at the 4th Sacral vertebrae and the Level of the base of hiatus at the 5th sacral vertebrae. The mean Height of Sacral Hiatus was 21.02±5.68 and Width was calculated to be 12.51±2.09. The mean Distance from SH Apex to S2 level was 29.78±6.32 And the mean Distance from SH Base to S2 level was 51.37±4.12. Distance b/w Upper Border S1 & SH Apex was 57.84±7.51. Conclusion:  These findings provide valuable anatomical insights for clinical procedures involving the sacral region, such as caudal epidural blocks, highlighting the importance of understanding morphological variations for safe and effective interventions.