Comparison of hemodynamic and anesthetic effects of hyperbaric bupivacaine and tetracaine in spinal anesthesia

Evaluation of the anesthetic effect of nasal mucosa with tetracaine 0.5% on hemodynamic changes and postoperative pain of septoplasty: A randomized controlled trial

The nasal septum repair surgery is the dangerous operations that any stimulation of this area causes a large change in the rhythm of the heartbeat and blood pressure. This study aimed to determine the effects of tetracaine 0.5% on changes in heartbeat and heart rhythm, hemodynamic changes during surgery, intraoperative bleeding, and pain after septoplasty surgery. The irregular double-blind clinical trial registry of clinical trials Iran with the code number (IRCT: 20150526625N8) in the first half of 2013 on 86 patients in Kashani hospital of Shahrekord. Having selected and matched the patients were divided into two groups. Case group was dropped tetracaine 0.5% in each of the nasal cavity 15 min before the beginning of the operation. The control group was dropped distilled water 15 min preoperation in each of the nasal cavity. The surgery lasted about 30-60 min. Clinical symptoms were evaluated after anesthetic induction as well as pain using the visual analog scale after the operation, in the recovery room. The collected data were analyzed using SPSS version software 17 through independent t-test, Chi-square, and repeated measures variance analysis. Postoperative pain intensity in the experimental group compared to the control group was significantly lower than the control group (P < 0.05); however, blood pressure and heart rate during anesthesia, there was no difference between groups (P > 0.05). Based on the findings, intake of tetracaine drop 0.5% has no impact on some hemodynamic changes during septoplasty operation. However, compared with the control group, pain was significantly reduced.

Single dose intravenous dexmedetomidine prolongs spinal anesthesia with hyperbaric bupivacaine

Background and Introduction:

Spinal block, a known technique to obtain anaesthesia for infraumblical surgeries. Now physician have advantage of using adjuvant to prolong the effect of intrathecal block, which can be given either intravenously or intrathecally, dexmedetomidine is one of them. We studied effect of intravenous dexmedetomidine for prolongation of duration of intrathecal block of 0.5% bupivacaine block.

Objective:

To evaluate the effect of intravenous dexmedetomidine on sensory regression, hemodynamic profile, level of sedation and postoperative analgesia.

Methodology:

60 patients of ASA grade I and II posted for elective infraumblical surgeries were included in the study and randomly allocated into two groups. Group D recieved intrathecal 0.5% bupivacaine heavy, followed by infusion of intravenous dexmedetomidine 0.5mic/kg over 10 min, patients in group C received intrathecal 0.5% bupivacaine heavy 3ml followed by infusion of same volume of normal saline as placebo.

Results:

Two segment regression of sensory block was achieved at 139.0 ± 13.797 in group D whereas in group C it was only 96.67 ± 7.649min, the total duration of analgesia achieved in both study groups was 234.67 ± 7.649min and 164.17 ± 6.170min respectively in group D and group C. The time at which first analgesic was given to the patients when VAS >3 achieved that is in group D at 234.67 ± 7.649min and in group C at 164.17 ± 6.170min. Inj diclofenac sodium 75mg intramuscular was used as rescue analgesic.

Comparison of the effects of pre-anesthetic administration of normal saline, ringer and voluven on the spread of sensory block with hyperbaric bupivacaine spinal anesthesia

BACKGROUND

Spinal anesthesia is an important and commonly used method for surgical anesthetic in operating rooms. However, even with identical drug dosage and administration mode, the extent of drug distribution in vivo is highly variable and difficult to control. Preanesthetic administration of fluids immediately before spinal anesthesia (preload) is normal practice. The choice of fluid type may affect drug distribution as well as the duration and level of the block.

OBJECTIVES

We examined whether preloads of normal saline, Ringer, or hydroxyethyl starch has different effects on the time it takes to reach maximum block, and the distribution and duration of spinal block level.

PATIENTS AND METHODS

This was a randomized trial and the 150 patients selected were evenly divided into three groups and given; normal saline, Ringer, or hydroxyethyl starch 130/0.4f luids. Preload was given at 10 mL/kg for the normal saline and Ringer groups, and 5 mL/kg for the hydroxyethyl starch group, 10 min before the spinal anesthesia. Sensory block levels were recorded every 5 min until 30 min after spinal anesthesia and then at 60 and 90 min. Time taken to reach maximum and median sensory block, maximum and median level of block, duration of block, and hemodynamic status were recorded.

RESULTS

There were no statistically significant differences in the demographic characteristics between the three groups. Maximum block was higher in normal saline compared to Ringer (P = 0.029). Time taken to reach maximum block was greater in Ringer compared to both normal saline (P = 0.001) and hydroxyethyl starch (P = 0.003). Normal saline had a longer duration of sensory block T10 compared to Ringer and hydroxyethyl starch (P = 0.03).

CONCLUSIONS

Preload fluids have an impact on the level, distribution and duration of sensory block in spinal block. Of the three fluids, normal saline produced the greatest maximum and longest duration of block, whereas time taken to reach maximum block was longer in the Ringer group.

Anaesthetic Agents for Advanced Regional Anaesthesia

Interest in the use of regional anaesthesia, particularly peripheral nerve blocks (PNBs) and continuous PNBs, has increased in recent years. Accompanying this resurgence in interest has been the development of new local anaesthetics and additives designed to enhance block duration and quality. This manuscript provides a literature-based review on accepted uses of local anaesthetics and adjuncts for a variety of regional anaesthesia techniques. A brief review of local anaesthetic pharmacodynamics describes the action of these drugs in preventing nerve depolarisation, thus blocking nerve impulses. Toxic adverse effects of local anaesthetics, specifically CNS and cardiac manifestations of excessive local anaesthetic blood concentrations and the direct neurotoxic properties of local anaesthetics, are discussed generally and specifically for many commonly used local anaesthetics. Clinically useful ester and amide local anaesthetics are evaluated individually in terms of their physical properties and toxic potential. How these properties impact on the clinical uses of each local anaesthetic is explored. Particular emphasis is placed on the long-acting local anaesthetic toxic potential of racemic bupivacaine compared with levobupivacaine and ropivacaine, which are both levorotatory stereoisomers. Guidelines for using ropivacaine and mepivacaine, based on the authors' experience using advanced regional anaesthesia in a busy practice, is provided. Finally, epinephrine (adrenaline), clonidine and other local anaesthetic additives and their rationale for use is covered along with other future possibilities.