Comparative analgesic efficacy of intravenous vs intrathecal dexmedetomidine as an adjuvant to hyperbaric bupivacaine in subarachnoid block for below knee orthopaedic surgery

Dural sac cross-sectional area measured using ultrasound to modify the dosage of local anaesthetic in spinal anaesthesia for transurethral resection of prostate surgery: A prospective, double blind, randomised controlled study

BACKGROUND AND AIMS

The area of lumbar spinal canal decreases with age, and hence the level of sensory blockade is higher in the elderly after spinal injection. The present study optimised the dose of local anaesthetic in elderly patients based on the lumbar dural sac cross sectional area (DSCSA) determined using ultrasound.

METHODS

Sixty patients of age above 60 years undergoing transurethral resection of prostrate (TURP) surgery in a tertiary care hospital were included in the study. Patients were categorised into two groups of 30 each based on a computer-generated random number table. In the control group (C), 2 ml of 0.5% hyperbaric bupivacaine was given and in the ultrasound group (U), the drug dose was modified according to DSCSA which was measured using the formula area = p (diameter/2) ².

RESULTS

The DSCSA and bupivacaine dosage were significantly lower in group U compared to control group (P = 0.0001). The maximal level of cephalad spread of sensory blockade was significantly lower in ultrasound group, than in control group (P = 0.002). The two-segment block regression time and motor recovery time was less in group U. Higher mean arterial pressure (105.8 ± 9.66 mmHg; P = 0.007), and a lower decrease from baseline (14.15 ± 7.55%; P = 0.041) was noted in group U after subarachnoid block.

CONCLUSION

The estimation of DSCSA is an effective parameter and can be used to modify the dose of local anaesthetic for subarachnoid block in elderly patients undergoing TURP surgery.

Comparison of block characteristics of intrathecal isobaric levobupivacaine versus isobaric ropivacaine for infra-umbilical surgeries in school-age children: A prospective randomised double-blind study

Background and Aims:

Levobupivacaine and ropivacaine are effective local anaesthetic drugs used in regional anaesthesia with low cardio-neurotoxicity profile than bupivacaine, but comparative studies are limited in children. So, we compared these two drugs intrathecally to study their efficacy and safety in school-age children.

Methods:

This study was carried out in 60 American Society of Anesthesiologists class I, II and III patients aged 6–12 years, of either sex undergoing infra-umbilical surgeries. After institutional ethical committee approval and written informed consent, the patients were randomly divided into two groups. Group A received isobaric levobupivacaine (0.5%, 0.3-0.4 mg/kg), whereas group B received isobaric ropivacaine (0.5%, 0.5 mg/kg) intrathecally. Fentanyl (0.2 μg/kg) was used as an adjuvant in both the groups. Onset, peak and duration of sensory and motor blockade, duration of post-operative analgesia, time for micturition, perioperative haemodynamic parameters and complications were compared.

Results:

Onset and peak of sensory and motor block were earlier in group A. Significantly longer duration of sensory and motor block was achieved in group A (251 ± 41 min, 201 ± 40 min) compared to group B (211 ± 21 min, 102 ± 16 min) (P < 0.001). The time to first rescue analgesic was also significantly prolonged in group A (270 ± 39 min) compared to group B (233 ± 18 min) (P < 0.001). Time to micturition was much early in group B (157 ± 27 min) compared to group A (225 ± 31 min) (P < 0.001).

Conclusion:

Intrathecal isobaric levobupivacaine and ropivacaine with fentanyl produces effective surgical anaesthesia and postoperative analgesia without any adverse effects. Early regression of sensorimotor blockade makes ropivacaine better in comparison to levobupivacaine for short infra-umbilical surgeries in children.