Introduction: Adding adjuvant drugs to intrathecal local anesthetics improves the quality and duration of the sensory blockade and prolongs postoperative analgesia. Intrathecal opioids are synergistic with local anesthetics, thereby intensifying the sensory block without increasing the sympathetic block. This study was designed to comparatively evaluate the two different dosages of nalbuphine as intrathecal adjuvants on subarachnoid block (SAB) characteristics of 0.5% hyperbaric bupivacaine. Methods: A randomized, triple arm study was conducted on 60 adult female patients with American Society of Anesthesiologists physical status I and II, aged 30-60 years, scheduled for total abdominal hysterectomy under SAB. Patients were randomized into three groups: group I received 15 mg of 0.5% hyperbaric bupivacaine, group II received 15 mg of 0.5% hyperbaric bupivacaine with 1.6 mg of nalbuphine, and group III received 15 mg of 0.5% hyperbaric bupivacaine with 2.4 mg of nalbuphine. The primary outcome was the duration of analgesia, while secondary outcomes included onset, duration of sensory and motor block, maximum cephalic extension, and two dermatome segment regressions. Results: The onset time of the sensory block was 3.2 ± 1.0 minutes, 3.5 ± 1.6 minutes, and 3.1 ± 1.1 minutes in groups I, II, and III, respectively. The onset time of the motor block was 8.5 ± 1.0 minutes, 8.5 ± 1.1 minutes, and 8.2 ± 1.1 minutes in groups I, II, and III, respectively. The onset of sensory and motor blocks was comparable among the three groups with no statistically significant difference (p > 0.05). The total duration of analgesia was 117.8 ± 23.3 minutes, 166.8 ± 27.8 minutes, and 181.8 ± 25.9 minutes in groups I, II, and III, respectively, with a statistically significant difference. Few incidences of manageable hypotension, but no incidences of bradycardia or respiratory insufficiency, occurred. Five patients of the control group shivered, which was managed well by tramadol 50 mg and ondansetron 4 mg. No patient suffered from pruritus, sedation, respiratory depression, nausea, and vomiting. Conclusion: The study concluded that intrathecal nalbuphine in a 1.6 mg dose is an effective adjuvant to 0.5% hyperbaric bupivacaine for SAB. It potentiated the SAB characteristics and enhanced the duration of analgesia with no effect on respiration. Nalbuphine in a dose of 2.4 mg did not offer any added advantage.

Labour is a physiological process which is associated with most severe pain. Goal of labour analgesia should be to ensure painless labour without any side effect. Various methods have been used to alleviate pain during labour but the only consistently effective method is lumbar epidural analgesia. Since higher doses of local anaesthetics cause undesirable effects like motor block and hemodynamic changes, adjuvants like opioids are used. The present study evaluates the clinical effectiveness of continuous lumbar epidural for vaginal delivery using 0.0625% bupivacaine with 2.5 mcg/ml of fentanyl. Materials and Method: 91 patients admitted to Lalladed hospital govt medical college Srinagar for vaginal delivery and who were in active labour were given first loading dose of 10ml 0.25% plain bupivacaine via epidural catheter followed by continuous epidural infusion of 0.0625% bupivacaine with 2.5 mcg/ml fentanyl @ 12ml/hr. the parturients were assessed for onset and duration of analgesia, hemodynamics, sensory block, mode of delivery, and APGAR(neonatal outcome). Results: Onset of analgesia was significantly faster(10 min). The duration of analgesia was also longer. There were no significant hemodynamic changes. No motor block was seen. 1 min and 5 min APGAR scores were comparable. Conclusion: It was concluded that epidural labour analgesia with low dose bupivacaine (0.0625%) with fentanyl (2.5mcg/ml) given through continuous infusion technique provides good pain relief to the parturient in labour with increased maternal satisfaction without significant maternal or fetal side effects.

Background: Day care knee arthroscopy can be performed with general anesthesia, central neuraxial blockade and peripheral nerve blocks. The adjuvants to local anaesthetic may be used to enhance the duration of analgesia without increasing the duration of motor blockade. The present study compared the clinical efficacy of clonidine with fentanyl as adjuvants to epidural ropivacaine (0.75%) for day care knee arthroscopy.Methods: Sixty adult patients of both gender of ASA physical status I and II scheduled for day care knee arthroscopy under epidural anaesthesia, were randomized into two groups of 30 patients each to receive either 15 ml of 0.75% ropivacaine with 1 ml of clonidine 50 µg (Group RC) or with 1 ml of fentanyl 50 µg (Group RF). Groups were compared for onset and duration of sensory and motor blockade and post-anesthesia discharge score (PADS) as primary end points. Intraoperative hemodynamic changes, time taken to void, total duration of hospital stay and any adverse effects were evaluated as secondary end points.Results: The onset of complete sensory block to T10 (15.4±4.7 versus 17.5±3.8 minutes) and time to achieve complete motor block (23.7±3.3 versus 26.9±1.4 minutes) was earlier in patients of Group RC. Intraoperative hemodynamic changes were comparable. Time to achieve PADS was earlier in patients of Group RF (6.37±1.08 versus 7.11±0.49 hour) with no statistical significant difference. Total duration of hospital stays (7.81±1.31 versus 8.27± 1.18 hour) was also comparable.Conclusions: Clonidine and fentanyl, both can be used as epidural adjuvant to 0.75% ropivacaine for day care knee arthroscopy as they could enhance the duration of analgesia without affecting the hospital stay.