Efficacy of premixed versus sequential administration of dexmedetomidine as an adjuvant to intrathecal hyperbaric bupivacaine in lower limb surgery

Chaudhry, Gunjan; Singla, Deepak; Dureja, Jagdish; Bansal, Prateek; Ahuja, Kirti

doi:10.1080/22201181.2016.1179468

Cited by 5 publications

(10 citation statements)

References 18 publications

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“…[ 18 ] Another study supporting the sequential use of LA and adjuvant was conducted by Chaudhry G et al . [ 11 ] The mechanisms of intrathecal spread of drug can explain our results with respect to onset of sensory and motor block. After injecting the drug into the subarachnoid space in lumbar region in sitting position and later making the patient supine, a hyperbaric solution spreads under the influence of gravity along the slope of lumbar spine curvature.…”

Section: Discussionmentioning

confidence: 87%

“…Sample Power calculated according to Kraemer and Theimann[ 10 ] using the proposed figure showed that the sample size for 80% power would require an N of more than 29/group, 85% power would require an N of 33/group, and 90% power would require N of 39/group. Thus, Thus, for the power to be 90% for assuring an effect, the current study sample size was chosen, after using results of previous study using onset of block (sensory) as the parameter,[ 11 ] which is the primary outcome of our study. Our sample size came out to be 40 patients per group at power of 0.90 and with an effect size of 0.961 with 10% chance of error with α = 0.05, β = 0.20 and confidence interval of 95%.…”

Section: Methodsmentioning

confidence: 99%

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Efficacy of premixed versus succedent administration of fentanyl and bupivacaine in subarachnoid block for lower limb surgeries: A randomised control trial

Malhotra

Singh

et al. 2020

Indian J Anaesth

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Background and Aims: Subarachnoid block is the most commonly used anaesthesia technique for lower limb surgeries. Opioids are the most commonly used adjuvants with local anesthetics (LA). Adjuvants are given premixed with LA loaded in a single syringe. This study was conducted to evaluate differences in level of sensory and motor block and incidence of hypotension whilst administering hyperbaric bupivacaine and fentanyl either in a single syringe or different syringes. The effect of administering opioid prior to LA and vice versa on these parameters was also assessed. Methods: One hundred and twenty patients were randomly allocated into three groups of 40 each: Group A received premixed 0.5% heavy bupivacaine 2.5 ml (12.5 mg) and 0.5 ml (25 microgram) of fentanyl in a single 3.0 ml syringe, Group B received 0.5 ml (25 microgram) of fentanyl in a 3.0 ml syringe followed by 0.5% heavy bupivacaine 2.5 ml (12.5 mg) in a 3.0 ml syringe, Group C received 0.5% heavy bupivacaine 2.5 ml (12.5 mg) in a 3.0 ml syringe followed by 0.5 ml (25 microgram) fentanyl in a 3.0 ml syringe. All statistical calculations were done using SPSS 21 version statistical program for Microsoft Windows. Results: The mean time for onset of sensory and motor block was least in group C followed by group B. The duration of sensory and motor block was prolonged in groups B and C. Patients in group A experienced more hypotension as compared to groups B and C. Conclusion: Administering hyperbaric bupivacaine first followed by fentanyl leads to an early onset and prolonged duration of sensory and motor block.

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Section: Discussionmentioning

confidence: 87%

Section: Methodsmentioning

confidence: 99%

Efficacy of premixed versus succedent administration of fentanyl and bupivacaine in subarachnoid block for lower limb surgeries: A randomised control trial

Malhotra

Singh

et al. 2020

Indian J Anaesth

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“…[7] The sequential administration of fentanyl and bu- and cesarean section respectively, compared to their mixed use with hyperbaric bupivacaine. [13,14] Conclusion:…”

Section: Resultsmentioning

confidence: 99%

Premixed versus sequential administration of intrathecal fentanyl as a bupivacaine adjuvant in lower limb orthopedic surgeries: a prospective randomized controlled study

Kenany

2016

Mansoura Medical Journal

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Introduction: Intrathecal fentanyl is routinely mixed with hyperbaric bupivacaine during spinal block, but this may alter the baricity of both drugs and hence affect their spread and action. Aim: This study aimed to compare the sequential administration of intrathecal fentanyl and bupivacaine to the routine mixing of the two drugs as regard the block characteristics, the postoperative analgesia duration, and the adverse effects. Methods: Current prospective, controlled, randomized trial was carried out on 100 adult participants subjected to lower limb orthopedic surgeries under spinal anesthesia. Subjects were allocated randomly into two equal groups (50 each). Group P: received premixed solution of hyperbaric bupivacaine (HB) 0.5 % (12.5 mg) plus 25 µg of fentanyl in the same syringe and group S: received 25 µg of fentanyl followed by 12.5 mg of HB in sequential manner. Block characteristics, time to the first rescue pethidine request, number of participants who requested for pethidine within the first 6 postoperative hours, and adverse effects were assessed. Results: Group S patients had statistically significantly faster onset of both sensory (4.58 ± 1.5 vs 5. 40 ± 1.8 min, p = 0.02) and motor block (5.79 ± 1.5 min versus 6.64 ± 1.9 min, p = 0.01), shorter time to achieve the highest sensory level (6.12 ± 1.96 min vs 8.77 ± 2.5min, p = 0.00), and a longer time till the first postoperative rescue analgesic need (252.26 ± 39.3 min versus 234.70 ± 40.2 min, p = 0.03). Group P patients achieved statistically significantly higher level of sensory blockade and showed longer sensory block duration (216.30 ±30.8 vs 199.44± 23.8, p = 0.003). Adverse effects were comparable in both groups. Conclusions: The sequential administration of fentanyl and hyperbaric bupivacaine improves the spinal block characters in patients subjected to lower limb orthopedic surgeries with comparable adverse effects profile in comparison to mixing both drugs.

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“…The addition of adjuvants like opioids, clonidine and dexmedetomidine have been reduced in hemodynamic change and improving analgesic quality at the same time [ [15] , [16] , [17] ].…”

Section: Introductionmentioning

confidence: 99%

“…Intrathecal fentanyl enhances analgesia with bupivacaine and achieve successful subarachnoid block by acting on mu-receptor found in spinal cord and resulted in improved quality and prolonged analgesia. In addition, fentanyl acts on the afferent nociceptive path so it causes less adverse hemodynamic effects [ 18 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

Comparison of sequential versus pre mixed administration of intrathecal fentanyl with hyperbaric bupivacaine for patients undergoing elective Caesarean section at Zewditu memorial referral hospital: A prospective cohort study

Chekole¹,

Kassa

Yadeta

et al. 2022

Annals of Medicine &Amp; Surgery

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Background Spinal anesthesia (SA) is the method of choice for surgery below umbilicus like elective cesarean section. However, Spinal anesthesia is associated with hypotension and limited analgesia duration. To minimize those complications adding opioids like fentanyl either sequentially with separate syringe or pre mixed with local anesthetics become common practice. Objective To compare the hemodynamic and analgesic effect of sequential versus pre mixed injection of intrathecal fentanyl with hyperbaric bupivacaine for patients who underwent elective CS under Spinal anesthesia. Method A prospective cohort study was performed on parturient who undergone elective cesarean section from 01 January 2020 to 30 March 2020. The decision to give either sequential or premixed drug was based on the responsible anesthetists. Sixty-six American society of Anesthesiologist Ⅱ age ≥18 was recruited. Those who received sequentially were grouped as (S- group) and those who had received pre mixed technique were grouped as (M-group). Data were entered into Epi Info version 7.0 and transported into SPSS Version 22 for analysis. Based on normality assumption, analysis was done by independent t -test for normally distributed data. Whereas Mann –Whitney U test for non-normally distributed data and x2 (Chi-square) test for categorical variable. P-value <0.05 was considered as statistically significant. Result Significant reduction in intra operative mean arterial blood pressure was seen in premixed group compared to Sequential group until 15th minute immediately after spinal anesthesia. Thus, the incidence of hypotension was higher in M − group compared to S- group, (p < 0.05). The median Postoperative pain VAS score was significantly lower in the S - group compared to M − group of 4th, 5th and 6th hr. The mean time for 1st rescue analgesic request time was prolonged in the S - group compared to M − group (287.909 ± 15.255 vs. 261.39 ± 25.378) min respectively (p < 0.001). Conclusion The Sequential intrathecal injection of fentanyl and hyperbaric bupivacaine provided significant improvement in the blood pressure stability and of sensory and motor block compared to premixed groups.

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Efficacy of premixed versus sequential administration of dexmedetomidine as an adjuvant to intrathecal hyperbaric bupivacaine in lower limb surgery

Cited by 5 publications

References 18 publications

Efficacy of premixed versus succedent administration of fentanyl and bupivacaine in subarachnoid block for lower limb surgeries: A randomised control trial

Efficacy of premixed versus succedent administration of fentanyl and bupivacaine in subarachnoid block for lower limb surgeries: A randomised control trial

Premixed versus sequential administration of intrathecal fentanyl as a bupivacaine adjuvant in lower limb orthopedic surgeries: a prospective randomized controlled study

Comparison of sequential versus pre mixed administration of intrathecal fentanyl with hyperbaric bupivacaine for patients undergoing elective Caesarean section at Zewditu memorial referral hospital: A prospective cohort study

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