R Arun Kumar

Abstract

Background: The most common nagging and inconveniencing complication of spinal anesthesia is intra operative shivering. Central neuraxial blockade blunts the thermoregulatory mechanism by restricting vasoconstriction, resulting in shifting of central heat to the periphery from the trunk. Various pharmacological and non pharmacological methods are used for the control of intraoperative shivering. Objectives: The aim of our study was to compare the efficacy of Tramadol, Ketamine and Dexmedetomidine in the prevention of intra operative shivering in patients undergoing surgeries under subarachnoid blockade. Materials and Methods: 90 patients of age group between 20 to 65 years belonging to ASA 1 and 2 posted for elective surgery under spinal anaesthesia will participate in this study. The patients were randomly allocated into 3 groups of 30 each and were named as by computer generated random table number. Group T received Tramadol 0.5 mg/kg in 100 ml NS over 10 – 15 minsGroup K Ketamine 0.25 mg/kg in 100 ml NS over 10 – 15 mins and Group D Dexmedetomidine 0.5 ?g/kg in 100 ml NS over 10 – 15 mins. Observation and Results: Data were statistically analysed with the SPSS version 22.0 software using two-sided unpaired t-test and Chi-square test. A repeated measure of ANOVA was applied for the three groups to know the with-in subject variability in prevention of shivering following subarachnoid blockade and p value < 0> Conclusion: The conclusion of our study is that Dexmedetomidine at the dose of 0.5 ?g/kg decreases effectively in the prevention of intra operative shivering in patients undergoing surgery under subarachnoid blockade when compared with Tramadol and Ketamine.   Keywords: Dexmedetomidine, Ketamine, Tramadol, Shivering, Subarachnoid blockade.

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Abstract

Background: Central neuraxial blockade is the most widely used form of regional anesthesia in surgeries involving abdominal, urological, obstetric, gynaecological and lower limb. The nerve blocking properties of the R and S-enantiomers were similar but that the S-enantiomer was less cardiotoxic. The aim of our study is to compare the efficacy and haemodynamic response between intrathecal hyperbaric 0.5% Bupivacaine with isobaric 0.75% Ropivacaine using Fentanyl as adjuvant in patients undergoing infra umbilical surgeries. Materials and Methods: 60 patients of age group between 25 – 65 years belonging to American Society of Anaesthesiologist (ASA) 1 and 2 posted for general surgical, urological, orthopaedic and gynaecological procedures involving lower abdominal surgeries under spinal anaesthesia divided into two groups of 30 each and randomly allocated to one of the two below mentioned groups: Bupivacaine group (Group B) n=30; Ropivacaine group (Group R) n=30 Observation and Results: Chi-square test and Student’s ‘t’ test were used to analyse the results. The sensory block in Bupivacaine group B was significantly higher compared to Ropivacaine group R attaining statistical significance. The 3 minutes motor block, incidence of hypotension was denser and higher in Bupivacaine group compared with Ropivacaine group. Incidence of bradycardia was not significantly different between the two groups. Although the onset of motor blockade was denser in Bupivacaine group, the total duration of motor blockade was similar between the groups. Conclusion: We conclude from our study that 0.75% isobaric Ropivacaine produces similar duration of efficacy with stable haemodynamics, as compared with 0.5% hyperbaric Bupivacaine. Keywords: Bupivacaine, Ropivacaine, Fentanyl, Motor blockade, Infra umbilical surgeries.

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