Comparative Study between Intrathecal 0.5% Isobaric Levobupivacaine, 0.5% Isobaric Ropivacaine, and 0.5% Hyperbaric Bupivacaine in Elective Lower Segment Cesarean Section: A Randomized Clinical Study.

Background: Neuraxial anesthesia in obstetrics began with the spinal block by Oskar Kreis in 1900. The technique of subarachnoid blockade has been refined since then and various drugs have been used to provide analgesia and anesthesia for infraumbilical surgeries. Materials and Methods: This study was conducted because of newer options available, such as an intrathecal drug with appropriate sensory and motor blockade and minimal haemodynamic changes that can be used in the lower segment cesarean section safely. Ninety patients were randomly divided into three groups including 30 patients in each group. Group B, Group L, and Group R, each receiving 2.2 mL of 0.5% hyperbaric bupivacaine, 0.5% isobaric levobupivacaine, and 0.5% isobaric ropivacaine, respectively. All groups were compared concerning sensory block, motor block, hemodynamic stability, and complications if any. Results: The onset of sensory block at T8, two-segment regression time from the highest block, time of regression to L1, total duration of analgesia, onset and total duration of motor block were comparable between Group B and L (P > 0.05), but both these groups were statistically significant with Group R (P < 0.05). Hypotension was observed among all the groups; however, the incidence was minimum in Group R. Conclusion: 12 mg of isobaric ropivacaine and 12 mg of isobaric levobupivacaine, compared to 12 mg hyperbaric bupivacaine (2.2 mL of 0.5% each), when administered intrathecally provides adequate anesthesia for cesarean section. The lesser duration of motor block in ropivacaine compared to the other two drugs could be beneficial for early ambulation, also the incidence of hypotension was lower in Group R.

A Randomized Comparative Study on Median and Paramedian Approaches for Subarachnoid Block using Sprotte Needle in the Cesarean Section: Quest for the Best.

Background: Since 1898 when August Bier, introduced spinal analgesia, there is lot of advancement made in the technique. There are various approaches and techniques for subarachnoid block. Aim: The aim of this study is to compare median and paramedian approach for spinal anesthesia for cesarean delivery using Sprotte needle in terms of number of attempts, success rate, adverse effects, and complications. Materials and Methods: One hundred patients were randomly divided into two equal groups and underwent subarachnoid block in median and paramedical block for elective cesarean section. Results: There is no significant difference between the two groups. Mean with standard deviation in the number of attempts for subarachnoid block through media and paramedian approach is 1.18 ± 0.48 and 1.06 ± 0.24, respectively (P = 0.51). The incidence of postdural puncture headache (PDPH) and lower backache was insignificant in both the groups (P = 0.218 and 0.646, respectively). Conclusions: Paramedian approach should not be considered as a reserve technique for spinal anesthesia and can be used as popularly as the median approach.

Randomized Double-Blinded Comparative Study of Intravenous Nalbuphine and Tramadol for the Treatment of Postspinal Anesthesia Shivering.

CONTEXT: Shivering is one of the most commonly recognized complications of the central neuraxial blockade. For optimal perioperative care, control of postspinal anesthesia shivering is essential. AIMS: The present study designed to compare the clinical efficacy, hemodynamic parameters, and side effects of nalbuphine and tramadol for control of postspinal anesthesia shivering. SETTINGS AND DESIGN: This was a prospective, randomized, double-blind study. MATERIALS AND METHODS: This study was conducted on 90 American Society of Anesthesiologists Physical Status I and II patients of either gender, aged between 18 and 60 years, who subsequently developed shivering grade 3 or 4, scheduled for different surgical procedures under spinal anesthesia. The patients were randomized into two groups of 45 patients each to receive either nalbuphine 0.06 mg.kg-1 (Group N) or tramadol 1 mg.kg-1 (Group T). Grade of shivering, onset of shivering, time interval for cessation of shivering, response rate at 5 and 30 min, rescue dose, hemodynamic parameters, and side effects were observed at scheduled intervals. STATISTICAL ANALYSIS USED: Independent t-test and Chi-square/Fisher's exact test were used to analyze the data. RESULTS: The time taken for cessation of shivering was significantly less with nalbuphine in comparison with tramadol (P < 0.05). It was observed that the response time at 5 and 30 min and rescue dose requirement for control of shivering were not much difference (P > 0.05). CONCLUSIONS: Both nalbuphine and tramadol are effective; however, the time taken for cessation of shivering is significantly less with nalbuphine when compared to tramadol. Furthermore, tramadol causes significantly more nausea and vomiting; however, nalbuphine causes significantly more sedation.