Randomised controlled trial comparing efficacy of two different doses of Intrathecal 0.75% Isobaric Ropivacaine in Elective Inguinal hernia surgery
Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2018, Vol 17, Issue 10
Abstract
INDRODUCTION :Ropivacaine was approved for a new route of administration, the intrathecal route, in the European Union in February 20041 . Ropivacaine was introduced into clinical practice in 1996, and has consistently demonstrated an improved safety profile over Bupivacaine, with reduced CNS and cardiotoxicity .In addition it has a wide clinical utility at different doses for a wide range of indications. It has been shown to provide effective, well tolerated surgical anaesthesia via central neuroaxial block, for major and minor nerve blocks and field blocks. It has also shown to have high-quality postoperative analgesia.2 AIM OF STUDY : Comparison of the use of 18.75 MG(2.5 ml) with 22.5 MG(3 ml) isobaric 0.75% Ropivacaine for adequate surgical anesthesia and motor blockade for elective inguinal hernia surgery. MATERIAL AND METHODOLOGY: Ethical committee approval obtained .This is prospective, randomized,double-blinded study. All patients with undergoing elective inguinal hernia. The sample size was restricted to 60 due to time constraint allotted for this study. Patients of either sex with age of 18-70 years, patients belonging to ASA grade I&II.Body weight not more than 20% above ideal body weight .Patient exclusion criteria’s were patient refusal, local site infection ,coagulopathy etc. The nature of study explained to patients and written informed consent taken before enrolling for study.Each group containing 30 patients and received two different doses of Ropivacaine. Computer based randomisation in two groups done asGroup 1: patients receiving 22.5 mg (3 ml) 0.75% isobaric Ropivacaine intrathecal. Group 2: patients receiving 18.75 mg (2.5 ml) 0.75% isobaric Ropivacaine intrathecal. SAB was given in sitting position to all patients under all septic precautions. In this study we investigated the adequacy of surgical anaesthesia of two different doses of Ropivacaine for patients who were posted for elective inguinal hernia surgery. We assessed sensory block using pin prick method and Modified Bromage’s score for motor assessment. RESULTS: The surgery lasted for an average for 40 minutes for which block of up to T10 was considered sufficient and motor block of grade II also noted introp. Three patients from group 1 and three patients from group 2 were excluded in this study. Onset of Sensory block:Time to attain T10 level was taken as time of onset of sensory block. Median time of onset of sensory block in Group 1 which was 10 minutes. In group 2 it was 10 minutes. There was no statistically significant difference in time of onset of sensory block between Group 1 and Group 2 (p value> 0.05). Duration of sensory block:Duration of sensory block at T10 was taken as duration of sensory block. Median duration of sensory block in Group 1 was 174 minutes, in Group 2 was 148 minutes .There is no significant difference (p>0.05).Adequate duration of sensory block at T10 was present with both groups for surgical time. Onset of motor block: Time to attain motor block up to modified Bromage score 3 was taken as time of onset of motor block. Mean time of onset of motor block in Group 1 was 20 minutes, in group 2 was 20 minutes There was statistically no significant difference in time of onset of motor block between group 1 and Group 2 (p >0.05). Duration of motor block: Median duration of motor block in group 1 was 137 minutes. In Group 2 was 148 minutes. There was statistically no significant difference in duration of motor block between Group 1 & Group 2 (p value>0.05).So adequate duration of motor block was obtained in both group 1 and group 2. CONCLUSION: There is no significant advantage in choosing higher dose of 22.5 mg (3 ml) of intrathecal Ropivacaine in inguinal hernia surgery as compared to 18.75 mg (2.5 ml).There is less fluctuation of blood pressure and pulse rate with group 2(2.5 ml) as compared with group 1(3 ml). So this study proves that isobaric 0.75%ropivacaine 18.75 mg (2.5 ml) is sufficient for inguinal hernia surgery with minimum hemodynamic changes compared to 22.5mg(3ml).
Authors and Affiliations
Nilesh Patil, Sunil Chapane
Keywords
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- EP ID EP401583
- DOI 10.9790/0853-1710027987.
- Views 39
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