Dinesh, D (2013) A Comparative Study on Three Doses of Morphine added to Hyperbaric Bupivacaine in Spinal Anaesthesia. Masters thesis, Chengalpattu Medical College, Chengalpattu.
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Abstract
INTRODUCTION: The discovery of neuraxial anesthesia was born out of mishap in 1885 when Corning was experimenting with effects of cocaine on the spinal nerves of dogs. Bier brought spinal anesthesia into clinical use for surgery in 1898, but only after self -experimentation and a personal experience with a well-described postdural puncture headache. Intrathecal anaesthesia is the commonly used and preferred anaesthetic technique used for abdominal, perineal, gynaecological and lower limb Surgeries. It offers excellent anaesthesia with fewer side effects than general anaesthesia. It is very easy to perform and provides faster onset and effective sensory and motor block. Bupivacaine is the commonly used local anaesthetic in spinal anaesthesia. It gives long lasting anaesthesia with fewer side effects and no transient neurological symptoms which occurs when lignocaine is used. Nowadays there has been interest in using additives to spinal local anaesthetics so that the dose of the local anaesthetic is decreased and also provide effective postoperative pain relief. Spinal (Intrathecal / subarachnoid) Anaesthesia is a type of Central neuraxial blockade where temporary interruption of nerve transmission is accomplished by injection of only local anaesthetic or with addition of adjuvants to local anaesthetics in subarachnoid space. Spinal anaesthetics exert their sensory block at the spinal cord, which is continuous cephalad with the brainstem through the foramen magnum and terminates distally in the conus medullaris. AIM OF THE STUDY: To compare the duration of analgesia and the incidence of side effects of three different doses of intrathecal morphine - 50μg, 100μg and 200μg added to 0.5% hyperbaric bupivacaine in patients undergoing subumbilical surgeries. MATERIALS AND METHODS: This study was conducted at the Chengalpattu Medical College Hospital, Chengalpattu- between February 2011 to February 2012 on 90 patients of ASA I and II undergoing infraumbilical surgeries. This study was done after ethical committee approval and written informed consent obtained from all patients included in the study. Study design: The study was done in a prospective double blinded randomized manner. Selection of cases: Inclusion criteria: 1. Patients in age group of 20 to 50 yrs, 2. ASA I and II, 3. Infraumbilical surgeries. Exclusion criteria: 1. Age <20 yrs and > 50yrs, 2. ASA III and IV, 3. Contraindication to spinal anaesthesia, 4. Patients with decreased cardiorespiratory reserve-COPD, Bronchial Asthma, 5. H/o allergy to morphine. STUDY POPULATION 90 patients were included in this double blinded randomised controlled study. STUDY GROUPS: Patients were divided into 3 groups of thirty patients each. 1. Patients in group M1 received 3ml of 0.5% hyperbaric bupivacaine plus 50μg preservative free morphine 0.1ml. 2. Patients in group M2 received 3ml of 0.5% hyperbaric bupivacaine plus 100μg preservative free morphine 0.2ml. 3. Patients in group M3 received 3ml of 0.5% hyperbaric bupivacaine plus 200μg preservative free morphine 0.3ml. METHODS: Patients who satisfy the inclusion criteria are selected and they underwent thorough preoperative evaluation which included the following : History: History of underlying medical illness, previous surgery, anaesthesia and hospitalisation. Physical examination: 1. General condition of the patient, 2. Vital signs, 3. Height and weight, 4. Examination of CVS, RS, CNS, 5. Airway and Spine examination. Investigations: Hb %, PCV,BT/ CT, Platelet count, RFT, Blood sugar, ECG, CXR, Blood grouping and cross matching were done. Patient who satisfies the inclusion criteria were explained about the nature of the study and the anaesthetic procedure. Written Informed consent obtained from all the patients taken up for study. Randomisation: Randomisation of the cases as per the group and the drug preparations were made by the anaesthesiology consultant who did not participate in the study. I performed the subarachnoid block and made intraoperative and postoperative observations. CONCLUSION: I conclude that adding 200 microgram of preservative free morphine sulphate provides long lasting analgesia without much adverse effects compared to 100 microgram and 50 microgram of morphine when added to 0.5% hyperbaric bupivacaine for spinal anaesthesia.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Three Doses of Morphine ; Hyperbaric Bupivacaine ; Spinal Anaesthesia ; Comparative study. |
| Subjects: | MEDICAL > Anaesthesiology |
| Depositing User: | Subramani R |
| Date Deposited: | 30 Apr 2018 04:25 |
| Last Modified: | 30 Apr 2018 04:45 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/7358 |
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