Bupivacaine 20mg/4ml (0.5%) / Glucose 320mg/4ml solution for injection ampoules

Abstract Objective Many studies have compared the anesthetic effects of different doses of hypobaric local anesthetics (without glucose) in spinal anesthesia for cesarean sections. Therefore, a meta-analysis of these trials is warranted. Methods Systematic review and meta-analysis of eligible randomized controlled trials comparing the efficacy of low-dose spinal hypobaric anesthetics (Bupivacaine < 10 mg, levobupivacaine < 10 mg, ropivacaine < 15 mg) with conventional dose (Bupivacaine/Levobupivacaine ≥ 10 mg, ropivacaine ≥ 15 mg) in elective and subemergency Cesarean sections in data sources (PubMed, Embase, Web of Science, and Cochrane Central) from inception to February 2025. Results We obtained data from 1,280 patients from 17 published trials. Low-dose hypobaric local anesthetics reduce hypotension occurrence (risk ratio [RR], 0.56; 95% confidence interval [CI], 0.43 to 0.73; low evidence grade) but comprise anesthesia effect (analgesic-supplementation risk: RR 3.13, 95%CI 2.14 to 5.59, moderate evidence grade). In the subgroup analysis (based on whether opioid adjuvants mixed with local anesthetics were equal), there were no differences in anesthetic effects between low-dose local anesthetics mixed with opioid adjuvants and conventional-dose local anesthetics without opioid adjuvants between the two groups (analgesic-supplementation risk: RR 1.32, 95%CI 0.58 to 3.00, moderate evidence grade). Other secondary outcomes, including hypotensive side effects (nausea/vomiting and bradycardia), ephedrine consumption, and highest block plane, were observed less or lower in the low-dose group. No significant differences were found in trembling, pruritus, time to maximum block, or neonatal outcomes between the two groups. Conclusion Low-dose hypobaric local anesthetics in spinal anesthesia may reduce maternal side effects (hypotension, nausea/vomiting, and bradycardia) but comprise anesthetic efficacy (analgesic-supplementation risk). Furthermore, intrathecal opioid adjuvants improve anesthetic efficacy. Details of registration The protocol for this systematic review was registered on PROSPERO (CRD42024533150).

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BackgroundThis study assessed the effect of perineural dexamethasone on block duration, opioid requirement, blood glucose levels, and stress response to surgery as measured by the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), following pediatric foot and ankle surgery.MethodsIn this parallel, double-blinded randomized controlled trial, 90 children (ages 2-5 years, >5 kg) scheduled for foot or ankle surgery under spinal anesthesia with ultrasound-guided single-shot popliteal sciatic nerve block were randomized into 3 groups: 0.5% ropivacaine with saline (control), 0.5% ropivacaine plus dexamethasone 0.1 mg/kg (DEX0.1), and 0.5% ropivacaine plus dexamethasone 0.05 mg/kg (DEX0.05). Primary outcome was the time to first rescue opioid analgesia. Secondary outcomes included motor block duration, pain scores, NLR, PLR, and blood glucose levels.ResultsTime to first rescue opioid analgesia was significantly longer in the DEX0.1 group compared with the DEX0.05 group (18.4 hours, SD 2.6 hours vs 16 hours, SD 2.8 hours), with a mean difference of 2.2 hours (95% CI 0.7 to 3.6), pConclusionsPerineural dexamethasone significantly prolonged postoperative motor block duration and did not influence blood glucose, NLR, or PLR levels.Trial registration numberNCT06086418.

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Background: The transversus abdominis plane (TAP) block is providing effective postoperative analgesia in patients undergoing cesarean section (CS). This study aims to evaluate and compare the effects on pain levels of bupivacaine alone versus bupivacaine combined with dexmedetomidine and bupivacaine combined with dexamethasone in ultrasound-guided TAP block for postoperative pain after CS. Material and Method: In this randomized controlled trial, 120 patients with American Society of Anesthesiologists (ASA) physical status I and II scheduled for elective cesarean section under spinal anesthesia were randomly divided into three groups. At the end of the surgery, an ultrasound-guided TAP block was performed on all patients: bupivacaine 0.5% (Group B), bupivacaine 0.5% + dexmedetomidine (1 µg/kg) (Group BD), and bupivacaine 0.5% + dexamethasone (4 mg) (Group BDx). Postoperatively, all patients were evaluated at 0, 1, 4, 8, 16, and 24 h for visual analog scores VASs, tramadol consumption, complications, and patient satisfaction. A p value of < 0.05 is statistically significant. Results: At 0 h, VASs in the sitting and supine positions were significantly higher in the BDx group (0.85 ± 1.61 and 0.85 ± 1.36, respectively) compared to the B group (0.05 ± 0.32 in both positions) and the BD group (0.15 ± 0.48 in both positions) (p = 0.005 and p = 0.001, respectively). At the 24th hour, VASs in the sitting and supine positions were significantly lower in the BDx group (1.7 ± 1.2 and 1.43 ± 1.05) compared to the B group (2.3 ± 0.68 and 2.2 ± 0.72) and the BD group (2.57 ± 1.01 and 2.28 ± 0.78) (p = 0.005 and p = 0.001, respectively). At 0 h, the tramadol requirement was highest in the BDx group at 12.5%, while it was not required in the B and BD groups (p = 0.005). At 0 h, the rate of nausea and vomiting was highest in the BDx group at 17.5%, compared to 2.5% in the BD group and 0% in the B group (p = 0.003). Patient satisfaction scores were higher in the dexamethasone group compared to the other groups. This was significant between Group B and Group BDx (p = 0.009 < 0.05). Conclusions: Adding dexmedetomidine or dexamethasone to bupivacaine in ultrasound-guided TAP blocks reduces postoperative pain and increases patient satisfaction after cesarean sections. Dexamethasone, due to its delayed onset but extended duration, achieves lower pain scores and higher satisfaction. Further research is necessary to confirm these findings.

Abstract licence: CC BY 4.0

Laparoscopic gynecological surgery, while minimally invasive, is frequently associated with significant postoperative pain requiring systemic analgesics. Local anesthetic administration, either intraperitoneally or at trocar sites, has been proposed to improve analgesia and recovery, but evidence remains inconsistent. To evaluate and compare the efficacy of intraperitoneal and port-site local anesthetic injection versus placebo in reducing postoperative pain and improving recovery outcomes in women undergoing gynecological laparoscopic surgery. This randomized, double-blind, three-arm controlled trial enrolled 90 women aged 18-60 years undergoing elective gynecological laparoscopy at Kasr Al-Ainy Hospital, Cairo, Egypt (March 2024-March 2025; ClinicalTrials.gov NCT07030647). Participants were randomized into: Group A (trocar site bupivacaine 0.25%), Group B (intraperitoneal bupivacaine 0.25%), and Group C (saline placebo). Postoperative pain was assessed using a visual analog scale (VAS) at 1, 6, 12, and 24 h. Secondary outcomes included rescue diclofenac use, time to first analgesic, total diclofenac dose, time to ambulation, hospital stay, and patient satisfaction. Baseline demographics were comparable across groups. Group B reported the lowest pain scores at 1, 6, and 12 h (0.1 ± 0.3; 2.9 ± 1.1; 2.1 ± 0.3, respectively), followed by Group A, while Group C had the highest (p < 0.001). At 24 h, pain scores were similar (p = 0.087). Diclofenac requirement was significantly reduced in Group B (26.7%) compared to Groups A (83.3%) and C (100%) (p < 0.001). Time to first rescue analgesic was longest in Group B (7.1 ± 1.1 h vs. 2.9 ± 0.7 and 1.5 ± 0.8; p < 0.001). Total 24-hour diclofenac consumption was lowest in Group B (75 mg) versus Groups A (114 ± 38.2 mg) and C (142.5 ± 22.9 mg; p < 0.001). Early ambulation occurred fastest in Group B (3.5 ± 0.9 h), followed by Group A (5.1 ± 0.6 h) and Group C (6.9 ± 0.8 h; p < 0.001). Hospital stay was 24 h in all groups. Patient satisfaction was highest in Group B (7.3 ± 1.2), intermediate in Group A (4.2 ± 1.6), and lowest in Group C (3.0 ± 0.8; p < 0.001). Both intraperitoneal and trocar site local anesthetic administration significantly reduced postoperative pain and analgesic requirements compared with placebo. Intraperitoneal administration demonstrated superior efficacy, leading to earlier ambulation and higher patient satisfaction. Routine use of intraperitoneal local anesthetic may enhance postoperative recovery in gynecological laparoscopy.Trial registration ClinicalTrials.gov Identifier: NCT07030647 (retrospectively registered 20 June 2025).

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Abdominal surgeries were major surgical procedures that were performed at any teaching hospital.  Pain control was a major concern during intra-operative as well as post-operative periods in these patients. Objective: To compare post-operative analgesic effectiveness of bupivacaine and bupivacaine plus dexmedetomidine wound infiltration in abdominal surgeries under General Anesthesia. Methods: This randomized controlled trial was conducted at the Department of Anesthesia, Sahiwal Teaching Hospital Sahiwal from 1st April, 2024 till 31st May 2024.  Sixty-four patients underwent a pre-operative assessment on the day before surgery. Both Groups received wound infiltration with studied drugs at the end of surgery. After surgery, patients were assessed for pain using a Visual Analog Scale (VAS) and data was collected and analyzed using Statistical Package for the Social Sciences (SPSS) version 26.0. Results: The mean post-operative analgesia duration of the patients on bupivacaine was 11.78 ± 1.64 but the mean post-operative analgesia duration of the patient on bupivacaine plus dexmedetomidine was 19.19 ± 2.49. (2-tailed significance 0.001). The mean opioid consumption in mg of the patients in bupivacaine was 20.69 ± 4.31 but the mean opioid consumption in mg of the patient in bupivacaine plus dexmedetomidine was 10.88 ± 4.53. (2-tailed significance 0.001). In bupivacaine, patients with bradycardia were 0% and patients without bradycardia were 100% but in bupivacaine plus dexmedetomidine, patients with bradycardia were 15.6% and patients without bradycardia were 84.4%. Conclusions: There was a difference in the analgesic effectiveness of dexmedetomidine when added to bupivacaine in wound infiltration in abdominal surgeries.

Abstract licence: CC BY 4.0