Ropivacaine presents several advantages over bupivacaine for spinal anesthesia in cesarean sections, making it a safer and potentially more effective option. It has lower cardiotoxicity and neurotoxicity, enhancing both maternal and fetal safety - an important factor in obstetric care. Ropivacaine provides comparable sensory block with significantly less motor blockade,promoting faster postoperative recovery and improved maternal mobility. It causes less maternal hypotension due to a more favorable sympathetic block profile further supporting its suitability for cesarean delivery. Post operative pain after cesarean section can impact early recovery , breastfeeding and maternal wellbeing. Intrathecal adjuvants like Fentanyl and Dexmedetomidine when combined with Ropivacaine , are used to enhance analgesia, but their comparative effectiveness remains unclear. This study aims to evaluate and compare the duration of post operative analgesia in parturients receiving intrathecal Ropivacaine with either Dexmedetomidine or Fentanyl , to help guide optimal pain management strategies. Fentanyl enhances analgesia without increasing motor or sympathetic block, reducing hypotension and allowing earlier recovery and mobilization. Dexmedetomidine, a highly selective alpha 2 agonist with eightfold higher receptor affinity than Clonidine, though FDA approved for intravenous sedation in ICUs, it is being used intrathecally to prolong analgesia without significant sedation .This study aims to assess its efficacy with 0.75 percent hyperbaric Ropivacaine, hypothesizing prolonged analgesia, improved intraoperative block, minimal motor block, and negligible side effects. Shivering during cesarean can cause up to 200 times increased oxygen demand, cardiovascular stress leading to Myocardial Infarction , impaired monitoring and wound discomfort intraoperatively. Postoperatively, it may delay recovery, raise infection risk, and increase intracranial or intraocular pressure. Prompt management helps prevent these complications and ensures better patient outcomes. IV Dexmedetomidine (0.5–1.0 µg/kg) effectively prevents it. While its intrathecal effect on shivering is unstudied, this double-blind trial evaluates its potential benefit during caesarean section with hyperbaric ropivacaine .
Primary Objective:To study the duration of post operative analgesia using visual analogue score (VAS Score) in parturients undergoing elective LSCS.
Secondary Objectives: 1. To study the intensity and severity of shivering using a four point scale in parturients undergoing elective LSCS. 2.To study the duration of motor blockade using modified bromage score in parturients undergoing elective LSCS. 3. To study the hemodynamic parameters in parturients undergoing elective LSCS.
Methodology 60 Full-term parturients aged 21-45 years, with American Society of Anaesthesiologists (ASA) physical status ll and lll, who will be scheduled for lower-segment cesarean delivery with subarachnoid block will be included after written informed consent. Block randomization will be performed using a computer generated block random number table to randomly assign 60 full-term parturient into two groups. The allocation sequence is concealed within sealed envelopes and opened by anaesthesiologist who will not be involved in the investigation. The study solutions will be prepared under sterile conditions in advance and enclosed within masked 2.5 ml syringes according to randomisation to maintain blinding. The treatment group will remain unkno;wn to the anaesthesiologist monitoring the patient.The two groups will be designated as follows: group RD , which will receive intrathecal 0.75% hyperbaric Ropivacaine 2 ml plus Fentanyl 20 mcg. As per institutional protocol, parturient will be fasted prior to surgery as per ASA guidelines, intravenous access will be established using an 18G iv canula with all parturients receiving a coload (10 ml/kg of crystalloid balanced solution) and inj Pantoprazole 40 mg iv, inj Ondansetron 4mg iv given 30 min prior to surgery. Pregnant women will be shifted to OT , all ASA standard monitors like pulse oximetry, non-invasive blood pressure cuff and electrocardiogram will be attached and baseline hemodynamic parameters will be recorded. Spinal anaesthesia will be administered in the sitting position using a 26 G quincke spinal needle under strict aseptic and antiseptic precautions after giving local anaesthesia in l3-l4 intervertebral space. all parturients receive 2.4 ml of the drug, regardless of their study group. After intrathecal injection, patients are positioned supine, a wedge is placed under right buttock to prevent IVC compression by gravid uterus and hemodynamic parameters are recorded for every 1 minute for first 10 minutes and every 5 minute interval until the surgery is concluded, followed by every 30 min for 6 hours during the postoperative period followed by every 2 hrs upto 24 hrs after the surgery concluded. A SBP below 90 mmHg or a drop of more than 20 percent from the basal systolic pressure is referred to as hypotension. Hypotension is managed with Inj Mephentermine 6 mg IV and repeated if necessary. Bradycardia, which is defined as a heart rate below 50 beats per minute, is managed with Inj Atropine 0.6 mg IV.
Pain assessment is done with the help of vas score Pain assessment will be done for the first 24 hrs Rescue analgesia- inj Paracetamol 1g and inj Diclofenac 75mg will be given. If required inj Tramadol 100 mg will be given. Modified Bromage Score 0- The patient is able to move hip, knee and ankle 1- Patient is unable to move hip but able to move knee and ankle 2- Patient is unable to move hip and knee but able to move ankle 3-Patient is unable to move hip, knee and ankle. Shivering is graded using a four point scale None- no perceptible tension of muscles observed Mild- slight muscle tonus of masseter muscle Moderate- shivering of proximal muscles Severe- generalised shivering of whole body
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