AIMS AND OBJECTIVES

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1) To compare the effects of addition of Midazolam, Fentanyl or Dexmedetomidine as adjuvant to 0.5% Bupivacaine(heavy) on:a) Quality of blockade b) Duration of post-operative analgesia. 2)To study the hemodynamic responses (effect on blood pressure, heart rate) after addition of these drugs as adjuvant intrathecally with 0.5% Bupivacaine(heavy). 3)To study any other side effects of these drugs.

Dexmedetomidine has mainly action on alpha2b and alpha2c receptors when given intrathecally.5% Bupivacaine (H). Midazolam. It was found to exhibit antinociceptive action when administered intrathecally by binding to GABA-a receptors. . Dexmedetomidine-It is a centrally acting selective alpha2 agonist.belongs to benzodiazepine group of drugs. Fentanyl or Dexmedetomidine) when administered intrathecally as adjuvant to 0. Fentanyl-It is a phenyl-piperidine derivative synthetic opioid agonist which has 75-125 times more potent than morphine. but duration is limited (short lasting) The research project will mainly focus about the additive action of 3 drugs (Midazolam. In which. It acts by directly inhibiting ascending transmission of information from spinal cord dorsal horn and also activating pain controlling circuit that descend from midbrain via rostral ventromedial medulla.INTRODUCTIONSubarachnoid blockade with local anaesthetics provides intense analgesia by segmental blockade of central neural axis.

2) GROUP 2-: That is group BFn=30 They will be administered intrathecally 3 ml of bupivacaine 0.5% (H) plus injection Fentanyl 25microgram in 0. volume.5% (H) plus injection Midazolam 2. They will be divided on the basis of computer generated random number table into three groups as follows: 1) GROUP 1-: That is group BMn=30 They will be administered intrathecally 3 ml of bupivacaine 0.5 ml. randomised. volume. . volume. scheduled for elective lower abdominal.5 ml. Approval from the institutional ethical committee and written informed consent from patients involved in this research will be taken.5 ml.5% (H) plus injection Dexmedetomidine 10 microgram in 0. lower limb and gynecological procedures and will be selected to participate in this prospective.5 mg in 0. double-blind study. 3) GROUP 3 – That is group BDn=30 They will be administered intrathecally 3 ml of bupivacaine 0.METHODOLOGY: A total of 90 patients.(diluted in normal saline).

(b) EXCLUSION CRITERIA-: 1) Patient not willing to take part in this study. . ischemic heart diseases. renal and hepatic derangements and diseases of central nervous system and spine. 3) Patient with major systemic illnesses like diabetics. 3) Patient with both male and female gender. uncontrolled hypertension. 2) Patients with obvious contraindications to regional anaesthesia. 4) Surgeries lasting up to duration 120 minutes. 4) Patient with obvious history of bleeding diathesis.SELECTION OF CASES: (a) INCLUSION CRITERIA: 1) American Society of Anesthesiologists (ASA) physical status I/II patients . or sensitivity to study drugs and who were on chronic Analgesic therapy. 2) Patients aged between 18–60 years.

will be injected through the spinal needle over a period of ten seconds with no barbotage.  After injecting the drug. Group BD(n=30) Patients and assessing anaesthesiologists will be blinded to the test drug. Patients will be randomly allocated into three groups in a double-blinded manner. time will be noted(T0)and the patient will be turned to supine position .Group 2 i. In the operating room. Group 1 i. and baseline vitals will be recorded. The study solution.e.ANAESTHESIA TECHNIQUEAll the patients will be premedicated with oral Alprazolam (0. An 20G intravenous line will be secured and preloaded with Ringer’s lactate 10 mL/kg.25 mg) and ranitidine (3 mg/kg) the night before surgery.e. GroupBM (n=30) . Group BF(n=30) and Group 3 I. prepared by another researcher who will not involved in the patient’s care. standard monitors (electrocardiogram. The drugs will be administered intrathecally in sitting position in L3–4 or L4–5 space with a 26-gauze spinal needle.e. Non-invasive blood pressure and pulse oximeter) will be Attached to the patient.

 Peak level of motor blockade (T4) will be assessed by using Bromage score. sedation.operatively and every ten minutes subsequently till 2-segment regression of block. vomiting.  Onset time of sensory block (T1). the patient will be given general anaesthesia and excluded from the study. . if VAS was found to be ≥ 5. Adverse effects such as nausea. Postoperatively. Pulse rate and blood pressure will be monitored every five minutes intra.  Duration of sensory block(T5)  Duration of motor block (T6)  Time for rescue analgesia will be noted. Pain will be assessed using the Visual Analogue Score (VAS) (0: no pain. If the Pain is not relieved.5mg/kg) will be administered intramuscularly. Hypotension (> 20% decrease in systolic blood pressure from baseline) will be managed with intravenous fluid (20 mL/kg) initially and then with mephenteramine 3 mg in incremental boluses. rescue analgesic medication with diclofenac sodium (1.Following observation will be recorded. Intraoperative rescue analgesia will be administered with Fentanyl (1 μg/kg) intravenously.(T3)  Onset of motor block (T2).  Level of sensory block(LMAX)  Time to achieve maximum sensory block level. when required. pruritis and urinary retention will be recorded. 10: maximum pain).

like Confusion.Dermatomal sensory block up to T10 was considered adequate for surgery. nausea.SD For all test ‘f ‘ value is calculated according to f distribution table. vomiting or Any neurological complications. Descriptive data will be presented as mean + / . In every 2hrs interval for post operative analgesia assessment and for any behavioral side effects. STATISTICAL ANALYSIS- Statistical analysis will be conducted with SPSS (19th version) for windows statistical package using ANOVA And any other relavant test. The maximum height of the sensory blockade will be noted at 20 minutes. All patients will be followed up after surgery. nystagmus. dizziness. .

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