Introduction: Surgeons have been tried to reduce tonsillectomy associated pain by multiple techniques, such as covering exposed sensory nerves and surgical wounds with fibrin or sucralfae and infiltration local anesthetic agent.Materials and Methods: 60 patients (6-40 years) in study group were injected with 3-10 ml of 0.5% BUPIVACAINE and 1,200,000 epinephrine, at the end of tonsillectomy, and 60 patients (6-40 years) in control group with 3-10ml of normal saline. The intensity of pains were evaluated by visual analogue scale (VAS) in both groups at 6, 12, 18 hours after tonsillectomy and oral feeding.Results: The study group fared better and had less pain than the control group; also, in study group oral feeding time is shorter than control group. Post tonsillectomy pain is not related to sex, tonsilar enlargement and the indication of tonsillectomy.Conclusions: Pillars and tonsilar-fossa infiltration with 0.5% BUPIVACAINE and 1,200,000 epinephrine, provides post-operative pain relief in pediatric and adult tonsillectomy.

Background & Objective: Caudal block with local anesthetic agents has been extensively used in pediatric patients to provide intra and postoperative analgesia for surgical procedures such as herniorrhaphy or orchidopexy. Various additives to local anesthetic solutions have been used to prolong and enhance analgesia after caudal block. The aim of this study was to evaluate effectiveness of BUPIVACAINE 0.25% with the addition of fentanyl or neostigmine for caudal block in children undergoing inguinal herniorrhaphy.Materials & Methods: This study was clinical trial and seventy five children were randomly allocated to three groups to receive a caudal block with either 0.75 ml/kg of 0.25% BUPIVACAINE with 1μg/kg neostigmine (group BN) or 1μg/kg fentanyl (group BF) or 0.75ml/kg of 0.25% BUPIVACAINE alone (group B). Haemodynamic variables, degree of pain and sedation, additional analgesic requirements and side effects were evaluated. Mean age, weight and duration of anesthesia and surgery were similar in the three groups. Baseline systolic arterial pressure and heart rate were similar in the three groups.Results: Mean intra-operative systolic arterial pressure and heart rate was higher in group B than the other groups but this was not statistically significant. Adequate analgesia was obtained in 21 patients (84%) in group B, and 23 (92%) in BN and BF groupd. This difference was not significant. There was no difference in degree of sedation and analgesia between the groups. The incidence of vomiting was similar in the studied groups. No other side effects were seen.Conclusion: We found that addition of 1μg/kg fentanyl or 1μg/kg neostigmine to 0.75ml/kg of 0.25% BUPIVACAINE provide no further analgesic advantage to 0.75ml/kg of 0.25% BUPIVACAINE alone in caudal block in children undergoing unilateral herniorraphy.

Background: Caudal block with local anesthetic agents has been extensively used in pediatric patients to provide intra and postoperative analgesia for surgical procedures such as herniorrhaphy or orchidopexy. Various additives to local anesthetic solutions have been used to prolong and enhance analgesia after caudal block. The aim of this study was to evaluate effectiveness of BUPIVACAINE 0.25% with the addition of fentanyl or neostigmine for caudal block in children undergoing inguinal herniorrhaphy. Materials & Methods: 75 children were randomly allocated to three groups to receive a caudal block with either 0.75 ml/kg BUPIVACAINE, 0.25% with 1mg/kg neostigmine (group BN), or 1µg/kg fentanyl (group SF) or 0.75ml/kg BUPIVACAINE 0.25% alone (group B). Haemodynamic variables, degrees of pain and sedation, additional analgesic requirments, and side effects were evaluated. Mean age, weight and duration of anesthesia and surgery were similar in the three groups. Baseline systolic arterial pressure and heart rate were silmilar in the three groups.Results: Mean intraoperative systolic arterial pressure and heart rate were higher in group B than the other groups, but this was not statistically significant. Adequate analgesia was obtained in 21 (84%) patients in group B, 23 (92%) in group BN and group BF. This difference was not significant. There was no difference in degree of sedation and analgesia between the groups. The incidence of vomiting was similar between the groups. No other side effects were seen.Conclusion: We found that addition of 1µg/kg fentanyl or 1mg/kg neostigmine to 0.75ml/kg BUPIVACAINE 0.25% provide no further analgesic advantage when compared to 0.75 ml/kg BUPIVACAINE of 0.25% alone in caudal block in children undergoing unilateral herniorraphy.

Background. Although epidural anesthesia is a Successful method for most surgical procedures on lower extremities and lower abdomen. It is not so favorable because of it's slow onset and differential sensory and motor block. In order to solve this problem effects of additive KCl (5 meq/L) into BUPIVACAINE 0.5 percent according to onset, intensity, duration of block and homodynamic changes during epidural anesthesia will be investigated through the present study. Methods. All the ASA I or II patients at medical centers of Isfahan university of medical sciences throughout 1378, candidate for elective Surgical procedures on lower extremities and lower abdomen with no contraindication for epidural anesthesia were Subdivided into Case (35 patients) and Control (35 patients) groups in a random manner to perform a double blind clinical trial. Epidural anesthesia applied to cases (by BUPIVACAINE 0.5 percent+ KCl 5meq/L) and controls (by BUPIVACAINE 0.5 percent). Under identical conditions, data indicating basic MAP, basic heart rate and their changes as well as the onset, duration and intensity of motor and sensory block, were obtained and recorded by the anesthesiologist. Quantitative & qualitative variables were examined by T.test and X2 test respectively.Findings. Sensory onset for cases (8.22±1.43Min) was faster than controls (11.56±1.45Min) (P<0.005). Motor onset for cases (12.77±1.83Min) was faster than controls (20.24±1.71Min) (P<0.005). Sensory duration for cases (l86.34±8.37 Min) was longer than controls (162.17±7.47Min) (P<0.005). Motor duration for cases (106.25±13.50 Min) was longer than controls (77.60±9.94Min) (P<0.005).Intensity of sensory block for cases was greater than controls (P<0.01). Intensity of motor block for cases was greater than controls (P<0.001). Mean heart rate changes for cases (7.28±9.37 percent) and controls (7±8 percent) were not different (P<0.8). Mean decrease in MAP for cases (20.17±2.10n percent) was greater than controls (18.08±2.105 percent) (P<0.01). Conclusion. According to the results, it is understood that addition of KCl (5 meq/L) into BUPIVACAINE 0.5 percent not only can improve the onset, intensity and duration of epidural  anesthesia which modifies this technique to a more practical and fovorable one, but also avoids administration of high concentrations (≥120 meq/L) of potassium and it's subsequent side effects which terminated further investigation as described by literature with no additional side effects.

Background: Regional blocks is a good alternative to general anesthesia in upper extremity surgeries. Supraclavicular is a kind of regional block which can be used to treat nerve block in the upper extremity. The ancillary drugs are nowadays used to enhance the quality and quantity of sensory and motor block. The present study has attempted to investigate the effect of three prescription drugs (composition Dexamethasone with BUPIVACAINE and Dexmedetomidine with BUPIVACAINE and BUPIVACAINE alone) on supraclavicular block. Methods: This parallel Design study was conducted in 2017 as a clinical trial at Ayatollah Taleghani Hospital in Tehran. For this purpose, 60 patients over the age of 18 and in class I, II of the American Anesthesiology Association (ASA) who were candidates for upper limb elective surgery, were enrolled. Patients included in the study (60 patients) were randomly divided into three equal groups (n= 20). Anesthesia procedure was performed for all patients in three equal groups. However, to evaluate the efficacy of selected drugs, different drugs were injected into each group. After completing the design and recording the results of the variables under study, the ttest was used to compare quantitative variables between the two groups. All statistical tests were performed in two domains (5% significance level) and SPSS 21 software was used for data analysis. Results: In the levels of intraoperative factors in the comparative conditions of the BB 1 with BDexa 2 and BB with BDex 3 groups. However, Duration of Sensory Block (P=0. 004) and Duration of Movement Block (P=0. 001) were significantly different in BD and BDex groups. Conclusion: What can be clearly seen in the results are the significant changes of Duration of Sensory Block and Duration of Movement Block compared to the BDexa and BDex groups. Based on these results, in both cases we find a significant decrease in the measured duration in the BDexa group compared to the opposite group. Use of BUPIVACAINE + Dexamethasone has a more positive effect on Supraclavicular block compared to BUPIVACAINE + Dexmedetomidine and BUPIVACAINE alone.

Background: Postoperative pain is a common problem suffering the patients after knee surgery. Treatment with intra-articular corticosteroid proparation has been advocated but the value of this approach had not been established. We compared the efficacy of intra-articular dexamethasone plus BUPIVACAINE with the efficacy of intra-articular BUPIVACAINE alone to prevent post-operative pain after meniscectomy.Methods: Sixty ASAI patients undergoing meniscectomy with general anesthesia were randomly assigned to receive intra-operative intra-articular BUPIVACAINE, BUPIVACAINE plus dexamethoasone, or placebo under double blinded condition. The goup 1 (n=20) received 10 ml of buplivacaine 0.5% with epinephrine 1:2000000, group 2 (n=20) received 8ml BUPIVACAINE 0.5% with epinephrine 1:200000 plus 2ml (8mg) dexamethosone and group 3 (n=20) received 10ml of normal saline. The patients were evaluated until 12 hours after the operation and pain levels at rest measured by a Visual Analogue Scale (VAS).Results: During the first six hours after the operation, both combination of BUPIVACAINE and dexamethasone and BUPIVACAINE alone significantly reduced patient’s pain (P=0.000) and during six to twelve hours after operation the patients in dexamethasone group had significantly lower pain scores comparing to other group (P=0.037). The low pain scores were associated with lower requirement of supplementary analgesics (P=0.000).Conclusion: Combination of intra-articular dexamethoasone and BUPIVACAINE significantly reduces post-poertive pain and consumption of analgesics following meniscectomy than intra-articular BUPIVACAINE alone.

Background: Postoperative pain management can be achieved by adjuvant medications during the analgesia procedure. The study investigated the effect of intrathecal dexamethasone-BUPIVACAINE combination with BUPIVACAINE alone in spinal anesthesia for cesarean delivery. Methods: This randomized, double-blind clinical examination included 50 females who had previously experienced a cesarean section. The participants were assigned randomly into two categories: the intervention group, received intrathecal BUPIVACAINE-dexamethasone, and the control group, received intrathecal BUPIVACAINE-normal saline. Levels of pain were evaluated using a 10 cm visual analog scale (VAS) at intervals of 30 minutes, 1 hour, 2 hours after the operation. The span of the sensory block and postoperative analgesia were assessed. Results: The inclusion of intrathecal dexamethasone with BUPIVACAINE resulted in a significant enhancement in the duration of pain relief during the intervention, lasting for an average of 473.4 ± 39.95 minutes (p<0.001). The duration of sensory and motor block analgesia in the intervention group was more than the control group (128.32 ± 7.30 vs. 92.84 ± 7.84) and (155.6±12.34 vs. 126.16±11.89), respectively (p<0.001). Pain score on the VAS scale at 30, 60, and 120 minutes was significantly lower in the intervention group (p<0.001). There was no difference in side effects and onset time between the study groups. Conclusion: The inclusion of intrathecal dexamethasone alongside BUPIVACAINE has demonstrated enhancement in the duration of sensory block during spinal anesthesia. This improvement was observed without any alterations in the time it takes for the anesthesia to take effect and without any adverse effects during the postoperative period.

Introduction: Neostigmine and midazolam are each added to BUPIVACAINE for the purpose of caudal anesthesia. In this study, we compared neostigmine and midazolam, each co-administered with BUPIVACAINE, in terms of analgesia and side effects during pediatric inguinal hernia operations.Materials and methods: We included 60 children 1–6 years old, candidates for elective unilateral herniorrhaphy. After general anesthesia induction with inhaled sevoflurane, a caudal block was performed. Patients were randomly allocated to one of two trial groups: midazolam group received BUPIVACAINE 25% 1ml/kg with midazolam 50 mg/kg, and neostigmine group received BUPIVACAINE 25% 1ml/kg with neostigmine 2 mg/kg through the caudal route. Heart rate, mean arterial pressure and oxygen saturation were recorded before induction and every five minutes after caudal anesthesia up to 30 minutes. Pain and sedation scores were recorded at 2, 4, 6, 12 and 24 hours after the operation, along with rescue analgesia dosage, vomiting and respiratory depression.Results: Mean duration of analgesia in the midazolam group was similar to the neostigmine group (18.8±9 vs.20.4±7.5, P=0.44). The analgesic dosage required was not significantly lower in the neostigmine group compared to the midazolam group (58.3±121.7 VS.70.8±125.8, P=0.63).The number of patients who needed analgesic agents was similar in both groups (P=0.76). Nausea (P<0.05) and vomiting (P=0.01) rates were higher in the neostigmine group.Conclusion: Midazolam (50 mg/kg) compared to neostigmine (2 mg/kg) provided higher sedation along with lower incidence of postoperative nausea and vomiting.

Objective: To evaluate the effects of BUPIVACAINE (B), ketamine (K), and a combination of BUPIVACAINE and ketamine (BK) after lumbosacral epidural analgesia in sheep.Design: Experimental study.Animals: Nine healthy male and non-pregnant female Iranian Chall sheep with mean body weight of 38.9±15.1 kg.Procedures: Animals were selected randomly and three treatments administered. The drugs were administered in the lumbosacral epidural space. The onset and duration of analgesia and sedation were determined and heart rate, respiratory rate, and rectal temperature, were recorded at 0, 5, 10, 15, 20, 30, 40, 50, and 60 min after administration. Analgesia was determined by lack of response to pin pricking and pinch test in the skin of caudal areas.Results: The onset of analgesia was significantly faster in BK than that in B and K alone. Treatments with ketamine, either alone (K) or in combination (BK) lead to mild sedation. The heart rate increased significantly with B treatment at 15 and 20 min, and the respiratory rate showed a significant decrease with K treatment at 10 and 15 min.Conclusion and Clinical Relevance: Epidural administration of BUPIVACAINE/ketamine combination resulted in fast onset and moderate duration of analgesia of caudal areas. The employed doses in BK treatment probably reduced the side effects observed in B and K treatments. It is concluded that the combination of BK could be used epidurally in sheep to perform operations without any marked side effects.