Comparing the duration of spinal anesthesia with bupivacaine between drug-dependent and non-dependent patients (original) (raw)
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Anesthesiology and Pain Medicine, 2014
Background: The addition of intrathecal opioids to local anesthetics seems to improve the quality of analgesia and prolong the duration of analgesia, when using a subarachnoid block in Iranian patients with their specific pain tolerance. Objectives: The aim of this study was to evaluate the effects of adding fentanyl or sufentanil, to intrathecal bupivacaine, in terms of the onset and duration of; sensory block, motor block, hemodynamic effects and postoperative pain relief. Patients and Methods: This randomized clinical trial included 90 patients who underwent orthopedic lower limb surgeries. Subjects were divided into experimental groups; intrathecal fentanyl 25 µg (F), and sufentanil 2.5 µg (S), along with a placebo 0.5 mL normal saline (C) group, which were added to bupivacaine 0.5%, 15 mg. Duration of complete and effective analgesia was recorded (by a visual analogue scale-VAS). The pain scores were assessed postoperatively. Intraoperative mean arterial pressure (MAP), heart rate and oxygen saturation (SPO 2 ) were recorded. The incidence of side effects such as; nausea, vomiting, pruritus, shivering, bradycardia and hypotension were also recorded. Results: MAP and heart rate results showed no significant changes at the designated time points among the three groups (P > 0.05). However, SPO 2 and VAS showed significant changes at the designated time points among the three groups (P < 0.05). The duration of complete and effective analgesia was also significantly longer in the sufentanil group (P < 0.05). Motor block did not exhibit any significant difference (P = 0.67). Only pruritus as a side effect was significantly higher in the sufentanil group (P < 0.05), while all other evaluated side effects were significantly lower in the sufentanil group (P < 0.05).
Brazilian Journal of Anesthesiology (English Edition), 2016
Objective: The primary outcome of this study was to evaluate the effect of adding sufentanil to hyperbaric bupivacaine on duration of sensory blockade of spinal anesthesia in chronic opioid users in comparison with non-addicts. Methods: Sixty patients scheduled for orthopedic surgery under spinal anesthesia were allocated into four groups: group 1 (no history of opium use who received intrathecal hyperbaric bupivacaine along with 1 mL saline as placebo); group 2 (no history of opium use who received intrathecal bupivacaine along with 1 mL sufentanil [5 g]); group 3 (positive history of opium use who received intrathecal bupivacaine along with 1 mL saline as placebo) and group 4 (positive history of opium use who received intrathecal bupivacaine along with 1 mL sufentanil [5 g]). The onset time and duration of sensory and motor blockade were measured. Results: The duration of sensory blockade in group 3 was 120 ± 23.1 min which was significantly less than other groups (G1 = 148 ± 28.7, G2 = 144 ± 26.4, G4 = 139 ± 24.7, p = 0.007). The duration of motor blockade in group 3 was 145 ± 30.0 min which was significantly less than other groups (G1 = 164 ± 36.0, G2 = 174 ± 26.8, G4 = 174 ± 24.9, p = 0.03). Conclusions: Addition of 5 g intrathecal sufentanil to hyperbaric bupivacaine in chronic opioid users lengthened the sensory and motor duration of blockade to be equivalent to blockade measured in non-addicts.
Mini dose bupicaine-buprenorphine vs bupicane for spinal anesthesia in orthopedic surgery
The Professional Medical Journal
Objective: To compare the effect of adding buprenorphine with small dose of isobaric bupivacaine on hemodynamics and duration of analgesia with bupivacaine alone in spinal anesthesia. Study Design: Randomised Controlled Trial. Setting: Allied and Abwa Hospital Faisalabad. Period: September 2019 to March 2020. Material & Methods: Sixty elderly pts. ASA III or IV undergoing hip surgery were selected randomly and divided into two groups A and B. pts received either small dose of isobaric bupivacaine 3.5 mg along with 120 micrograms buprenophine or 10 mg isobaric bupivacaine alone. Pts. were given 250 ml normal saline prior to spinal anesthesia administration. Level of block noted. Blood pressure, Heart rate, respiratory rate, Spo2, ECG monitored. BP and HR every 5 min recorded comparison done at 5 min of block and 20 min after block. Duration of postoperative analgesia noted for 24 hrs. Results: Comparing the two groups showed that 50% pts. in group B had a drop in systolic Bp at 5 min...
2016
The analgesic effect of the centrally acting opioid, tramadol, is well-known. It has been shown in clinical studies that using tramadol epidurally can provide longer duration of analgesia, without the common side effects of opioids. The study was undertaken to evaluate the duration of analgesia and/or pain free period produced by intrathecal tramadol added to bupivacaine in patients undergoing lower limb orthopaedic surgery in a randomized double blind placebo controlled protocol. 100 patients ASA I & II scheduled for various lower limb orthopaedic surgeries were randomly allocated to two equal groups. Group A (n=50) received 3 ml of 0.5% hyperbaric bupivacaine (15 mg) with 0.2 ml of normal saline and Group B (n=50) received 3 ml 0.5% hyperbaric bupivacaine and 0.2 ml (20 mg) tramadol by intrathecal route at L3-4 inter space. Standard monitoring of the vital parameters was done during the study period. Levels of sensory block and sedation score were recorded every two minutes for th...
Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2011
Background We have always been searching for the ideal local anesthetic for outpatient spinal anesthesia. Lidocaine has been associated with a high incidence of transient neurological symptoms, and bupivacaine produces sensory and motor blocks of long duration. Preservative-free 2-chloroprocaine (2-CP) seems to be a promising alternative, being a short-acting agent of increasing popularity in recent years. This study was designed to compare 2-CP with bupivacaine for spinal anesthesia in an elective ambulatory setting. Methods A total of 106 patients were enrolled in this randomized double-blind study. Spinal anesthesia was achieved with 0.75% hyperbaric bupivacaine 7.5 mg (n = 53) or 2% preservative-free 2-CP 40 mg (n = 53). The primary endpoint for the study was the time until
International Journal of Medical Science And Diagnosis Research
As it is a comparative study of Bupivacaine and Ropivacaine therefore Ropivacaine is a long-acting amide local anaesthetic with a potentially improved safety profile when compared to bupivacaine . Ropivacaine is less lipophilic than bupivacaine and is less likely to penetrate large myelinated motor fibres, resulting in a relatively reduced motor blockade. Subject and Methods: 90 patients, who belongs to American society of Anesthesiologist grade I & II of age 18-65 years randomized into three groups (n=30). All three groups received propofol bolus 0.75mg/kg IV followed by IV infusion at 0.025 mg/kg/min. group A received Nalbuphine 50 μg/kg IV bolus, group B fentanyl 1.5 μg/kg IV bolus and group C received Dexmedetomidine infusion 1 μg/kg given over 10 min as bolus followed by 0.1 mg/kg/hr IV infusion for maintenance. Ramsay sedation score and Visual analogue scale measured for sedation and analgesia respectively at 10 minute interval for 1st hour of surgery then every 30 minutes up...
IOSR Journals , 2019
Background: Analgesia, one of the components of triad of anaesthesia, has now extended to relief of postoperative pain, chronic pain and cancer pain. The spinal cord has taken the center stage in analgesia practice and Spinal anaesthesia is the commonly used technique for lower limb surgeries as it is easy to administer, economical and causes less hemodynamic variation than general anaesthesia. Hence different additives can be used to increase the duration of postoperative analgesia. Since there are no studies comparing Buprenorphine and Nalbuphine, we have selected this study to evaluate the effect of intrathecal Bupivacaine with Buprenorphine compared with Nalbuphine for postoperative analgesia. Materials and Methods: In this prospective randomised controlled study, 60 patients of ASA physical status I and II belonging to age group of 18-60years undergoing elective lower limb surgery under sub-arachnoid block were randomly allocated into 2 groups of 30patients each, Group A (Bupivacaine and Nalbuphine) and Group B (Bupivacaine and Buprenorphine). Group A received 2.8ml of 0.5%(H)Bupivacaine+[0.2 ml (2mg) of Nalbuphine (undiluted) taken in 1ml tuberculin syringe 1mg/0.1ml] and group B received 2.8ml of 0.5%(H)Bupivacaine+0.2ml(60µg) of buprenorphine for spinal anaesthesia. The onset and duration of sensory and motor blockade, 2 segment regression, duration of postoperative analgesia, side-effects and haemodynamic parameters were compared between the groups. Results: The mean time of onset of sensory and motor block, 2 segment regression and duration of motor block was comparable and statistically not significant between the two groups. The duration of postoperative analgesia was significantly prolonged with Buprenorphine compared to Nalbuphine with Bupivacaine (p<0.05). Conclusion: Intrathecal Bupivacaine with Buprenorphine 60μg caused prolonged duration of postoperative analgesia when compared to intrathecal Bupivacaine with Nalbuphine 2mg.
A PROSPECTIVE STUDY OF EPIDURAL ANALGESIA WITH BUPIVACAINE AND MORPHINE IN POSTOPERATIVE PATIENTS
National Journal of Medical Research, 2013
Background: Epidural analgesia has been shown to be superior to intravenous analgesia for postoperative analgesia after thoracic, abdominal and lower extremity surgery. However it is unclear which opioid is optimal for epidural analgesia. Morphine has potential advantages, yet there was little to establish its efficacy and safety. Thus we prospectively monitored our patients receiving epidural analgesia with Bupivacaine combined with Morphine postoperatively. Patients and Methods: A prospective study was conducted in 100 adult patients of either sex of age between 20 and 65 years belonging to ASA grade I and II. The study was conducted for relief of pain, amount of sedation and incidence of side effects like nausea, vomiting, pruritus and retention of urine in post operative patients receiving epidural analgesia when 0.125% Bupivacaine is combined with morphine. Lumbar epidural analgesia was initiated after central neuroaxial anaesthesia, with 0.125% Bupivacaine combined with 0.25mg/ml of morphine. Results: The addition of Morphine to 0.125% Bupivacaine given epidurally resulted in good analgesia in the post operative period. It also yielded sedation, especially after the second dose with minimal minor side effects. Conclusion: The addition of Morphine to Bupivacaine increases the duration of post-operative analgesia and it is more marked with the second top-up dose of Morphine and Bupivacaine.
Egyptian Journal of Anaesthesia, 2015
Background: Greater numbers of patients are presenting for surgery with aging-related, pre-existing conditions that place them at greater risk of an adverse outcome. Hemodynamic instability due to high sympathetic block largely limits the use of conventional dose spinal anesthesia in high risk elderly patients. In this study we aim to compare the hemodynamic stability and the incidence of hypotension in continuous spinal anesthesia (CSA) versus single low dose spinal anesthesia (SD) in elderly high risk patients. Methods: This prospective randomized blinded study was carried on 34 ASA III & IV elderly patients aged >75 years undergoing orthopedic lower limb surgery. The patients were randomly assigned to one of the study groups. Group CSA received intermittent dosing of local anesthetic solution via an intrathecal catheter using 0.5 ml of 0.5% isobaric bupivacaine increments and 0.5 ml of fentanyl (25 lg) while group SD single dose of 1.5 ml of 0.5% isobaric bupivacaine and 0.5 ml of fentanyl (25 lg). The study groups were compared regarding hemodynamic stability, incidence of hypotension and total ephedrine consumption. Results: Incidence of severe hypotension was significant. 52.9% of patients in SD group experienced an episode of severe hypotension versus none of them in CSA group (p 0.033 *). Total dose of fluids infused was significantly more in the SD group. The use of ephedrine was significantly more in SD group. Conclusion: CSA provided fewer episodes of hypotension and no severe hypotension versus SD 7.5 mg bupivacaine. CSA offers the added advantage of the ability to titrate dose of local anesthetic as needed while maintaining hemodynamic stability.