A comparison of five solutions of local anaesthetics and/or sufentanil for continuous, postoperative epidural analgesia after major urological surgery (original) (raw)
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Epidural ropivacaine or sufentanil–ropivacaine infusions for post-thoracotomy pain☆
European Journal of Cardio-Thoracic Surgery, 2005
The aim of this study was to compare the analgesic efficacy and side effects of continuous epidural infusions of ropivacaine and ropivacaine-sufentanil mixtures after thoracotomy. Methods: Sixty-two patients scheduled for thoracic surgery were allocated in this prospective double-blinded randomised study. They received an epidural catheter inserted from thoracic 5-6 (Th 5-6) interspace a day before surgery and were randomly assigned into two groups, sufentanil-ropivacaine group (Group SR, nZ31) and ropivacaine group (Group R, nZ31). Bolus dose of the study drugs, ropivacaine 0.2% or ropivacaine 0.2% and sufentanil 0.75 mg/ml calculated in ml according to the patient's height was given through the epidural catheter before surgery. One hour after anaesthesia induction, another bolus was given and the epidural infusion was started (4.5-8 ml). Whenever visual analogue scale (VAS) scores were R4 during function, the patients received additional boluses and the infusion rate was increased by 1 ml/h. If the pain was not relieved after administration of two boluses, the patient was excluded from the study. Results: VAS at rest and during function was lower in ropivacaine-sufentanil group and the need for additional boluses and infusion rate increase was high in ropivacaine group (P!0.05). Ropivacaine-sufentanil infusion rate was decreased due to nausea and vomiting in two patients and due to CO 2 retention in one patient. There was no statistically significant difference between the incidences of side effects except pruritus significantly higher in Group SR. The total epidural solution volume was more in Group R (P!0.05). Conclusions: The continuous epidural infusion of ropivacaine with sufentanil provided superior pain relief than ropivacaine alone without causing any severe side effect or postoperative pulmonary impairment.
Anesthesia & Analgesia, 2000
In this randomized double-blinded study, we sought to determine an optimal dose-combination of sufentanil with ropivacaine 0.2% wt/vol as postoperative epidural analgesics. One hundred twenty patients undergoing major abdominal surgery under general and thoracic epidural anesthesia (T9-11) were assigned to groups receiving patient-controlled epidural analgesia with ropivacaine 0.2% wt/vol (R), ropivacaine 0.2% wt/vol ϩ sufentanil 0.5 g/mL (RϩS0.5), 0.75 g/mL (RϩS0.75), 1.0 g/mL (RϩS1). A visual analog score of less than 40 was considered effective, and all side effects were recorded. In randomized subgroups (10 patients per group), plasma pharmacokinetic data were obtained for both epidural drugs. Four patients in Group R and two in Group RϩS0.5 were excluded because of inadequate analgesia. The drug infusion rates (range of means: 5.4-5.9 mL/h) were similar in all patients. Analgesia was superior for sufentanil 0.75 g/mL with no further enhancement by the larger sufentanil concentration of 1 g/mL. Sufentanil plasma levels were Supported by ASTRA GmbH,
Southern African Journal of Anaesthesia and Analgesia, 2009
Background: The aim of this prospective, double blind, randomised trial was to compare the analgesic and adverse effects of three concentrations of the thoracic epidural sufentanil with bupivacaine in patients undergoing thoracotomy. Methods: We studied 60 (randomised) patients who were to receive a 10 ml bolus dose of sufentanil, 1μg/ml, 2 μg/ml and 3 μg/ml, in bupivacaine 0.125%, via thoracic epidural. Postoperatively, pain at rest, on coughing and with ambulation was assessed using a visual analogue scale (VAS) and observer verbal ranking score (OVRS) at 2, 6, 12 and 24 hours. Adverse effects were simultaneously assessed. Results: There was no significant difference in the baseline characteristics between the three groups. The number of patients with episodes of unsatisfactory pain, i.e. a VAS scores ≥ 40 and OVRS ≥ 2, at each of the four assessments postoperatively, was significantly higher with sufentanil 1 g/ml than with sufentanil 2 μg/ml or μ3 g/ml (p < 0.05). In the 3 μg/ml sufentanil group, four patients (20%) had a sedation score ≥ 3 compared with one (5%) and no (0%) patients in the 2 μg/ml and 1 μg/ml sufentanil groups, respectively (p < 0.05). In addition, 30% patients experienced pruritus in the 3 μg/ml sufentanil group compared with 10% and 5%, respectively, in the 2 μg/ml and 1 μg/ml sufentanil groups. In the sufentanil 3 μg/ml, 2 μg/ml and 1 μg/ml groups, 30%, 20% and 5% patients, respectively, had emetics symptoms (p < 0.05). Conclusions: We conclude that a thoracic epidural bolus of 10 ml sufentanil 2 μg/ml with bupivacaine 0.125% provides the optimal balance between pain relief and side-effects following thoracotomy.
Indian Journal of Anaesthesia, 2016
Background and Aims: Caudal epidural analgesia is the most commonly used method of post-operative analgesia in children undergoing subumbilical surgeries. Many additive drugs have been used to prolong the post-operative analgesia. The aim of this study was to compare the efficacy of tramadol or midazolam addition to caudal ropivacaine for post-operative analgesia in children undergoing subumbilical surgeries. Methods: In this prospective, randomised, double-blinded comparative study, sixty children of either gender, in the age group of 1-5 years and scheduled for elective subumbilical surgeries were randomly divided into three groups of twenty each. Children in Group R received an epidural injection of 1 mL/kg of 0.2% plain ropivacaine whereas children in Group RT received an epidural injection of 2 mg/kg of tramadol plus 1 mL/kg of 0.2% ropivacaine and Group RM received an epidural injection of 50 µg/kg midazolam plus 1 mL/kg of 0.2% ropivacaine. The primary outcome variable was the duration of time to rescue analgesia. The secondary outcome variables were motor block, sedation score and urinary retention. Statistical comparison among the three groups was performed using one-way ANOVA with post hoc analysis using Bonferroni. For qualitative variables, Chi-square test was used. Statistical significance was defined as P < 0.05. Results: The mean duration of time to rescue analgesia was significantly longer (P < 0.001) in Group RT (913 ± 315.5 min) and Group RM (769.2 ± 331.9 min) compared to Group R (437.75 ± 75.68 min). However, there was no significant difference in the duration of time to rescue analgesia between RT and RM groups. Motor block and sedation scores were comparable between groups. Conclusions: The addition of tramadol or midazolam to caudal epidural ropivacaine prolongs the duration of analgesia without causing significant side effects.
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).
Saudi Journal of Anaesthesia, 2011
Background: The objective of the present study was to compare the onset, degree and recovery time of sensory and motor block and hemodynamic effects of intrathecal bupivacaine alone and bupivacaine with sufentanil or butorphanol in endoscopic urological surgeries. Methods: In a randomized, double-blind study, 90 patients of either sex and age, belonging to ASA Grades I and II, scheduled for elective endoscopic urological surgeries under spinal anesthesia, were allocated into three groups of 30 each. Patients received either 2.5 ml of 0.5% hyperbaric buypivacaine 12.5 mg (Group A), 1.5 ml of 0.5% hyperbaric bupivacaine 7.5 mg with 10 µg sufentanil (Group B) or 1.5 ml of 0.5% hyperbaric bupivacaine 7.5 mg with 25 µg butorphanol (Group C). Vital parameters, level, duration and regression of sensory block and motor block and side-effects were recorded and compared. Statistical Analysis Analysis of variance (ANOVA), post hoc test and Chi-square test were used. Results: Intrathecal addition of sufentanil/butorphanol prolonged the duration of sensory block (DOSB) compared with bupivacaine alone (DOSB being 156.83±23.83 min, 170.87 ± 22.21 min and 171.17 ± 23.99 min in groups A, B and C, respectively) without altering the duration of motor blockade. Bromage score 3 was achieved in 100%, 90% and 54.4% patients in groups A, B and C, respectively. The time to first request for analgesia was 112 ± 46.3 min, 323 ± 65.0 min and 299 ± 73.9 min in groups A, B and C, respectively. Complications were reduced by the addition of butorphanol, which also has a lower tendency than sufentanil to produce pruritus (60%). Conclusions: The analgesia was significantly prolonged in groups B and C; group C had a less-intense motor block. Complications were reduced by the addition of butorphanol, which also has a lower tendency than sufentanil to produce pruritus. Thus, this combination of butorphanol with low-dose bupivacaine is especially beneficial in the geriatric group of patients who have multiple co-morbid conditions.
Revista Brasileira de Anestesiologia, 2007
A associação do opióide ao anestésico local melhora a qualidade da analgesia de parto e reduz o risco de toxicidade sistêmica pelo anestésico local. Os opióides, entretanto, podem determinar efeitos colaterais. O objetivo desta pesquisa foi comparar os efeitos adversos determinados pelo sufentanil, administrado por via subaracnóidea, associado à bupivacaína, com aquele determinado pelo sufentanil por via peridural, associado à ropivacaína, nas doses utilizadas no Serviço de Anestesia, em gestantes submetidas à analgesia de parto.