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Relative potencies of bupivacaine and ropivacaine for analgesia in labour
British Journal of Anaesthesia, 1999
We have used the technique of randomized, double-blind sequential allocation to compare the minimum local analgesic concentrations (MLAC) of epidural bupivacaine and ropivacaine for women in the first stage of labour. The test bolus was 20 ml of local anaesthetic solution. The concentration was determined by the response of the previous woman to a higher or lower concentration of local anaesthetic, according to up-down sequential allocation. Efficacy was assessed using a 100-mm visual analogue pain score (VAPS). The test solution had to achieve a VAPS of 10 mm or less to be judged effective. For bupivacaine, MLAC was 0.093 (95% CI 0.076-0.110)% w/v, and for ropivacaine, 0.156 (95% CI 0.136-0.176)%w/v (PϽ0.0001, 95% CI difference 0.036-0.090). The analgesic potency of ropivacaine was 0.60 (0.47-0.75) relative to bupivacaine. Claims for reduced toxicity and motor block must be considered with differences in analgesic potency in mind.
Acta Anaesthesiologica Scandinavica, 2002
In recent studies, minimum local analgesic concentrations have been defined as 0.93 mg/mL for bupivacaine and 1.56 mg/mL for ropivacaine for epidural analgesia for the first stage of labour, resulting in an analgesic potency ratio of 1 : 0.6. In the current study we compared ropivacaine and bupivacaine in a PCEA system (combined with sufentanil) taking this potency ratio into account but administering drug doses providing sufficient analgesia for all stages of labour. Methods: In a prospective, double-blinded study 114 parturients were randomised to receive either ropivacaine 2 mg/mL with sufentanil 0.75 mg/mL or bupivacaine 1.25 mg/with sufentanil 0.75 mg/mL. After epidural catheter placement, PCEA was available with boluses of 4 mL, a lock-out time of 20 min and no basal infusion rate. We evaluated pain intensity during contractions, sensory and motor function, duration of labour, mode of delivery and neonatal outcome. Consumption of local anaesthetic and opioid drugs and PCEA system variables were recorded. Results: Mean total consumption as well as mean hourly drug consumption was significantly increased in the ropivacaine-su-
Journal of Anaesthesiology Clinical Pharmacology, 2016
Background and Aims: Ropivacaine is considered as a safe alternative to bupivacaine for labor analgesia. The aim was to compare epidural ropivacaine and bupivacaine in intermittent doses for obstetric analgesia. Material and Methods: In this prospective, randomized, double-blind study, 60 women in labor were randomly allocated to receive either bupivacaine 0.1% with fentanyl 2 μg/mL (BF), or ropivacaine 0.1% with fentanyl 2 μg/mL (RF). Bromage scale, loss of cold sensation to ether swab in midclavicular line, visual analog scale were used to test for motor block, sensory block and pain, respectively. Hemodynamic parameters, onset of analgesia, dose requirement of drug to produce analgesia, duration of labor, and incidence of side effects were also recorded. Data were expressed as mean ± standard deviation and analyzed using students unpaired t-test, Chi-square and Mann-Whitney U-tests at P < 0.05. Results: Both drugs were similar with respect to hemodynamic stability, onset of analgesia, quality of analgesia, sensory blockade, neonatal outcome, requirement of drugs, duration of labor, and incidence of side effects. Three parturient in bupivacaine (B-F) group had a motor block of Bromage 1 and were delivered using forceps. None of the parturient in ropivacaine (R-F) group had any motor block, and all had spontaneous vaginal delivery, but this difference was not statistically significant (P = 0.081). Conclusions: Bupivacaine and ropivacaine provide equivalent analgesia in low (0.1%) concentration.
International journal of obstetric anesthesia, 1999
We have compared three different methods of epidural analgesia in labour, bupivacaine 2.5 mg/ml (group B), bupivacaine 0.625 mg/ml + sufentanil 1 microg/ml (group BS) and bupivacaine 0.625 mg/ml + sufentanil 1 microg/ml + epinephrine 1 microg/ml (group BSE). One hundred and forty parturients with a singleton fetus with cephalic presentation were randomly allocated to one of the three groups. Group BSE had significantly less pain than groups B and BS. Group B had a significantly higher degree of motor blockade assessed on the Bromage scale. Significantly, more women in group B required urinary bladder catheterization than in the two other groups and they also had significantly less urge to push during active delivery. The incidence of mild pruritus was 18% in group BS and 36% in group BSE. The frequency of instrumental delivery and caesarean section was low (12% and 6.4%, respectively) with no significant differences between the groups. All women were highly satisfied with the method...
British Journal of Anaesthesia, 1996
Ropivacaine is a new aminoamide local anaesthetic. Compared with bupivacaine, ropivacaine possesses a higher threshold for systemic toxicity and a high selectivity for sensory fibres. We have compared prospectively these two agents in a concentration of 0.25 % for extradural analgesia in labour. A total of 104 parturients requesting extradural analgesia were randomized to receive either ropivacaine or bupivacaine. The women in the bupivacaine group required more top-up doses to maintain analgesia (median 3.0 vs 2.0) (P : 0.05). The onset of sensory block, quality of analgesia, ultimate level of maximum sensory block and maternal satisfaction were similar in both groups. The incidence, intensity and duration of motor block were slightly but not significantly less in the ropivacaine group. The ropivacaine group had a higher incidence of spontaneous vaginal delivery (70.59 % vs 52.00 %). There was no significant difference in neonatal outcome as assessed by Apgar scores, umbilical acid-base status and neurological and adaptive capacity score at 2 and 24 h after delivery. We conclude that ropivacaine and bupivacaine in a concentration of 0.25 % produced comparable analgesia for pain relief of labour with no detectable adverse effect on the neonate. (Br.
International Journal of Contemporary Medical Research [IJCMR], 2019
Providing effective as well as safe analgesia to the parturients in labour is always a concerned for the anaesthesiologists. We conducted this study to compare the analgesic efficacy and fetomaternal outcome of ropivacaine and bupivacaine at equianalgesic dose with fentanyl in low dose infusion. Material and Methods: This prospective, single blind study was carried on 60 nulliparous parturients of ASA grade I and II, with uncomplicated singleton, term pregnancy. The patients were randomly divided into two groups, to receive bolus dose of either 20 ml of 0.075% Ropivacaine and 0.05% Bupivacaine with fentanyl 2 µg/ml in Group RF and Group BF respectively, followed by infusion at the rate of 10ml/hr. Onset of analgesia, motor block, maternal hemodynamics, mode of delivery and foetal outcome was assessed. Results: Visual Analog Scale (VAS) score < 3 was achieved in 25 min in Group RF as compared to 30 min in Group BF. At 30 min, 77% parturients achieved T 10 as compared to 50% in group BF. Maternal haemodynamics, APGAR score, umbilical cord blood analysis was comparable in both the groups. None of the patients had motor block in both groups. The percentage of instrumental delivery was more in Group RF. Conclusions: The onset of analgesia was faster in Group RF as compared to Group BF. However once the analgesia was established, both the groups had effective and satisfactory analgesia throughout the labour with good foetal outcome. The incidence of instrumental delivery was more in Group RF.
Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2001
The study was aimed primarily at comparing the duration of analgesia produced by intrathecal fentanyl 25 µg with sufentanil 5 µg when added to bupivacaine 1.25 mg as the initial component of the combined spinal epidural (CSE) technique in early labour. Methods: Forty healthy parturients were randomly assigned into two groups to receive either intrathecal sufentanil 5 µg plus bupivacaine 1.25 mg (Group S) or intrathecal fentanyl 25 µg plus bupivacaine 1.25 mg (Group F). Apart from the duration of analgesia, pain scores and side effects were also evaluated. Results: There was no significant difference in the duration of analgesia (mean 109 ± SD 49 min in Group F vs 118 ± 54 min in Group S, P=0.9). Group F had a more rapid onset of analgesia (P <0.05) and a higher cephalad block (median T4 vs T7, P <0.05) in the first 30 min after the block. No difference in the side effects was detected. Conclusion: Fentanyl 25 µg is a good alternative to sufentanil 5 µg when added to bupivacaine 1.25 mg for early labour analgesia. Objectif : Comparer principalement la durée de l'analgésie produite par 25 mg de fentanyl intrathécal ou de 5 mg de sufentanil ajouté à 1,25 mg de bupivacaïne comme composant initial d'une analgésie rachidienne et péridurale combinée (RPC) pendant le début du travail. Méthode : Quarante parturientes en bonne santé ont été réparties au hasard en deux groupes et ont reçu, soit 5 mg de sufentanil intrathécal avec 1,25 mg de bupivacaïne (Groupe S), soit 25 mg de fentanyl avec 1,25 mg de bupivacaïne (Groupe F). On a évalué la durée de l'analgésie en plus de déterminer les scores de douleur et des effets secondaires. Résultats : La durée de l'analgésie n'a pas présenté de différence intergroupe significative (Groupe F : moyenne de 109 ± écart type de 49 min vs Groupe S : 118 ± 54 min, P = 0,9). Dans le groupe F, le début d'action de l'analgésie a été plus rapide (P <0,05) et le bloc plus élevé en direction céphalique (médiane de T4 vs T7, P <0,05) pendant les 30 premières min après le bloc. Aucune différence d'effets secondaires n'a été détectée. Conclusion : L'administration de 25 mg de fentanyl remplace bien celle de 5 mg de sufentanil lorsqu'on l'ajoute à 1,25 mg de bupivacaïne pour l'analgésie du début du travail obstétrical.
IP Innovative Publication Pvt. Ltd., 2018
Introduction and Aim: Ropivacaine and bupivacaine have been found to provide adequate labor analgesia when given epidurally. The aim of this randomized double blind study was to compare the onset of sensory block in epidural ropivacaine and bupivacaine with Fentanyl for labor analgesia and to assess the maternal and fetal outcome. Materials and Methods: In this prospective double blind study, 60 ASA II parturients with singleton vertex presentation were randomly allocated to two groups of 30 each. Group R received 5 ml 0.2% ropivacaine with 50mcg Fentanyl as bolus, followed by continuous infusion of ropivacaine 0.1% with Fentanyl 1 mcg/ml at 6 ml/hr. Group B received 5 ml 0.125% bupivacaine with 50 mcg Fentanyl as bolus, followed by continuous infusion of bupivacaine 0.0625% with Fentanyl 1 mcg/ml at 6 ml/hr. Onset and regression of sensory level, degree of motor block, hemodynamic effects, mode of delivery, neonatal outcome and patient satisfaction were compared. The statistical analysis was done using the Mean, Standard Deviation and the student ‘t’ test. Results: There was a significantly faster onset of sensory block with ropivacaine (5.67±0.99min) compared to bupivacaine (6.67±1.39min) (p <0> Conclusion: Ropivacaine provides effective analgesia with faster onset of sensory block in comparison to bupivacaine and is safe for mother and fetus. Keywords: Labor analgesia, Epidural, Bupivacaine, Ropivacaine, Fentanyl.
Colombian Journal of Anesthesiology, 2015
Introduction: Epidural analgesia is the safest and most effective method for the treatment of pain during childbirth. Epidural bupivacaine provides excellent analgesia for labor and remains the most widely used local anesthetic in obstetric anesthesia. Objective: To evaluate the analgesic efficacy of two concentrations of bupivacaine in women in labor. Methods: 114 patients in labor with term pregnancy were included in the study. They were grouped randomly into two groups: patients who received bupivacaine at 0.125% (group A) and those who received 0.25% bupivacaine (group B). Patients in group A received a bolus injection of 10 ml of 0.125% bupivacaine. The patients in group B received a bolus of 10 ml bupivacaine 0.25%. Pain intensity according to VAS, blood pressure, heart rate, respiratory rate, and the degree of motor block was assessed using the Bromage scale at different periods of time. Results: Demographic characteristics and parity were compared with no statistically significant differences found. By comparing the values of the VAS measure at 0, 15, 30, 60 and 90 min, statistically significant differences in favor of the group with 0.25% bupivacaine were found with decreased pain perception after 30 min, p-value = 0.02. No differences in arterial pressure, heart rate and respiratory rate were found between the two groups.