Mini dose bupicaine-buprenorphine vs bupicane for spinal anesthesia in orthopedic surgery (original) (raw)
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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.
International Journal of Anesthesiology & Research, 2021
This study was performed at a tertiary care centre after the approval of the Institutional Ethical Committee and obtaining written informed consent from all patients. Sixty ASA I and II, aged 18-65yrs, bodyweight 45-70kgs scheduled for gynaecological surgeries under spinal anaesthesia were chosen for the study and were divided into two groups named Group B and Group BN each comprising 30 patients. Group B received 3ml of 0.5% hyperbaric bupivacaine with 0.5 ml normal saline and Group BN received 3ml of 0.5% hyperbaric bupivacaine with 0.5ml (150mcg) of buprenorphine. Vital parameters like pulse rate, blood pressure, respiratory rate, SpO2 were recorded at 0 (basal) 15, 30, 45, 90 and 180 minutes. Postoperatively heart rate, blood pressure, respiratory rate and SP02 were monitored at 3 ,6 ,12 and 24 hrs. The mean age, height, weight, duration of surgery were comparable. Time of onset of sensory blockade and motor blockade were noted. The time for rescue medication was 909.0±216.9 min in group BN with a range from 690 min to 1500 min and in group B it was 412.0±89.28 min with a range from 130 min to 195 min. Comparing both groups duration of effective analgesia was significantly higher in group BN with P<0.0001.thus, it can be concluded that addition of buprenorphine as an adjuvant in spinal anaesthesia excellently prolongs duration of analgesia in postoperative period with minimal 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).
Introduction: Pain is a unique emotional experience, which is associated with actual or potential tissue damage. Postoperative pain management is necessary. The most effective preemptive analgesic regimens are those that are capable of limiting sensitization of the nervous system throughout the entire perioperative period. Material & Methods: Radomly patients were assigned in two groups of 60 patients who underwent lower limb orthopedic surgery. The clinical effects of intrathecally administered Inj Bupivacaine 0.5% hyperbaric 2.5 ml (group B) with Inj Buprenorphine preservative free 150 mcg additional to the hyperbaric bupivacaine 0.5% 2.5 ml (group B) for lower limb orthopedic surgeries were studied . Results: Surgery had mean duration of 87.3(16.7) min for group B and 96.3(17.1) min for group BN. There was statistically no significant (P>0.05) difference of time of onset, maximum level and time required reaching maximum level of sensory block in between the groups. All patients in both groups had complete motor blockade. There was statistically no significant (P>0.05) difference in preoperative, during surgery and postoperative hemodynamic parameters in between two groups. Sensory recovery was significantly (P<0.01) delayed in BN group compared to B group. Mean duration of effective analgesic was markedly raised (P<0.001) to 909 (216.9) min in group BN from 158(17.3) min in group B. Complication of nausea, vomiting and shivering was noted in both the groups with no significant difference(P>0.05). Conclusion: Buprenorphine added to Bupivacaine hyperbaric have effective and considerably prolonged postoperative analgesia.
SciDoc Publishers, 2021
This study was performed at a tertiary care centre after the approval of the Institutional Ethical Committee and obtaining written informed consent from all patients. Sixty ASA I and II, aged 18- 65yrs, bodyweight 45-70kgs scheduled for gynaecological surgeries under spinal anaesthesia were chosen for the study and were divided into two groups named Group B and Group BN each comprising 30 patients. Group B received 3ml of 0.5% hyperbaric bupivacaine with 0.5 ml normal saline and Group BN received 3ml of 0.5% hyperbaric bupivacaine with 0.5ml (150mcg) of buprenorphine. Vital parameters like pulse rate, blood pressure, respiratory rate, SpO2 were recorded at 0 (basal) 15, 30, 45, 90 and 180 minutes. Postoperatively heart rate, blood pressure, respiratory rate and SP02 were monitored at 3 ,6 ,12 and 24 hrs. The mean age, height, weight, duration of surgery were comparable. Time of onset of sensory blockade and motor blockade were noted. The time for rescue medication was 909.0±216.9 min in group BN with a range from 690 min to 1500 min and in group B it was 412.0±89.28 min with a range from 130 min to 195 min. Comparing both groups duration of effective analgesia was significantly higher in group BN with P<0.0001.thus, it can be concluded that addition of buprenorphine as an adjuvant in spinal anaesthesia excellently prolongs duration of analgesia in postoperative period with minimal side effects.
Introduction: Hip fracture is a frequent and severe disease. Its prognosis depends on the perioperative hemodynamic stability which can be preserved by the unilateral spinal anesthesia especially with low doses of local anesthetics. This study aims to compare the efficacy and hemodynamic stability of two doses of hypobaric bupivacaine (7.5 mg vs 5 mg) in unilateral spinal anesthesia. Methods: In this prospective, randomized, double-blind study, 108 patients scheduled for hip fracture surgery under unilateral spinal anesthesia were enrolled to receive either 5 mg (group 1) or 7.5 mg (group 2) of hypobaric bupivacaine. Spinal anesthesia was performed in lateral position. Patients' socio-demographic characteristics, hemodynamic profile, sensory and motor blocks parameters were recorded. Results: Both groups were comparable regarding to demographic data. Two cases of failure occurred in group 1 and one case in group 2 corresponding to a comparable efficiency rates (96.29% and 98.14% respectively; p = 0.5). A higher mean onset and lower mean regression times of sensory block were significantly noted in group 1 (7.79±3.76 min vs 5.75±2.35 min, p < 0.001 and 91.29±31.55 min vs 112.77±18.77 min, p <0.001 respectively). Incidence of bilateralization (29.62% vs 87.03%, p < 0.001), incidence of hypotensive episodes (59.25% vs 92.59%, p < 0.001) and vascular loading (1481.48±411.65 ml vs 2111.11±596.10 ml, p < 0.001) were significantly higher in group 2. Conclusion: The dosage of 5mg of hypobaric bupivacaine in unilateral spinal anesthesia is as effective as the dosage of 7.5 mg with lower bilateralization incidence and better hemodynamic stability.
British Journal of Anaesthesia, 1997
Postoperative pain after major orthopaedic operations can be controlled by continuous intrathecal administration of opioids or local anaesthetics. Effective intrathecal analgesia can be achieved through synergism of low doses of the two analgesic drugs and, possibly, less drug-related adverse effects. Therefore, we have evaluated the usefulness of a combined low-dose bupivacaine and morphine infusion in patients undergoing hip and knee arthroplasty. Spinal anaesthesia was induced in 55 ASA I-III patients with 0.5% bupivacaine 2 ml via a 28-gauge spinal catheter (L3-4 interspace) and 0.5-ml increments were given if needed. Intrathecal 24-h infusions consisted of bupivacaine 2 mg h 91 alone (n:18), bupivacaine 1 mg h 91 alone (n: 18) or bupivacaine 1 mg h 91 combined with morphine 8 g h 91 (n:19). The interview after 3,6,12 and 24 h included assessment of pain at rest and on movement (VAS scale), occurrence of sensory and motor block and nausea/vomiting. Bupivacaine 1 mg h 91 combined with an infusion of morphine provided as good postoperative analgesia as bupivacaine 2 mg h 91 , but motor block disappeared earlier (P:0.01). Patients in the bupivacaine 1-mg h 91 group required more supplementary doses of oxycodone i.m. than the other groups (P:0.04). Time to first oxycodone dose from the start of intrathecal infusion did not differ between groups. The frequency of nausea and vomiting was similar in all groups. In spite of this, antiemetic medication was required more often in the bupivacaine 1-mg h 91 group (possible because of opioid rescue medication). On the ward, one patient in the bupivacaine 2-mg h 91 group experienced a new increase in sensory block with concomitant hypotension. One patient in the same group had minor decubitus on the heel of the operated leg, probably because of prolonged motor block. We conclude that intrathecal infusion of a combination of bupivacaine 1 mg h 91 and morphine 8 g h 91 produced adequate postoperative analgesia. Unfortunately, postoperative nausea and vomiting was a frequent disturbing adverse effect. (Br.
Indian Journal of Clinical Anaesthesia
Spinal anaesthesia (SA) with bolus dose has rapid onset but rapid onset may precipitate hypotension. If local anaesthetic is injected in fractions with some time gap, it may provide dense block with haemodynamic stability and prolonged duration of analgesia. We aimed to compare bolus dose with fractionated dose in SA for haemodynamic stability and duration of analgesia in patients undergoing lower limb surgery. After the Institutional Ethics Committee clearance, the study was carried out in sixty patients undergoing lower limb surgery. Patients were divided into two groups. Group B patients received single bolus SA with injection bupivacaine heavy (0.5%), 3 ml and Group F patients fractionated dose with two-third (2ml) of the total dose of injection bupivacaine heavy (0.5%) given initially followed by one- third (1ml) dose after 90s. Time of onset and regression of sensory and motor blockage, intraoperative haemodynamics and duration of analgesia were recorded and analysed with Stud...
The Professional Medical Journal, 2019
To determine the effect of speed of hyperbaric bupivacaine (0.75%) injection on clinical characteristics of spinal anaesthesia in elderly patients undergoing lower limb orthopaedic surgeries. Study Design: Prospective, randomized, double-blind study. Setting: This study was conducted in the operating theatre of Fauji Foundation Hospital, Rawalpindi. Period: August 2018 - March 2019. Materials and Methods: 60 elderly patients undergoing lower limb orthopaedic surgery were randomized into two groups based on injection rate (fast and slow). 1.5 ml of 0.75% hyperbaric bupivacaine was injected over 5 seconds (fast group) and 50 seconds (slow group). Study was undertaken after taking permission from institutional ethical review committee. Level of sensory block, motor block, and systolic blood pressure were recorded at pre-specified intervals. Incidences of hypotensive episode, nausea, phenylephrine and antiemetic use were also documented. Results: Our study did not reveal any difference ...