Comparative Study Between Intrathecal Bupivacaine 0.5% Heavy + Fentanyl (0.5 Micrograms/KG) Versus Intrathecal Bupivacaine 0.5% Heavy + Buprenorphine (2 Micrograms/KG) in Lower Abdominal and Lower Limb Surgeries (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.
2018
Opioids have an important place as adjuvant to local anaesthetic agents in the management of spinal anaesthesia, the most commonly used being fentanyl. Other alternatives like opioid agonist antagonist agents like nalbuphine, butorphanol and buprenorphine are now being studied as adjuvants to prolong the duration of sensory and motor block with lower incidence of opioid related side effects. 60 patients belonging to ASA status I and II of either sex were randomly divided into three groups of 30 each to receive either butorphanol25 µg (Group A) or fentanyl 25 mcg (Group B)) with 2.5 mL 0.5% hyperbaric bupivacaine, making intrathecal drug volume to 3mL in each group.. Sensory and motor block characteristics in terms of time to onset and duration were recorded for each group. Drug-related side effects of pruritus, nausea/vomiting, and respiratory depression were also recorded. The two groups were comparable regarding the demographic profile. The fentanyl group showed delayed onset of sensory block (274 ± 73.39 sec) as well as a longer duration of sensory block (145.07 ± 5.34 mins vs 141.33 ± 3.51) than butorphanol. The duration of motor block was also prolonged in the fentanyl group(149 ± 7.13 vs 140.37 ± 2.31). Both the findings were significant. Butorphanol provided a significantly longer duration of postoperative analgesia (250.10 ± 4.05 vs 244 ± 7.11 min). No drug related side effects were observed in either group. Addition of 25 μg of butorphanol as adjuvant to hyperbaric bupivacaine 0.5% provides a faster onset of sensory block as compared to 25 μg fentanyl. Fentanyl provided a significantly greater duration of both sensory and motor block than butorphanol. The duration of postoperative analgesia was significantly greater with butorphanol.
International Journal of Medical Anesthesiology, 2020
Pain is a complex subjective experience which has been proved difficult to measure in reproducible way. It is found that operative pain is more severe after surgery and thereafter gradually diminishes over next 24 hours. Providing effective analgesia for patients undergoing major surgery is a daily challenge for most anesthetists. The treatment of acute postoperative pain is a major health care issue. Epidural anesthesia /analgesia is one of the best accepted techniques for lower limb surgeries as it provides good sensory and motor block, decreases adverse physiologic responses to surgery such as autonomic hyperactivity, cardiovascular stress, tissue breakdown, increased metabolic rate, pulmonary dysfunction, and immune system dysfunction. Intraoperatively, sensory and motor blockade, quality and duration of Postoperative analgesia, hemodynamic and respiratory parameters, side effects like nausea, vomiting, respiratory depression, urinary retention. In this observational study an effort was made to study the peri operative analgesic efficacy of Inj. buprenorphine and Inj. fentanyl with 0.5 % Bupivacaine epidurally for lower limb surgeries. There were no significant hemodynamic and respiratory side effects in either of the groups. The postoperative analgesia was definitely of a longer duration with the Buprenorphine group. So it is concluded that epidural Buprenorphine is better in providing prolonged satisfactory postoperative analgesia as compared to Inj. Fentanyl. Regarding the side effects, the incidence of nausea and vomiting was more in buprenorphine as compared to fentanyl group, which could be easily treated with antiemetic's like Ondansetron. Both buprenorphine and fentanyl along with bupivacaine 0.5% can be given epidurally as a single shot injection for perioperative analgesia obviating the need for epidural catheter.
Introduction: Intrathecal anesthesia and epidural anesthesia (EA) are the most popular regional anesthesia techniques used for surgeries below umbilicus. EA is more versatile in providing anesthesia, analgesia and treatment of chronic disease syndromes. It provides better postoperative pain control and more rapid recovery from surgery. It also provides effective prolonged surgical anesthesia, prolonged postoperative analgesia, reduces the incidence of hemodynamic changes and reduces the incidence of PDPH as the dura is not pierced. Aims And Objectives: To Compare with the efficacy of lumbar epidural block with 0.5% bupivacaine 10ml with Fentanyl 50µg and 0.5%bupivacaine 10ml with butorphanol 1mg in lower limb surgeries focusing on Onset and duration of analgesia, Cardio respiratory effects, Sedation, Adverse effects Summary: The study was conducted to compare the effect in lower limb surgeries. 100 patients belonging to ASA grade I&II were selected. Bupivacaine (0.5%) 10ml with fentanyl (50µg) was given in Group I, and Bupivacaine (0.5%)10ml with butorphanol (1mg) was given in Group II. The patients studied across the group did not vary much with respect to age, sex or height. The onset of sensory blockade was delayed by about 20 seconds in groupII and the onset of motor blockade was delayed by about 20-25 seconds in group-II compared to group-I. Duration of sensory blockade in Group II is longer compared to group I , thus prolonging the duration of analgesia. Duration of motor blockade in group II is prolonged than in Group I. The time of first request of analgesics by the patients in group-II is longer (360 minutes) compared to group-l (206 minutes) thus prolonging the duration of analgesia. Visual analogue scores were significantly lower in group-II compared to group-l thus reducing the requirement of supplemental postoperative analgesics. The adverse effects observed in the study were minimal. Conclusion: Addition of the opioids, i.e., Butorphanol and Fentanyl significantly quickens the onset and prolongs analgesia Onset is fast with Bupivacaine with Fentanyl combination compared with Bupivacaine with Butorphanol combination. Bupivacaine with Butorphanol provide more effective and longer duration of analgesia as compared with Bupivacaine with Fentanyl.
National Journal of Medical Research, 2016
Objective:To know the effects of intrathecal 0.5% Bupivacaine 2.5 cc with 0.5 cc normal saline and 0.5% Bupivacaine 2.5 cc witth 25 μg fentanyl for various lower abdominal surgeries. Methods: A comparative study were conducted in 60 (ASA grade I / II) patients. The onset and duration of both sensory and motor blockade was compared using relevant scales i.e. Sensory scale and Bromage Scale. - Intra-operative and post-operative hemodynamic monitoring was done. The complications which occurred were noted and studied. - The duration of analgesia after sensory wear off was compared between the 2 groups using Visual Analogue Scale. - Quality of post-operative analgesia was studied between the groups. Results: The duration of sensory and motor block as well as duration of effective analgesia was significantly longer in the bupivacaine–fantanyl group as compared with both bupivacaine–normal saline groups. Conclusion: Addition of intrathecalfantanyl to bupivacaine was more advantageous than bupivacaine with normal saline with special regard to its analgesic properties among surgical patients.
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.
Sri Lankan Journal of Anaesthesiology, 2016
Introduction: Regional Anaesthesia particularly spinal Anaesthesia is one of the most commonly used technique world wide. Risk of Neuropathies of 5% Lidocaine, Bupivacaine and Ropivacaine are the alternatives for routine use. The duration of the drugs were 2-4 hrs and maximal allowable volume and doses are associated with high incidence of side effects despite suitable precautions. A number of Opioid adjuvants are used to spinal anaesthesia with reduced doses of local anaesthetics to prolong the post operative analgesia, avoiding residual motor paralysis and potential side effects of Opioids given through other routes (IM/IV) for post operative pain relief. Fentanyl Citrate an opioid has been used as an adjuvant in various clinical trials. The aim of the study was to compare the subarchnoid block characteristics with low dose fentanyl with intrathecal bupivacaine. Methodology: After institutional ethics committee approval and written informed consent, 50 Patients of ASA I&II belonging to both sexes posted for elective lower abdominal and orthopedic surgeries. They were randomnly allocated into 2 groups, 25 each. Group A received 0.5% hyperbaric bupivacaine 2.5ml with 0.9% normal saline 0.5ml. Group B received 0.5% hyperbaric bupivacaine 2.5ml with fentanyl 0.5ml 25µg. Total volume made up to 3ml to achieve subarchnoid block, Sensory block, motor block, haemodynamic characteristics adverse effects, duration of post operative analgesia statistical analysis and results were noted in two groups. Statistical analysis was done with one way analysis of variance. Duration of Sensory, Motor blockade significantly longer in group B. (P<0.01). Time to first request of analgesia was significantly longer in group-B than group-A (P<0.001) Conclusion: Addition of Fentanyl Citrate to intrathecal bupivacaine prolonged the duration of sensory, motor and post operative analgesia without causing significant deleterious effects on the patients.
"For all the happiness mankind can gain, is not in pleasure, but in rest from pain." -John Dryden Alleviation of pain is one of the most fundamental goals in anesthesiology. Postoperative pain, apart from patient's suffering, has many other adverse physiological and psychological effects like respiratory depression, circulatory disturbances and metabolic stress responses induced by anesthesia and surgery. Thus, postoperative pain management plays a vital role in deciding the overall outcome of any surgery.
Journal of Evolution of Medical and Dental Sciences, 2015
BACKGROUND: Among all the spinal adjuvants, clonidine, an alpha-2 agonist has the ability to alleviate both the somatic and visceral pain and is more potent at spinal site, favoring its neuraxial administration. OBJECTIVE: This study was done to compare the onset and duration of sensory and motor blocks, duration of analgesia, haemodynamic and adverse effects of Clonidine, buprenorhine and fentanyl used intrathecally with hyperbaric 0.5% bupuvacaine. SETTINGS & DESIGN: This prospective, randomized and comparative study included 90 ASA class 1 & 2 patients undergoing lower abdominal and lower limb surgeries under spinal anesthesia after approval from hospital ethics committee with written informed consent of patients. MATERIALS AND METHODS: Patients were randomly allocated into three groups (n=30) and received 50μg of clonidine, 25μg of fentanyl and 75μg of buprenorphine respectively in group BC,BF and BB as adjuvants to 15mg of 0.5% hyperbaric bupivacaine (3.0ml). The onset time and duration of sensory and motor block, duration of analgesia, haemodynamic changes and side effects were recorded. RESULTS: The onset time of motor block and durations of sensory, motor blockade and analgesia were prolonged in-group BC as compared to group BF and BB (P<.001). There was no significant difference in the onset time of sensory block in three groups (P>.05). Group BC had lower heart rate and mean blood pressure and higher sedation score. CONCLUSION: Intrathecal Clonidine in a dose of 50μg is an effective adjuvant to local anesthetics in neuraxial blocks despite mild sedation and haemodynamic variations.
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).