Analgesic Effect Of Bupivacaine Research Articles

A Comparative Study of Cardiovascular Response and Analgesic Effects of Bupivacaine and Butorphanol

A Comparative Study of Cardiovascular Response and Analgesic Effects of Bupivacaine and Butorphanol

Caudal bupivacaine plus ketamine compared with bupivacaine plus tramadol for postoperative analgesia in children

Background Caudal epidural block has been used commonly in pediatric postoperative pain management. However, the analgesic effect of caudal of bupivacaine lasts for 4-12 h. Aim The aim of this study was to compare the analgesic efficacy of the coadministration of tramadol (2 mg/kg) and ketamine (0.25 mg/kg) on the duration of caudal block produced by 0.25% bupivacaine 0.75 ml/kg on postoperative pain after an elective subumbilical surgery in children. Settings and design This is a controlled, randomized, single-blinded study. Patients and methods This study was carried out on 40 children between 2 and 12 years of age, ASA grade 1, of both sexes in Tanta University after obtaining the approval of the local hospital organization and parents' consent. The patients were divided into two equal groups. The patients in the bupivacaine plus ketamine group (group 1) received caudal bupivacaine 0.25%, 0.75 ml/kg mixed with ketamine 0.25 mg/kg, diluted in a 0.9% NaCl solution to a total volume of 1 ml/kg. The patients in the bupivacaine plus tramadol group (group 2) were administered caudal bupivacaine 0.25%, 0.75 ml/kg mixed with tramadol 2 mg/kg, diluted in a 0.9% NaCl solution to a total volume of 1 ml/kg. Statistical analysis Mean and SD were calculated as numerical data. Continuous variables were compared using the unpaired Student's t -test. Nominal nonparametric data were analyzed using the χ 2 -test. Results Patients were monitored over the first 24 h postoperatively to assess analgesia using the All India Institute of Medical Science (AIIMS) objective pain discomfort scale and associated hemodynamic and respiratory changes. Our results showed that the addition of tramadol in group 2 significantly prolonged the analgesic effect of bupivacaine; also, there was hemodynamic stability and pain scores indicated minimal pain. Conclusion Caudal epidural tramadol has been proven to be safe at the concentration used and to prolong bupivacaine's analgesic duration postoperatively in children.

Local anesthetic infusion pump for pain management following open inguinal hernia repair: A meta-analysis

ObjectivesOpen inguinal hernia repair is one of the most painful procedures in day surgery. A continuous ambulatory analgesic is thought to reduce postoperative pain when it is applied to the surgical site. The aim of this study is to evaluate the efficacy of local anesthetic infusion pump following open inguinal hernia repair for the reduction of postoperative pain. MethodsWe conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) that have investigated the outcomes of using an infusion pump for delivering a local anesthetic contrasted to a control group for open inguinal hernia repair. Pain was assessed from Day 1 to Day 5 following the surgery. The secondary outcomes included analgesia use and postoperative complications. ResultsWe reviewed 5 trials that totaled 288 patients. The analgesic effects of bupivacaine (4 trials) and ropivacaine (one trial) were compared with a placebo group. The pooled mean difference in the score measuring the degree of pain diminished significantly at Day 1 to Day 4 in the experimental group. Two studies have reported that the number of analgesics required also decreased in the experimental group. No bupivacaine-related complication was reported. ConclusionOur results revealed that applying a local anesthetic infusion pump following inguinal hernia repairs was more efficacious for reducing postoperative pain than a placebo. However, the findings were based on a small body of evidence in which methodological quality was not high. The potential benefits of applying a local anesthetic infusion pump to hernia repair must still be adequately investigated using further RCTs.

Comparison of the analgesic, clinicophysiological and hematobiochemical effects of epidural bupivacaine in healthy and uremic goats

The analgesic effect of bupivacaine (0.5 mg/kg) was evaluated in the uremic ( n = 6) and healthy goats ( n = 6) after its lumbosacral epidural administration by clinicophysiological and hematobiochemical parameters. The onset of analgesia was delayed in uremic animals than in healthy animals. Bupivacaine produced complete analgesia of tail, perineum, inguinal and thigh regions in both groups. However, in healthy animals it produced a longer duration of complete analgesia than in uremic animals. Greater ataxia was produced in healthy animals than in uremic animals. The heart rate, respiratory rate, rectal temperature, hemoglobin, packed cell volume and differential leukocyte count did not show any significant changes in both healthy and uremic animals. However, total leukocyte count, urea nitrogen and creatinine showed significantly higher values in uremic animals. The blood electrolytes, blood gases and acid base parameters did not show any significant changes in any group. However, base excess was significantly higher in uremic animals. The changes in these parameters were however, minimal and transient and became normal as the effect of the drug was over. Therefore, bupivacaine (0.5% solution at 0.5 mg/kg) may be used in clinical situations in uremic caprines and in the animals which are under a similar type of physiological stress.

Clinical Effects of Ketamine on Ropivacaine in Brachial Plexus Blockade

Background: Ketamine enhances local anesthetic and analgesic effects of bupivacaine by peripheral mechanisms. We evaluated the additive effects of ketamine (30 mg) on 0.5%, and 0.75% ropivacaine (total 30 ml) for an interscalene brachial plexus blockade (IBPB). Methods: Thirty five adult patients scheduled for major forearm or hand surgery were prospectively randomized to receive one of the following solutions. Group 1 received 0.75% ropivacaine 28 ml with normal saline 2 ml, group 2 received 0.75% ropivacaine 28 ml with 5% ketamine 0.6 ml and normal saline 1.4 ml, group 3 received 0.75% ropivacaine 20 ml with normal saline 10 ml, and group 4 received 0.75% ropivacaine 20 ml with 5% ketamine 0.6 ml and normal saline 9.4 ml. At 1 minute intervals after IBPB, patients were assessed to determine loss of shoulder abduction, elbow flexion, wrist flexion and loss of pinprick in the deltoid, radial, median, and ulnar dermatomes. At 5 minute intervals after IBPB, pulse rate, blood pressure, sedation score and level of discomfort were assessed. Before discharge, patients were asked to document when incisional discomfort began and when full sensation and motor control returned to the arm. Results: The onset time of loss of pinprick and motor blockade were similar. Duration of sensory and motor blockade were similar in all groups. Hemodynamic changes and sedation scores were not significantly different in all groups. Conclusions: We demonstrated that 30 mg of ketamine didn't enhance the onset and duration of sensory or motor blockade of ropivacaine during the 0.75% or 0.5% ropivacaine IBPB. (Korean J Anesthesiol 2001; 40: 721∼727) ꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏ

Additivity of bupivacaine and morphine for peripheral analgesia in rats

Infiltration of the surgical wound is a classical technique for post-operative analgesia. Recent studies have suggested that local anaesthetic may be combined with other drugs such as opioids. This study has evaluated, in rat, the infiltration with morphine, bupivacaine and their combination. In all groups, the two hind paws were injected with carrageenin. The left hind paw was used as control. The vocalisation threshold to paw pressure (VTPP) of both hind paws was evaluated 2 h after induction of carrageenin inflammation (baseline value), then every 10 min until the return to baseline value after injection of analgesic drugs. The development of oedema was evaluated in both hind paws by measurement of paw circumference (PC) before, then after, carrageenin injection. All analgesic drugs were injected in the right inflamed paw diluted in 0.2 mL of normal saline. The analgesic effect of bupivacaine (0.1, 0.25 and 0.5%), morphine (25, 50 and 100 microg) and their combination (bupivacaine 0.1%/morphine 20 microg, bupivacaine 0.2%/morphine 40 microg and bupivacaine 0.4%/morphine 80 microg) was tested. The effect of naloxone on morphine induced analgesia was tested. The interaction between bupivacaine and morphine was evaluated with an isobolographic analysis. Bupivacaine produced a dose-dependent antinociceptive effect. Morphine infiltration produced a peripheral, dose-dependent analgesic effect antagonised by naloxone. This analgesic effect of morphine was associated with an anti-inflammatory effect. The isobolographic analysis revealed only additivity between bupivacaine and morphine. The infiltration with morphine offers a peripheral analgesic effect which is additive with the effect of bupivacaine. An anti-inflammatory effect of morphine participates in this peripheral analgesic effect.

Ketamine enhances local anesthetic and analgesic effects of bupivacaine by peripheral mechanism: a study in postoperative patients

Patients with unilateral ( n=14) and bilateral ( n=4) herniorrhaphy participated in this study. With bilateral herniorrhaphy, at the end of the surgery, the wound was infiltrated with a solution of bupivacaine 0.5% and ketamine 0.3% on one side and a solution of bupivacaine 0.5% only, on the other. With unilateral herniorrhaphy, the patients were randomly assigned to one of two groups ( n=7). One group at the end of the surgery received the infiltration with a solution of bupivacaine 0.5% and ketamine 0.3%, the other group received the infiltration with a solution of bupivacaine 0.5% only. The duration of the local anesthetic (response to a von Frey filament) and postoperative analgesic (time to mild spontaneous pain) effects of the infiltrations, as well as wound pain threshold 24 h after surgery (pressure algometry), were determined. In patient with unilateral herniorrhaphy, the addition of ketamine for wound infiltration enhanced the duration of infiltration anesthesia (206±76 versus 343±108 min, P<0.02) and analgesia (240±45 versus 420±151 min, P<0.03). Similar enhancement of the local anesthetic effect was observed in patients with bilateral herniorrhaphy. The increase in pain threshold to pressure on the wound with the addition of ketamine was evident in bilateral herniorrhaphy patients and also with a combination of bilateral and unilateral results (1.39±0.40 versus 2.35±0.92 kg, P<0.02). In the group of five volunteers, the subcutaneous infiltration with 0.3% ketamine produced a local anesthetic effect lasting only 10–20 min. The results indicate that ketamine acting via a peripheral mechanism can profoundly enhance anesthetic and analgesic actions of a local anesthetic administered for infiltration anesthesia.

Continuous blockade of the lumbar plexus after knee surgery: a comparison of the plasma concentrations and analgesic effect of bupivacaine 0.250% and 0.125%

In 20 patients a continuous block of the lumbar plexus was administered after knee-joint surgery, and the analgesic effect of two different concentrations of bupivacaine was compared. The same volume of bupivacaine was given to both groups of patients: a bolus dose of 0.4 ml/kg, 0.5% or 0.25%, followed by infusion of 0.14 ml/kg/h, 0.25% or 0.125%, respectively, via a catheter placed in the neurovascular fascial sheath of the femoral nerve according to the "3-in-1 block" technique. The median morphine consumption during the first 16 h postoperatively was 6.0 mg when bupivacaine 0.5/0.25% was used and 9.5 mg when 0.25/0.125% was used. This difference is not significant. The visual analogue pain scores were also similar in the two groups (P greater than 0.05). All plasma concentrations were below 4 micrograms/ml, the highest concentration measured being 3.6 micrograms/ml. It is concluded that when used for a continuous block of the lumbar plexus after knee-joint surgery, bupivacaine in a concentration of 0.125% offers the same pain relief as a concentration of 0.25%, and the risk of toxic reactions is reduced.