Bupivacaine For Analgesia Research Articles

Evaluation of preoperative rectus sheath block with bupivacaine for analgesia in cats undergoing ovariohysterectomy: a cadaveric and randomized clinical study

ObjectivePhase 1: to determine the feasibility of desensitizing ventral branches of spinal nerves within the rectus sheath using an ultrasound-guided rectus sheath block (USRSB). Phase 2: to determine the effect of preoperative USRSB on intraoperative responses to surgical stimulation and postoperative pain. Study designCadaveric study and prospective, randomized, blinded, parallel-arm clinical trial. AnimalsA group of five cat cadavers and 37 shelter-owned cats undergoing ovariohysterectomy. MethodsPhase 1: anatomical dissection was performed on one uninjected cadaver. Abdominal walls were dissected in four cadavers (eight hemiabdomens) following bilateral USRSB using 1:1 new methylene blue and 0.5% bupivacaine (0.8 mL kg–1 total). Phase 2: preoperative bilateral USRSB was performed with 0.8 mL kg–1 of 0.25% bupivacaine (RSB) or equivalent volume of 0.9% saline (CONTROL). Intraoperative systolic arterial blood pressure (SAP), heart rate (HR), respiratory rate (fR) and vaporizer setting (vap%) were recorded before skin incision, during celiotomy and abdominal wall closure. In recovery, cats were administered robenacoxib (2 mg kg–1; CONTROL) or 0.9% saline (0.1 mL kg–1; RSB) subcutaneously. Postoperative pain was evaluated for 6 hours using the Glasgow Composite Measure Pain Scale. ResultsPhase 1: spinal nerves T9–L3 were identified within the rectus sheath, and stained in 0%, 40%, 63%, 75%, 100%, 88%, 50% and 13% of hemiabdomens, respectively. Phase 2: 37 cats were included (RSB, n = 17; CONTROL, n = 20). Intraoperatively, SAP, HR and fR were not significantly different between groups. Vap% was significantly lower in RSB during celiotomy (p = 0.036) and closure (p = 0.044). Postoperatively, RSB cats were 5.3 times (95% CI 1.8–8.3) more likely to require rescue analgesia than CONTROL cats. Conclusions and clinical relevanceDuring surgery, USRSB with bupivacaine offered minor benefits and provided markedly less postoperative analgesia than robenacoxib, indicating that relying on USRSB provides insufficient postoperative analgesia for ovariohysterectomy in cats.

Ultrasound-Guided Transversus Abdominis Plane Block Versus Intraperitoneal Instillation of Bupivacaine after Laparoscopic Cholecystectomy – A Randomized Control Trial

Background: Postoperative pain prolongs hospital stay after laparoscopic cholecystectomy and remains a major challenge during the postoperative period. Effective pain control encourages early ambulation, which significantly reduces postoperative complications. In recent years, multimodal analgesia has been recommended with fewer adverse effects and more effective analgesia. The primary objective of this study was to compare the efficacy of analgesia between Transversus Abdominis Plane Block (TAP) Block and intraperitoneal instillation of bupivacaine by comparing the meantime of the first dose of rescue analgesia in either group and the total supplementary analgesia required. Methods: This retrospective observational study was conducted on 150 patients who underwent laparoscopic cholecystectomy Group 1 comprised of patients who had received Intraperitoneal Bupivacaine for analgesia and Group 2 received TAP Block for pain relief. Results: Time of the first dose of analgesia after surgery was observed earlier in Group 1 as compared to Group 2 (Time – hours: 9.2 ± 2 vs. 12.3 ± 1.6; p = 0.0001. The Total dose of analgesic was higher in the Intra Peritoneal Bupivacaine Group as compared to the TAP group. Conclusion: AP block provided for a better quality of analgesia as assessed by the reduced requirement of intravenous supplementary analgesia which was less in patients who were given TAP Block as compared to local instillation of Bupivacaine. Keywords: Cholecystectomy, Bupivacaine, Transversus abdominis plane block

Intrathecal bupivacaine with fentanyl compared to levobupivacaine with fentanyl for painless labor: a double-blind, randomized clinical trial

Background & Objective: Labor pain relief has been a challenge for the clinicians for centuries. A lot many regimes and therapeutic interventions, including spinal and epidural injections, have been tried with variable effect. We aimed to compare the duration of analgesia and potency of bupivacaine plus fentanyl vs. levobupivacaine plus fentanyl for painless labor.
 Methodology: We enrolled 70 parturients who requested spinal analgesia in active labor, and randomly divided them into two groups; Group B (35 women) received 2.5 ml of bupivacaine 0.5% plus fentanyl 25 µg, and Group L (35 women) received 2.5 ml of levobupivacaine 0.5% plus fentanyl 25 µg. We assessed motor and sensory block, the efficacy of analgesia, pain scores, adverse effects, and obstetric and neonatal outcomes of both groups.
 Results: Time to reach maximum sensory block was significantly longer in Group L than in Group B (P = 0.002*). There was a statistically significant increase in the duration of motor blocks in Group B than in Group L (P < 0.05). The median VAS scores were significantly lower in Group L than in Group B after 2 and 3 h after injection. The duration of analgesia was significantly longer in Group L than in Group B (P < 0.05). The two study groups had no differences in the measured obstetric and neonatal outcomes.
 Conclusion: Levobupivacaine with fentanyl was superior to bupivacaine with fentanyl regarding the duration and potency of analgesia with lower pain scores, high maternal satisfaction, and no adverse obstetric or neonatal outcomes. Therefore, spinal levobupivacaine plus fentanyl was a reasonable choice for labor analgesia and can be used without jeopardizing the safety of the mother and fetus.
 Key words: Bupivacaine; Fentanyl; Levobupivacaine; Labor pain; Spinal Analgesia
 Citation: Ali WN, Youssef HA, Abbas AM, Roshdy PE, ImbabyASS. Intrathecal bupivacaine with fentanyl compared to levobupivacaine with fentanyl for painless labor: a double-blind, randomized clinical trial. Anaesth. pain intensive care 2023;27(4):478−484; DOI: 10.35975/apic.v27i4.2256
 Received: July 29, 2022; Reviewed: April 19, 2023; Accepted: April 21, 2023

The Efficacy of a Caudal Bupivacaine and Bupivacaine-Tramadol Combination for Postoperative Analgesia in Pediatric Lower Abdominal Surgeries

Background: The major responsibility of perioperative pediatric anesthesia is to control acute pain in children undergoing surgery. Because some analgesics have synergistic or additive effects, they can be used to create balanced analgesia. This method of pain treatment is widely employed. Caudal analgesia is the most appropriate and tolerable type of postoperative analgesia for small children undergoing anoperineal, inguinal, or urogenital surgery. Objective: To evaluate the duration of analgesia in two comparison groups where one group is given bupivacaine only and the other group tramadol is given tramadol in addition to bupivacaine. Study Design: A Randomized Control Trial Place and Duration: This study was conducted in CMC Hospital @ SMBBMU Larkana from March 2022 to March 2023 Methodology: A total of 110 patients undergoing lower abdominal surgery were inducted into the study, with 955 in each group using a simple random sampling method. The lottery approach was used to randomly assign 55–55 patients to each group. Patients in Group A received 90.59 mL/kg 0.25%, while patients in Group B received 0.5 mL/kg of bupivacaine 0.25% with tramadol 2 mg/kg. We analyzed the data using SPSS version 23. Results: The mean age and mean weights were 4.83 ± 1.87 and 11.31 ± 3.88 in group A and 5.16 ± 1.9 and 12.46 ± 3.77 in group B. There were 38 (69.09%) males in group A and 42 (76.36%) males in Group B. Most (58.18%) of the children were aged 2 to 6 years in group A; similarly, in group B, most (52.73%) of the children were in the same age group. The mean duration of the analgesia in all three age groups in Group A was significantly higher than all the children in Group B, with a p-value of less than 0.005. Conclusion: It is concluded that for post-operative patients who went through lower abdominal surgeries, the use of tramadol along with bupivacaine for analgesia yields sustained analgesia and is completely safe for the young and elderly patients. Keywords: Bupivacaine, Tramadol, Abdominal Surgery, Pain

Evaluation of pre-operative rectus sheath block with bupivacaine for analgesia in cats undergoing ovariohysterectomy

Introduction: This study determined the effect of preoperative ultrasound-guided rectus sheath block (USRSB) on intra-operative hemodynamic responses to surgical stimulation and its effect on post-operative pain as compared to a standard treatment with robenacoxib.

Comparing the Effect of Intrathecal Injection of Meperidine, Meperidine-Bupivacaine, and Bupivacaine Alone on Pain Severity and Hemodynamic Parameters after Elective Cesarean Section.

This study aimed to evaluate the effect of meperidine and bupivacaine on maternal hemodynamic changes prior to anesthesia and compare it with post-intervention. In this clinical trial, the rate of postoperative analgesia on 90 healthy women candidates for elective cesarean section with spinal anesthesia was evaluated by meperidine, bupivacaine, and a combination of these two drugs. The study was conducted on 90 patients, including 30 patients receiving injection of meperidine, 30 patients receiving injection of bupivacaine, and 30 patients receiving injection of meperidine plus bupivacaine. Nausea, vomiting, headache, itching, and shortness of breath were also recorded. The mean systolic and diastolic blood pressure as well as heart rate and mean arterial blood pressure in the meperidine group were significantly lower than those detected before the intervention (P < 0.05). The mean SpO2 index was significantly decreased in meperidine and meperidine+bupivacaine groups (P < 0.05). The prevalence of nausea, vomiting and itching was higher in meperidine group compared to those in the other two groups (P = 0.032). In sum, the prevalence of nausea, vomiting, and itching in the meperidine group was higher than those in the other two groups. Due to almost equal performance of meperidine and meperidine plus bupivacaine in analgesia, the stabilization of other hemodynamic indices in the meperidine plus bupivacaine group, and the decline in the prevalence of nausea, vomiting, and itching, this combination may have been a good alternative to meperidine.

EFFICACY OF NEOSTIGMINE METHYLSULFATE AND MAGNESIUM SULFATE AS ADDITIVES TO HYPERBARIC BUPIVACAINE FOR SPINAL ANAESTHESIA: A CLINICAL COMPARATIVE STUDY

Background: Intrathecal neostigmine and magnesium sulfate (MgSO4) produce substantial antinociception, potentiate analgesia of bupivacaine without neurotoxicity. The aim of the study was to investigate the effect of neostigmineAims: and MgSO4 on characteristics of spinal anesthesia (SA), hemodynamic stability and postoperative analgesia when added to 0.5% hyperbaric bupivacaine for SA. In this prospective, randomized, single-blindSubjects and Methods: study 90 American Society of Anesthesiologist status I and II adult males and females posted for major lower abdominal surgery were assigned to one of the three groups (n = 25). Group N received Neostigmine 50

Comparison between Caudal and TAP Blocks Post-Inguinal Surgery Analgesia in Children

Background: The optimal and lonely method to achieve typical analgesia post-inguinal surgeries in children is still not determined. This study compared the analgesic efficacy and adverse effects between caudal analgesia and TAP (Transversus Abdominis Plane) block. Methods: 40 children (male) between 3-9 years old, with parental consent and institutional board approval, undergoing elective inguinal hernia repair surgery, randomly divided in two groups were enrolled in this study. Both groups received induction on Sevoflurane, Fentanyl, Propofol and Atracurium (dose dependent), with laryngeal mask airway and mechanical ventilated, maintenance on Sevoflurane and smoothly recovered. The first group (C) received caudal analgesia of Bupivacaine 0.25% (1ml/kg). The second group (T) received TAP block of Bupivacaine 0.25% (0.5 ml/kg). Pain was assessed by CHEOPS (Children's Hospital of Eastern Ontario Pain Scale). Parents also assessed pain (after explain and orient them) with Wong-Baker scale 0 (no pain) and 10 (worst pain imaginable). Results: The first group (C) of patients had about 240 ± 30 minutes, while the second group (T) had about 360 ± 60 minutes, early ambulation and feeding and finally, most of them missed the pain till they were home discharged. Conclusion: TAP block enhances comfortable long-time post-op state for the patients, especially the young age group as they are hardly pain dealt off. Also TAP block has an easily performed procedure with less dose and complications compared to the caudal ones.

“Comparative Evaluation of Caudal Tramadol and Adjuvant to Bupivacaine in Paediatric Age Group”

Background: Caudal anaesthesia is a type of regional anaesthesia in which local anesthetic is injected into epidural space. It is most popular regional anaesthesia with a predictable level of blockade used in paediatric surgeries. Adjuvants can be added to local anaesthetics for prolonging the duration of analgesia. Objective: To find out the duration of analgesia of caudal Bupivacaine in combination with Tramadol. Methods: This prospective, randomised, double-blind, comparative study was done in Department of Anesthesiology, Sher-e-bangla Medical College Hospital, Barishal, Bangladesh from June to December 2020. Total of 50 patients, aged between 2 to 9 years undergoing elective lower abdominal, urological and lower extremity surgeries. The patients were randomized to group A (n=25) receiving 1 ml/kg of 0.25% bupivacaine and group B (n=25) receiving 1 ml/kg of 0.25% bupivacaine plus 1mg/kg of tramadol caudally. Duration of analgesia, hemodynamic responses and adverse effects were noted and analysed. Results: Thirty patients in both groups were comparable with regard to demographic data and hemodynamic response and were statistically non-significant (P&gt;0.05). It was observed that the mean duration of analgesia was significantly longer in group B (468.5±164.5 min versus 241.5±69.4 min, P&lt;0.001). One patient in each group had postoperative vomiting. Conclusion: This study concludes that Tramadol 1 mg/kg can be added to 0.25% Bupivacaine for caudal analgesia with total volume of 1 ml/kg to prolong the duration of postoperative analgesia in children undergoing lower abdominal, urological, lower extremity surgery without an increase of adverse effects.

Comparitive Study of Epidural Fentanyl and Bupivacaine with Epidural Clonidine and Bupivacaine for Postoperative Pain Relief in Lower Abdominal and Lower Limb Surgeries: RCT

Postoperative pain and discomfort are the major concerns in all patients undergoing any surgery. Delay of discharge is mainly due postoperative pain. So, postoperative pain relief becomes very important. Epidural anal gesiaisone of many recent evidence-base dregimens for postoperative pain relief after surgeries particularly surgeries of abdomen. The objective of this study is to compare the efficacy, onset and duration of epidural analgesia of Bupivacaine - Clonidinecombination Vs. Bupivacaine-Fentanyl combination for post-operative analgesia in lower abdominal and lower limb surgeries. Materials and Methods: 50 patients belonging to ASA 1 and 2 were assigned into two groups (25 each). Group F received epidural Fentanyl with 0. 25% Bupivacaine and Group C received epidural Clonidine with 0.25% Bupivacaine. Results: With regard to anxiolysis, increased sedative property with easy arousal, longer and better quality analgesia and patient comfort, epidural clonidine and Bupivacaine combination was found to be superior to epidural Fentanyl and Bupivacaine. Various parameters like HR, Blood pressure (both systolic and diastolic), SPo2, Visual Analogue Scale (VAS) and Ram say Sedation Score (RSS) were observed for 24 hours post operatively. It was follow edup at 15 minutes, 30 min, 120 min, 240 min, 360 min, 480 min, 600 min, 720 min, 840 min, 960 min, 1080 min, 1200 min, 1320 min and 1440 min. Incidencesof side effects were also noted. Conclusion: Clonidine has proved to be very efficient compared to Fentanyl in postoperative analgesia.

Liposomal Bupivacaine Intercostal Block Is Important for Reduction of Pulmonary Complications

We have previously demonstrated that Enhanced Recovery After Surgery protocols are associated with a reduction in pulmonary complications. As a component of enhanced recovery pathways, intercostal nerve blocks with liposomal bupivacaine are increasingly utilized, but the extent to which this element may contribute to such outcomes has not been evaluated. Patients undergoing lung resection for stage I to III non-small cell lung cancer at a single institution from 2006 to 2017 were examined for major postoperative pulmonary morbidity, defined as pneumonia, acute respiratory distress syndrome, respiratory arrest, reintubation, bronchoscopy, or need for discharge with oxygen. Pharmacy records were queried for administration of liposomal bupivacaine via posterior intercostal nerve block. Patients treated with and without liposomal bupivacaine were compared in a logistic regression to determine the impact on pulmonary morbidity. A total of 2865 patients were identified, including 860 (30%) who were treated with liposomal bupivacaine via posterior intercostal block. Pulmonary morbidity occurred in 455 (16%). Adoption of liposomal bupivacaine analgesia occurred over several years, beginning in 2012 to full adoption by 2017. Liposomal bupivacaine management was associated with a reduction in pulmonary complications, as compared with nonuse (odds ratio, 0.63; P= .006). Additional factors associated with the occurrence of pulmonary morbidity were age, body mass index, smoking, spirometry values, and operative blood loss. As a component of an active enhanced recovery program, liposomal bupivacaine is associated with a reduction in major pulmonary complications, and utilization should be evaluated on a hospital-by-hospital basis.

Comparison between bupivacaine and ropivacaine in thoracic epidural anaesthesia for modified radical mastectomy – A randomized controlled trial

Modified radical mastectomies (MRM) is conventionally done under general anaesthesia. Various regional anesthetic techniques have also been used to provide effective analgesia in the perioperative period. This study was to compare the analgesia and hemodynamic effects of bupivacaine and ropivacaine when used in thoracic epidural for modified radical mastectomy. 67 patients scheduled for MRM were enrolled in the study. They were randomized into two groups – Group R and Group B. Through an epidural catheter inserted at T5-T6, the patients in Group R received 12ml of 0.5% ropivacaine whereas those in group B received 12 ml of 0.5% bupivacaine. After one hour, 4 ml of the test drug was repeated every 30 minutes till the end of surgery. Intraoperative hemodynamic, side effects and postoperative VAS scores were recorded. 60 patients completed the study and their results were analyzed. Statistically significant differences were observed in heart rate and mean arterial pressure between the two groups at various time intervals. The mean time of onset of the analgesia was shorter in Ropivacaine group 12.90±2.04mins, 19.27±5.51 in the Bupivacaine group. Post operative VAS scores were similar in both the groups. Patients in both groups were equally satisfied. High thoracic epidural is a safe and reliable alternative to general anaesthesia in modified radical mastectomies. Ropivacaine 0.5% is preferred due to its faster onset, better hemodynamic stability and good analgesia.

The Efficacy of Intrathecal Morphine With Bupivacaine For Postoperative Analgesia After TUR-B

Objective,: In this randomized study, we evaluated two different doses of intrathecal (IT) morphine with bupivacaine for analgesia after transurethral resection of bladder (TUR-B). Methods: Seventy-five patients were randomly divided into three groups. They were allocated to receive IT morphine (100 µg) with 12.5 mg 0.5% bupivacaine (Group 1), IT morphine (200 µg) with 12.5 mg 0.5% bupivacaine (Group 2), and IT 12.5 mg 0.5% bupivacaine without morphine (Group 3). Postoperative pain was evaluated by VAS during 24 h and each patient was given intravenous paracetamol and Dexketoprophen trometamol if pain severity was moderate. Results: VAS scores were significantly lower in Groups I and II than Group III at 1h, 2h, 4h, 6h, 12h (p&amp;lt; 0.05) (Figure 1). The request for analgesia was significantly higher in Group III than the other two groups (p&amp;lt; 0.05). More patients reported postoperative nausea in Group II than the other two groups (p&amp;lt; 0.05) (Figure 2). Conclusion: IT morphine (100 µg and 200 µg) with 12.5 mg 0.5% provided a significant reduction in postoperative pain scores compared to IT 12.5 mg 0.5% bupivacaine alone. IT morphine 100 µg provided comparable postoperative pain control with significantly lower side effects than IT morphine 200 µg after TUR-B.

Bupivacaine vs. lidocaine: a comparison of local anesthetic efficacy in impacted third molar surgery.

The aim of this study was to compare the anesthetic efficacy, the duration of anesthesia, and the postoperative analgesia of lidocaine and bupivacaine and to determine any difference in hemodynamic parameters in patients who required impacted third molar removal. Thirty-eight patients between the ages of 18 and 40, with no systemic disease, were included in the study, with an indication of impacted lower third molar extraction. One of two local anesthetic agents (Marcaine and Jetokain Simplex) was randomly selected for tooth extractions. The parameters evaluated were the onset of anesthetic agent action, the duration of operation, the duration of postoperative analgesia, and postoperative visual analog scale scores. Hemodynamic parameters were observed and evaluated preoperatively and during the operation. All data were evaluated statistically. When the time of anesthesia onset was analyzed according to both anesthetic solutions, the difference was in favor of lidocaine (p = 0.01). The duration of action was longer in the bupivacaine group than in the lidocaine group (p = 0.00002). VAS values for the pain obtained during injection were lower in the lidocaine group (p = 0.009).However, according to the results of our study, the postoperative analgesic efficacy of bupivacaine is similar to that of lidocaine (p = 0.087). After evaluation of these results, we can recommend the use of lidocaine and bupivacaine safely in dentistry practice. But long-duration effect of bupivacaine and the rapid effect of lidocaine may make lidocaine more preferable. It is important to determine the clinically effective and safe anesthetic solution.

P145 OPTIMAL PERIOPERATIVE PAIN MANAGEMENT IN ESOPHAGEAL SURGERY

Abstract Aim To compare paravertebral analgesia with epidural analgesia in thoracolaparoscopic Ivor Lewis esophagectomy. Background In esophagectomy, thoracic epidural analgesia (TEA) is standard of care for perioperative pain management. Although TEA is effective, it has unwanted side-effects, such as hypotension, urinary retention and epidural haematoma. Thoracoscopic guided paravertebral analgesia (PVA) is an alternative that is being applied more in thoracic surgery and supposedly has less side-effects. Methods In this feasibility study, TEA was compared with PVA for efficacy in two consecutive series of 25 thoracolaparoscopic Ivor Lewis esophagectomies. In PVA the catheter was placed by the surgeon under direct thoracoscopic vision. TEA consisted of continuous bupivacaine and sufentanil with a patient-controlled bolus function. PVA consisted of continuous bupivacaine and intravenous morphine patient-controlled analgesia. Primary outcome was the highest recorded Numeric pain Rating Scale (NRS) every 8 hours. Secondary outcomes included opioid consumption, vasopressor consumption, fluid administration and length of hospital stay. Results In both groups, the NRS was acceptable (below 5) during the first three postoperative days with no difference in overall pain. Patients with PVA had a higher NRS the first postoperative night (median 4 vs 0, p&lt;0.001). Opioid consumption was significantly lower in patients with PVA. In TEA three catheters failed after successful insertion, in PVA only two. There was no difference in vasopressor consumption, fluid administration and length of hospital stay. Conclusion PVA seems to be a safe and effective alternative for TEA in thoracolaparoscopic Ivor Lewis esophagectomy. This hypothesis should be confirmed in a randomized trial.

Intradermal Sterile Water Injection versus Epidural Bupivacaine in Painless First Stage of Labor

Background: Many women have moderate to severe low back pain during labor. It has been shown that injection of sterile water can reduce the pain of 1ststage. This method is very cheap, easy to learn and can be used as alternative method for reducing the labor pain. Objectives: The aim of this study was to compare the effectiveness, women satisfaction safety and safety of intradermal sterile water injection and epidural bupivacaine in decreasing the pain of1st stage of labor. Patients and Methods: After approval of Institutional Ethical Committee and obtaining written informed consent from eligible parturient women, 120 healthy parturient divided into 3 groups. 1st group epidural bupivacaine plus fentanyl, Initiated with 10 ml of bupivacaine 0.125% with 2 micrograms/ ml of fentanyl and maintained with 10 ml/ h of the same mixture. 2nd group intradermal injection of sterile water 0.1 ml, while 3rd group intradermal injection of 0.1 ml normal saline. Results: The study reported good pain relief in epidural and sterile water group compared to normal saline group. Pain relief was comparable in both the epidural and sterile water group. Complications were more demonstrated in epidural compared to the sterile water and the normal saline groups. A good maternal satisfaction in epidural and sterile water group with no satisfaction in the normal saline group. Conclusion: The evidence from this study suggests that sterile water injections are safe and effective method for relieving pain of the 1st stage of labor similar to epidural bupivacaine analgesia.

Comparison of the Effects on the Postoperative Analgesia of Bupivacaine or Ropivacaine Application on Intraperitoneal and Incisional Line during Ovariohysterectomy in Dogs

Bu çalışmada köpeklerde genel anestezi altında gerçekleştirilen ovariohisterektomi sırasında intraperitoneal ya da ensiyon hattına lokal olarak uygulanan bupivacaine ve ropivacainin postoperatif analjezi üzerine etkisinin karşılaştırmalı olarak değerlendirilmesi amaçlandı. Ksilazin-ketamin genel anestezisi altında ovariohisterektomi yapılan köpekler, her birinde 8 hayvan olacak şekilde 2 gruba ayrıldı. İlk gruba (BG, n=8) operasyon sırasında korpus uteri ile serviks uteri arasına yapılan ensiyon hattına (I), intraperitoneal (II) olarak ve kas üzerindeki ensizyon hattı (III) olmak üzere farklı üç noktaya bupivacaine diğer grubta (RG, n=8) ise benzer şekilde bu üç noktaya ropivacaine uygulaması yapıldı ve operasyon rutin bir şekilde tamamlandı. Operasyondan sonraki 2., 4., 6., 8., 12. ve 24. saatlerde nabız, solunum sayısı ve vücut sıcaklığı ölçümleri yapıldı. Benzer şekilde aynı saatlerde her bir köpek basit ağrı tanımlama (SDS) skalası, Melbourne ağrı skalası ve Glaskow kompozit ağrı skalaları kullanılarak değerlendirildi. Özellikle nabız bakımından gruplar arasında istatistiksel farklar bulunsa da nabız, solunum sayısı ve vücut sıcaklığı değerleri referans sınırlar arasında idi. SDS ve Melbourne ağrı skalasının değerlendirme sonuçlarına göre postoperatif 4. ve 6. saatlerde BG ve RG arasında istatistiksel bir fark belirlendi (P&amp;lt;0.001, P=0.003). Glaskow kompozit ağrı skalasının sonuçları 4. saatte gruplar arasında istatistiksel olarak anlamlı bir fark bulundu (P&amp;lt;0.001). Sonuç olarak çalışmadan elde edilen veriler bir arada değerlendirildiğinde uzun etkili bir lokal anestezik olan bupivacainin köpeklerde ovariohisterektomi operasyonlarında ensizyonel ve intraperitoneal kullanımının postoperatif analjezik etkisinin ropivacaine göre daha güçlü olduğu sonucuna varıldı.

A Comparison of Analgesia of Intrathecal Bupivacaine and Intrathecal Bupivacaine with Tramadol as Adjuvant in Orthopaedic Surgery among Adults Undergoing Lower Limb Surgery

A Comparison of Analgesia of Intrathecal Bupivacaine and Intrathecal Bupivacaine with Tramadol as Adjuvant in Orthopaedic Surgery among Adults Undergoing Lower Limb Surgery

IMPROVEMENT OF COMBINED MULTIMODAL ANESTHESIA FOR ABDOMINAL SURGICAL INTERVENTIONS IN CHILDREN

The aim of the study was to enhance the efficiency and safety of the combined methods of anesthesia using propofol and epidural anesthesia for the abdominal surgery in children by assessing the hemodynamic regulation of the heart rhythm and the clinical course of anesthesia. Materials and methods. We studied children aged of 1 to 14 years operated for diseases and malformations of the abdominal cavity. To ensure the anesthetic protection in 57% of affected children there was used combined epidural anesthesia by bupivacaine combined with propofol and fentanyl in cases from the 1 (main) group and in 43% of affected children there was applied the combined anesthesia by fentanyl and droperidol with lidocaine epidural anesthesia - 2 (control) groups. Results The results showed the relative stability of the patients providing adequate pain relief after the surgery in children. Use of a combination of drugs: early fentanyl analgesic effect develops, whereas propofol implements its action later, and provides a prolongation of analgesia. Propofol, fentanyl with epidural analgesia bupivacaine for analgesic effect appeared to be several times higher than methods of neuroleptanalgesia.

The Difference Duration between Analgesia Bupivacaine Hyperbaric Morphine and Bupivacaine Hyperbaric Epinephrine Intrathecal toward Post Surgery of Sectio Caesaria Patient in Bhayangkara Mataram Hospital

Background and Objectives: The most used of regional anesthesia technic is spinal anesthesia. Spinal anesthesia is an easier technic to get the depth and speed of nerve blockade. Some medicine can be used as an adjuvant of local anesthesia to increase the effect of analgesia bupivacaine. This research is aimed to compare the effectiveness of administration of 0.1 mg intrathecal morphine and 0.1 mg intrathecal epinephrine to prolong 0.5% 12.5 mg hyperbaric analgesia bupivacaine toward caesarean section postoperative period. Method: This research is an experimental clinical trial randomized double-blind phase II. Subject of this study is the elective surgery patients (ASA I and II) with spinal anesthesia who are 18–40 years old and having weight around 50–70 kgs. There are 48 patients that is divided into 2 groups; 24 patients of group M (morphine 0.1 mg) and 24 patients of group E (epinephrine 0.1 mg). Result: The result of this study revealed the duration of analgesia is longer in group M (morphine 0.1 mg) than group T (tramadol 25 mg) (309.08±5.55 vs 221.66±6.43). Conclusion: adjuvant of 0.1 mg morphine and 0.5% 12.5 mg intrathecal hyperbaric bupivacaine can make the work period of analgesia longer while post caesaria section surgery rather than 0.5% 12.5 mg bupivacaine and 0.1 intrathecal epinephrine.