Bupivacaine Group Research Articles

Effect of Infraorbital Block by Bupivacaine and Bupivacaine-Ketamine against Analgesics duration in Labioplasty patients

Labioplasty discomfort can be prevented by inhibiting the infraorbital nerve. Ketamine can be utilized as an adjuvant to lengthen the duration of analgesia in the infraorbital block when bupivacaine is used for infraorbital blocks within a relatively short period. This study aimed to assess the analgesic duration of bupivacaine and bupivacaine-ketamine on the infraorbital block in patients undergoing labioplasty, using the FLACC pain score.The research is a prospective approach, randomized, controlled clinical experiment with double-blinding. Thirty subjects, 3-12month-old children with ASA I and II status, received labioplasty surgery. Subjects were administered 1mL of each infraorbital block with 0.25% Bupivacaine and 0.25% Bupivacaine with Ketamine 0.5mg/kg BW to each group. The Paired T-test was used to compare subject characteristics, while the Independent T-test was used to compare heart rate. Chi-square (Fisher's exact) analysis revealed a significance level of p 0.005 for the FLACC value comparison. All statistical test results were examined with SPSS version 25.0. In the Bupivacaine group, there was an increase in mild pain within 4-5hours (7:46.7%); by 6 hours, there was an increase in mild pain in all 15 participants. At eight hours, it progressed to moderate pain (7:46.7%) with 496 minutes of analgesia and light pain (8:53.7%). The individuals in the Bupivacaine-Ketamine group had pain between 5-8 hours. Six patients (40%) with a pain-free analgesia duration of 1.440 minutes and nine (60%) with a minor pain status had FLACC values 4 during 24-hour observations.Bupivacaine and Bupivacaine-Ketamine have no side effects and no change in heart rate. Combining Bupivacaine with Ketamine has a more prolonged postoperative analgesic effect (24 hours) than the bupivacaine group in the infraorbital block in labioplasty patients (8 hours).

Intrathecal Anesthesia Prevents Ventricular Arrhythmias in Rats with Myocardial Ischemia/Reperfusion

Introduction: Ventricular arrhythmia is commonly provoked by acute cardiac ischemia through sympathetic exaggeration and is often resistant to anti-arrhythmic therapies. Thoracic epidural anesthesia has been reported to terminate fatal ventricular arrhythmia; however, its underlying mechanism is unknown. Methods: Rats were randomly divided into four groups: sham, sham plus bupivacaine, ischemia/reperfusion (IR), and IR plus bupivacaine groups. Bupivacaine (1 mg/mL, 0.05 mL/100 g body weight) was injected intrathecally into the L5–L6 intervertebral space prior to establishing a myocardial IR rat model. Thereafter, cardiac arrhythmia, cardiac function, myocardial injury, and electrical activities of the heart and spinal cord were evaluated. Results: Intrathecal bupivacaine inhibited spinal neural activity, improved heart rate variability, reduced ventricular arrhythmia score, and ameliorated cardiac dysfunction in IR rats. Furthermore, intrathecal bupivacaine attenuated cardiac injury and myocardial apoptosis and regulated cardiomyocyte autophagy and connexin-43 distribution during myocardial IR. Conclusion: Our results indicate that intrathecal bupivacaine blunts spinal neural activity to prevent cardiac arrhythmia and dysfunction induced by IR and that this anti-arrhythmic activity may be associated with regulation of autonomic balance, myocardial apoptosis and autophagy, and cardiac gap junction function.

Effect of liposomal bupivacaine for preoperative erector spinae plane block on postoperative pain following video-assisted thoracoscopic lung surgery: a protocol for a multicenter, randomized, double-blind, clinical trial.

There is still a controversy about the superiority of liposomal bupivacaine (LB) over traditional local anesthetics in postoperative analgesia after thoracic surgery. This study aims to determine the effect of LB versus bupivacaine hydrochloride (HCl) for preoperative ultrasound-guided erector spinae plane block (ESPB) on postoperative acute and chronic pain in patients undergoing video-assisted thoracoscopic lung surgery. This multicenter, randomized, double-blind, controlled trial will include 272 adult patients scheduled for elective video-assisted thoracoscopic lung surgery. Patients will be randomly assigned, 1:1 and stratified by site, to the liposomal bupivacaine (LB) group or the bupivacaine (BUPI) HCl group. All patients will receive ultrasound-guided ESPB with either LB or bupivacaine HCl before surgery and patient-controlled intravenous analgesia (PCIA) as rescue analgesia after surgery. The numeric rating scale (NRS) score will be assessed after surgery. The primary outcome is the area under the curve of pain scores at rest for 0-72 h postoperatively. The secondary outcomes include the total amount of opioid rescue analgesics through 0-72 h postoperatively, time to the first press on the PCIA device as rescue analgesia, the area under the curve of pain scores on activity for 0-72 h postoperatively, NRS scores at rest and on activity at different time points during the 0-72 h postoperative period, Quality of Recovery 15 scores at 72 h after surgery, and NRS scores on activity on postsurgical day 14 and postsurgical 3 months. Adverse events after the surgery are followed up to the postsurgical day 7, including postoperative nausea and vomiting, fever, constipation, dizziness, headache, insomnia, itching, prolonged chest tube leakage, new-onset atrial fibrillation, severe ventricular arrhythmia, deep venous thrombosis, pulmonary embolism, pulmonary atelectasis, cardiac arrest, ileus, urinary retention, chylothorax, pneumothorax, and organ failure. Analyzes will be performed first according to the intention to treat principle and second with the per-protocol analysis. We hypothesize that LB for preoperative ultrasound-guided ESPB would be more effective than bupivacaine HCl in reducing postoperative pain in video-assisted thoracoscopic lung surgery. Our results will contribute to the optimization of postoperative analgesia regimens for patients undergoing video-assisted thoracoscopic lung surgery.Clinical trial registration:http://www.chictr.org.cn, identifier ChiCTR2300074852.

Analgesic Effectiveness of Liposomal Bupivacaine versus Plain Local Anesthetics for Abdominal Fascial Plane Blocks: A Systematic Review and Meta-analysis of Randomized Trials.

Liposomal bupivacaine is reported to prolong the duration of analgesia when used for abdominal fascial plane blocks compared to plain local anesthetics; however, evidence from randomized trials is mixed. This meta-analysis aims to compare the analgesic effectiveness of liposomal bupivacaine to plain local anesthetics in adults receiving abdominal fascial plane blocks. Randomized trials comparing liposomal bupivacaine and plain (nonliposomal) local anesthetics in abdominal fascial plane blocks were sought. The primary outcome was area under the curve rest pain between 24 to 72 h postoperatively. Secondary outcomes included rest pain at individual timepoints (1, 6, 12, 24, 48, and 72 h); analgesic consumption at 0 to 24, 25 to 48, and 49 to 72 h; time to analgesic request; hospital stay duration; and opioid-related side effects. Data were pooled using the Hartung-Knapp-Sidik-Jonkman random effects method. Sixteen trials encompassing 1,287 patients (liposomal bupivacaine, 667; plain local anesthetics, 620) were included. The liposomal bupivacaine group received liposomal bupivacaine mixed with plain bupivacaine in 10 studies, liposomal bupivacaine alone in 5 studies, and both preparations in 1 three-armed study. No difference was observed between the two groups for area under the curve pain scores, with a standardized mean difference (95% CI) of -0.21 cm.h (-0.43 to 0.01; P = 0.058; I2 = 48%). Results were robust to subgroup analysis based on (1) potential conflict of interest and (2) mixing of plain local anesthetics with liposomal bupivacaine. The two groups were not different for any of the day 2 or day 3 secondary outcomes. This systematic review and meta-analysis suggests similar analgesic effectiveness between liposomal bupivacaine and plain local anesthetics when used for fascial plane block of the abdominal wall. The authors' analysis does not support an evidence-based preference for liposomal bupivacaine compared to plain local anesthetics for abdominal fascial plane blocks.

A Randomized Controlled Trial of Intrathecal versus Caudal Morphine-Bupivacaine on Postoperative Analgesia and Cortisol Levels in Pediatric Patients.

Morphine is commonly used in pediatric caudal blocks. We compared the analgesic efficacy and effect on cortisol levels of intrathecal morphine and bupivacaine with caudal morphine and bupivacaine in children undergoing lower abdominal surgeries. Forty children undergoing lower abdominal surgeries were randomized to receive 4 μg/kg of intrathecal morphine and 0.5% hyperbaric bupivacaine (n = 20), or caudal morphine 40 μg/kg and 0.25% bupivacaine (n = 20). Postoperative analgesia was provided with intravenous (IV) paracetamol (PCM). The primary outcome was time to reach Face, Legs, Activity, Cry, and Consolability (FLACC) score ≥4 postoperatively. Secondary outcomes were perioperative serum cortisol levels, analgesic requirement, and parent satisfaction. Since seventy 5% of patients receiving intrathecal morphine and bupivacaine did not reach a FLACC score ≥4 within 24 hours, the primary outcome was presented as the Kaplan-Meier curve. The probability of FLACC score <4 was significantly higher with intrathecal morphine and bupivacaine than with caudal morphine and bupivacaine (P < .001). The unadjusted and adjusted (for gender) hazard ratio (95% confidence interval [CI]) of occurrence of pain (FLACC score ≥4) was 0.07 (0.03-0.15, P < .001) and 0.06 (0.03-0.14, P < .001), respectively. The difference in means (95% CI) of cortisol levels between caudal morphine (with bupivacaine) and intrathecal morphine (with bupivacaine) groups were after intubation -0.667 (-4.99 to 3.65, P = .76), at 2 hours intraoperatively 7.88 (3.55-12.2, P < .001), 6 hours postoperatively 16.8 (12.5-21.1, P < .001), and 24 hours postoperatively 15.4 (11.1-19.7, P < .001) μg/dL. Intraoperatively, rescue fentanyl was required by 60% of patients on caudal morphine and bupivacaine against 20% of patients receiving intrathecal morphine and bupivacaine (absolute risk-reduction [95% CI] of 40% [12%-68%]; P = .010). Postoperative rescue fentanyl was required in 45% of patients on caudal morphine and bupivacaine and 5% of patients on intrathecal morphine and bupivacaine. All (100%) patients on caudal morphine and bupivacaine required postoperative PCM against 6 (30%) patients on intrathecal morphine and bupivacaine (absolute risk-reduction [95% CI] of 70% [50%-90%]; P < .001).The median (interquartile range [IQR]) parent satisfaction score for patients on caudal morphine (with bupivacaine) and intrathecal morphine (with bupivacaine) was 0(0-0) and 2(2-2) at 12 hours postoperatively (P < .001) and 0(0-1) and 2(1.5-2) at 24 hours postoperatively (P < .001). One patient in each group developed nausea and vomiting, and 1 patient in the intrathecal group developed pruritus. There was no incidence of respiratory depression. Intrathecal morphine and bupivacaine results in longer duration of analgesia, lower analgesic consumption, prevents surgical-stress-related elevation of serum cortisol, and improves parent satisfaction compared to caudal morphine with bupivacaine in children undergoing lower abdominal surgeries.

Comparison of Ropivacaine versus Bupivacaine in Spinal-Induced Hypotension in Preeclampsia Patients: A Randomized Control Trial.

Spinal anesthesia is considered to be the safest method of anesthesia for cesarean sections in patients with preeclampsia. Patients with preeclampsia are at an increased risk of experiencing severe hypotension following spinal anesthesia, which could have more profound and deleterious effects on both the fetus and the mother. However, bupivacaine, the most commonly used drug, can induce severe hypotension even at low doses. The purpose of this study is to minimize post-spinal hypotension in both the mother and the fetus. To determine and compare the reduction in hypotension following spinal anesthesia in patients with preeclampsia between the ropivacaine and bupivacaine groups. In a randomized clinical trial, a total of 90 parturients with preeclampsia undergoing spinal anesthesia were enrolled and randomly divided into 2 groups: One receiving ropivacaine and the other receiving bupivacaine. The dose of spinal ropivacaine was 15 mg of a 0.5% solution, and the dose of bupivacaine was also 15 mg of a 0.5 % solution. Hemodynamic parameters, including systolic and diastolic blood pressure and heart rate, were recorded following the administration of spinal anesthesia. Pain scores and the time until the return of motor movement were also documented. For statistical analysis, the t-test, Chi-square, and ANOVA tests were utilized to compare the groups. Demographic variables, including maternal age, gestational age, parity, and gravidity, were not significantly different between the 2 groups. The trend of mean systolic blood pressure (SBP) was significantly lower in the bupivacaine group compared to the ropivacaine group at all measured time points in the study (P < 0.05). The amount of ephedrine used after spinal anesthesia was significantly different at 2 and 4 minutes in the ropivacaine group compared to the bupivacaine group (P = 0.012, P = 0.025). Post-operative pain scores at 1 hour in recovery were not significantly different between the ropivacaine and bupivacaine groups (P = 0.015). The time to knee movement was also significantly shorter in the ropivacaine group compared to the bupivacaine group (P < 0.001). Ropivacaine reduces the incidence of hypotension in spinal anesthesia compared to bupivacaine for cesarean section in patients with preeclampsia. This is attributed to a lower occurrence of spinal-induced hypotension, improved hemodynamic control, reduced ephedrine usage, and faster patient ambulation. A future study could focus on investigating different dosages of both drugs with a larger number of participants.

Sphenopalatine ganglion block with lidocaine versus bupivacaine for optimizing intraoperative bleeding and surgical field visibility during endoscopic septoplasty: a randomized double-blind controlled trial

Background &amp; objective: The benefits of sphenopalatine ganglion (SPG) block during endoscopic septoplasty are yet unclear due to a lack of adequate data. We investigated the efficacy of SPG block (SPGB) with lidocaine versus bupivacaine for minimizing intraoperative bleeding and providing a bloodless surgical field in patients having endoscopic septoplasty under general anesthesia. Methodology: In this double-blind, randomized controlled trial, 60 patients with ASA I and II were scheduled for endoscopic septoplasty. Following standard general anesthesia, patients were randomly assigned to one of three groups. Group C (n = 20): SPGB was performed using normal saline in the control group; Group L (n = 20); patients received SPGB with 2% lidocaine, and Group B (n = 20); patients received SPGB with 0.5% bupivacaine. Intraoperative blood loss, surgical field quality, postoperative pain-free duration, postoperative analgesic requirements, and the patient satisfaction were recorded. The collected data were verified, coded by the researcher, and analyzed using the Statistical Package for Social Sciences (IBM-SPSS/PC/VER 21). Statistical analysis was done with the Shapiro-Wilk test, one-way ANOVA test and two-way repeated measure ANOVA test as required. The Kaplan–Meier curve was plotted to explore the differences in the post-operative pain-free durations among the studied groups using the log-rank test. A p-value less than 0.05 was considered significant. Results: The intraoperative blood loss and surgical field grading were lower in the groups treated with lidocaine (44.9 ± 3.7 ml, P &lt; 0.001) or bupivacaine (41.4 ± 2.9 ml, P &lt; 0.001) in comparison to the control group (89.95 ± 7.8 ml). There was no difference between the two groups. Postoperative meperidine requirement in 24 h was higher in the control group (36.25 ± 2.9 mg) than the lidocaine group (18.75 ± 2.5 mg; P &lt; 0.001) and the bupivacaine group (16.25 ± 2.7 mg; P &lt; 0.001). Conclusion: Sphenopalatine ganglion blockade with bupivacaine or lidocaine decreased intraoperative blood loss and improved surgical field visibility compared to placebo during endoscopic septoplasty under general anesthesia. There were statistically no significant differences in sphenopalatine ganglion blocks with either lidocaine or bupivacaine. Abbreviations: SPG- Sphenopalatine Ganglion; SPGB- Sphenopalatine Ganglion Block; VAS- Visual Analog Scale Keywords: Bupivacaine; Endoscopic Septoplasty; Lidocaine; Postoperative Analgesia; Sphenopalatine Ganglion Block Citation: Ghazaly HF, Khalefa MM, Sedeek MA, Hasanen MK. Sphenopalatine ganglion block with lidocaine versus bupivacaine for optimizing intraoperative bleeding and surgical field visibility during endoscopic septoplasty: a randomized double-blind controlled trial. Anaesth. pain intensive care 2024;28(1):92-99; DOI: 10.35975/apic.v28i1.2393 Received: August 29, 2023; Reviewed: December 29, 2023; Accepted: December 31, 2023

Comparison of clinical efficacy of hyperbaric ropivacaine with hyperbaric bupivacaine in spinal anesthesia for transurethral resection of prostate: A randomized and double-blind study

Background: Ropivacaine is an ammino-amide local anesthetic agent with properties similar to bupivacaine, but its decreased lipophilicity is associated with reduced incidence of central nervous system toxicity and cardiotoxicity. This study evaluated the safety, efficacy, effects on hemodynamics and complications of spinal anesthesia using 0.5% hyperbaric bupivacaine and 0.75% hyperbaric ropivacaine in patients undergoing transurethral resection of the prostate (TURP). Aims and Objectives: The aim was to evaluate the safety, efficacy, hemodynamic stability, and side effects of spinal anesthesia using 0.5% hyperbaric bupivacaine and 0.75% hyperbaric ropivacaine in patients undergoing TURP. Materials and Methods: Sixty adult patients with physical status classes I and II, as determined by the American Society of Anesthesiologists, scheduled to undergo elective transurethral resection of prostate, were randomly allocated to receive either hyperbaric ropivacaine 0.75% 2.8 mL plus fentanyl 15 mcg or hyperbaric bupivacaine 0.5% 2.8 mL plus fentanyl 15 mcg. The parameters, such as demographic characteristics, duration of surgery, onset of sensory and motor blockade, hemodynamic stability, and complications, were compared in both groups. Results: Hyperbaric ropivacaine exhibited significantly slower onset times for sensory and motor blockade compared to hyperbaric bupivacaine. Patients in the ropivacaine group demonstrated better hemodynamic stability and experienced less hypotension compared to those who received bupivacaine. Moreover, the sensory and motor block lasted significantly longer in the bupivacaine group. Conclusion: About 0.75% hyperbaric ropivacaine is a better choice for spinal anesthesia in elderly patients undergoing TURP as compared to 0.5% hyperbaric bupivacaine.

Liposomal bupivacaine in transversus abdominis plane blocks for lower abdominal surgery.

Transversus abdominis plane blocks are an established method of postoperative analgesia for abdominopelvic surgeries. Liposomal bupivacaine is an extended-release formulation of bupivacaine providing up to 72 h of analgesia. This study aims to determine if transversus abdominis plane blocks performed with liposomal bupivacaine are associated with reduced opioid consumption and level of pain intensity compared to conventional bupivacaine in patients undergoing lower abdominal surgery. This retrospective cohort study was conducted at a single institution between December 2020 and December 2021. After institutional review board approval, we identified patients who underwent lower abdominopelvic surgery with transversus abdominis plane blocks done with liposomal or conventional bupivacaine and collected demographic, clinical, and procedural information for analysis. We compared total opioid consumption over 72-h postoperatively in milligram morphine equivalents (MME), frequency of opioid utilization, and average level of pain intensity between groups. These outcomes were also evaluated after adjusting for covariates. Data were presented as mean ± SD, median [IQR] or frequency (%), as appropriate; p < 0.05 was accepted as significant. A total of 178 patients met inclusion criteria, with 79 patients receiving an admixture of liposomal bupivacaine and conventional bupivacaine and 99 patients receiving conventional bupivacaine. The liposomal bupivacaine group had a median opioid consumption 72-h postoperatively of 47.5 [18-91.8] MME compared to 88 [43.8-160] MME in the conventional bupivacaine group, p = 0.045. Differences in opioid consumption between the groups did not reach statistical significance after adjustment for demographic and clinical characteristics, p = 0.11. There was no significant difference in frequency of opioid use or average pain intensity. Transversus abdominis plane blocks using an admixture of liposomal bupivacaine conventional bupivacaine are not associated with decreased opioid consumption or reduced pain up to 72 h following elective abdominopelvic surgery.

Liposomal Bupivacaine Use During Orthognathic Surgery in Cleft Lip and Palate Patients.

Effective pain management is crucial in cleft lip and palate (CLP) patients undergoing orthognathic surgery for earlier recovery and decreased opioid reliance. Liposomal bupivacaine (Exparel) is a local anesthetic that provides extended postoperative analgesia in adult patients; however, research on its use in adolescents is limited. This study explores the efficacy of liposomal bupivacaine for postoperative pain management in adolescent CLP patients undergoing orthognathic surgery. The authors performed a retrospective chart review at their institution between July 2020 and December 2022 to identify patients who underwent LeFort I or mandibular osteotomy. Two cohorts were compared: patients who received liposomal bupivacaine and patients who received standard pain medications alone. Outcome measures included intraoperative pain medications, length of stay, breakthrough opioid use, time to first oral intake, volume of oral intake, and opioids prescribed at discharge. This study included 22 patients who underwent orthognathic surgery. The liposomal bupivacaine group (n=10) demonstrated earlier and greater oral intake during hospitalization compared with controls (n=12). The most significant difference was observed in total breakthrough opioid use, with an average of 8.60 morphine milligram equivalents for liposomal bupivacaine patients compared with 35.1 morphine milligram equivalents for controls (P=0.037). This study provides the first analysis of liposomal bupivacaine use in adolescent CLP patients undergoing orthognathic surgery, demonstrating a significant reduction in postoperative opioid consumption compared with controls. These results may guide future studies of liposomal bupivacaine within CLP patients, potentially as a component of enhanced recovery after surgery guidelines, as well as in cost-analysis studies.

Comparison of Equivalent Doses of Intrathecal Hyperbaric Levo-bupivacaine and Hyperbaric Bupivacaine for Caesarean Section: A Prospective Randomised Double-Blind Study

Introduction: Subarachnoid Block (SAB) with Hyperbaric Bupivacaine (HB) is the most common anaesthetic technique for Lower Segment Caesarean Section (LSCS). Levo-bupivacaine, an enantiomer of racemic bupivacaine, has been developed to provide anaesthesia with the same effectiveness but with better haemodynamic stability. Aim: To compare the effectiveness of hyperbaric levobupivacaine to HB in achieving sensory and motor blocks in Caesarean Section(CS) using equivalent doses. Materials and Methods: Eighty parturients aged 18-38 years with no co-morbidities were randomly divided into two groups receiving equivalent doses of HB and hyperbaric levobupivacaine for SAB. The effectiveness of the two drugs was compared in terms of the time taken to achieve sensory and motor blocks, as well as the time for block regression for two segments for sensory block and the return of motor block assessed by the ability to flex the ankle joint. Adverse events such as a fall in Systolic Blood Pressure (SBP) and the dose of vasopressor were noted for the two groups. Results: The time taken to attain a T6 dermatomal block level was 2.43±1.00 and 2.80±1.51 (p-value 0.08) for the bupivacaine and levo-bupivacaine groups, respectively. Complete motor block of the lower limb was achieved in 4.85±1.67 and 5.15±1.82 (p-value 0.53). However, the time to 2-segment regression for sensory block was significantly faster in the levo-bupivacaine group than in the bupivacaine group (125.9±28.56 minutes and 109.13±28.84 minutes, respectively, p-value 0.009). Regression from motor block was also found to be highly statistically significant (158.38±34.92 minutes for bupivacaine and 138.75±25.71 minutes for the levobupivacaine group, p-value 0.006). Spinal-induced hypotension was comparable in both groups, but the bupivacaine group needed a much higher repetition of dose of vasopressor than the levo-bupivacaine group. Conclusion: Levo-bupivacaine is comparable to its racemic isomer bupivacaine in achieving anaesthesia when administered Intrathecally (IT) for CS. However, with equivalent doses, the duration of action is significantly shorter with hyperbaric levobupivacaine. Dose adjustment might be required with hyperbaric levo-bupivacaine based on the duration of the surgery. Haemodynamic stability is also similar with both drugs.

Continuous Intra-Incisional Bupivacaine for Postoperative Analgesia after Hip Nailing Surgery: A Randomized Clinical Trial.

The effectiveness of continuous wound infiltration (CWI) as a postoperative pain-control technique has been shown in many surgical procedures. This study investigates the effect of CWI of local anesthetic on postoperative pain control in intertrochanteric fracture patients undergoing hip nailing surgery. In this randomized clinical trial, 48 patients who were scheduled for hip nailing surgery were randomly assigned to receive (n = 24) or not receive (n = 24) bupivacaine infusion through a catheter inside the surgical wound, postoperatively. Pain intensity (NRS), required dose of morphine, and drug-related complications within 24 hours of the intervention were assessed and compared. Pain intensity was significantly lower in the bupivacaine group both during the recovery room stay and in the ward in the first 24 hours after the procedure (P < 0.001). In the recovery room, the control group patients had a higher morphine consumption compared to the bupivacaine group (P < 0.001) and requested it earlier than the bupivacaine group (60 (45-60) vs. 360 (195-480) minutes) (P < 0.001). In the ward, all control group patients used the PCA morphine pump, while only 54% of the bupivacaine group self-administered morphine through the pump, with a significantly lower total morphine consumption (1 (0-2) vs. 10 (5-14) mg, P < 0.001). None of the patients in the bupivacaine group required additional morphine, while 37.5% of the control requested additional morphine (P=0.002). Altogether, the control group had a higher total morphine consumption compared to the bupivacaine group in the first 24 hours (10.5 (6-15.5) vs. 1 (0-2) mg, P < 0.001). CWI of bupivacaine helps better pain reduction during the early postoperative hours while it reduces opioid consumption, minimizes nausea and vomiting, and improves patient satisfaction.

Effects of liposomal bupivacaine in preoperative fascia iliac block on postoperative pain and delirium in elderly patients undergoing hip fracture surgery: a study protocol for a randomised, parallel controlled prospective clinical study

IntroductionPostoperative delirium (POD) is the most common acute fluctuating mental state change after hip fractures in older adults. Postoperative pain is a Grade A risk factor for POD and is...

A Comparative Study on the Efficacy of Wound Infiltration of Tramadol versus Bupivacaine for Postcesarean Section Pain Control in a Tertiary Hospital in Manila, Philippines: A Double-blind Randomized Controlled Trial

ABSTRACT Background: In developing countries, postcesarean pain control remains a challenge due to the limited supply of medication and medical equipment. Wound infiltration provides a cost-effective, easy-to-administer postoperative analgesia with a high safety of margin. Several studies suggest that tramadol and local anesthetics have similarities in terms of its action. The study aims to compare the efficacy of tramadol and bupivacaine administered through wound infiltration in postcesarean patients aged 18-40 years old at a tertiary hospital in Manila, Philippines. Methods: Using a double-blind randomized controlled trial, study participants for low transverse cesarean section (CS) were allocated to either Group A or Group B. Group A (n = 20) received a local infiltration of 2 mg/kg tramadol diluted to 20 ml of 0.9% saline solution. Group B (n = 20) received a local infiltration of 0.5 ml/kg of 0.25% bupivacaine isobaric diluted to 20 ml of 0.9% saline solution. All wound infiltrations were performed once at the postoperative site to establish cost-effectivity. Pain severity was assessed using the Visual Analogue Scale (VAS) scoring at rest and at movement done by the anesthesiologist at 4, 8, 16 and 24 h post-CS. A significance level of 0.05 was set and P&lt;0.05 was considered statistically significant. Before inclusion in the study, informed consent was secured from the study participants. The research protocol and informed consent were submitted for ethical review and were subsequently approved. Results: There is no significant difference between the VAS scores of patients treated with tramadol and those treated with bupivacaine across all times of recording except for VAS scores at movement during the 16th and 24th hours. Results of the study revealed that the VAS scores in the tramadol group are lower at all times than those of the bupivacaine group. In general, it is also observable that the VAS scores are higher when the patient is moving than when at rest. There were no observed effects in breastfeeding and no allergic, cardiovascular or central nervous system side effects were observed among all study participants. Conclusion: Because of its mechanism similar to that of local anesthetics, tramadol wound infiltration is a suitable, safe and cost-effective alternative to bupivacaine for pain control after CS.

The effect of ozonation of bupivacaine on bupivacaine-induced neurotoxicity in rats

Bupivacaine-induced neurotoxicity (BIN) is common condition associated with free oxygen radicals based degenerative cellular changes. Morever, a apoptotic damages increase the occurences of the BIN. Ozone is a medical gas widely used in the treatment of degenerative diseases, due to its antioxidant and cytoprotective effects. The aim of the study was to investigate the effects of ozonation of bupivacaine in reducing or preventing BIN. Sixty male rats were randomly and equally divided into three groups: control (distilled water), bupivacaine and ozonated bupivacaine. The sciatic nerve was surgically dissected under anesthesia and distilled water, bupivacaine or ozonated bupivacaine was injected perineurally according to the group. The nerve samples were then extracted on 3rd and 7th days, and were examined using immunohistochemical stainings and Terminal Transferase dUTP Nick End Labeling (TUNEL) staining. The effect of ozonation of bupivacaine, on the motor and sensory functions of the sciatic nerves was examined and compated against that of the bupivacaine. H-score analyzes of neuroflament, S100, superoxide dismutase, and Tumor necrosis factor (TNF)-alpha immunostainings, and apoptotic index values after TUNEL staining were used for the assessment of the efficiency levels. The findings in this paper show that ozonation of bupivacaine statistically reduced neurotoxicity in both the 3rd and 7th day groups. No significant differences between bupivacaine and ozonated bupivacaine groups was obtained from the sensory and motor functional tests. No deterioration in the biochemical structure of bupivacaine was induced by the ozonation. The findings in this paper highlight the effectiveness of the, ozonation of bupivacaine in reducing BIN. There were also no significant differences in the resolution times of motor and sensory blocks between ozonated bupivacaine and bupivacaine alone groups.

The impact of adding fentanyl to bupivacaine on spinal anesthesia for caesarean

Background and aim: A spinal block is commonly used procedure for cesarean section surgery worldwide. It involves injecting fentanyl, an opioid, into the spinal fluid to enhance and prolong the analgesic effects of spinal anesthesia. This study aimed to evaluate the effect of adding fentanyl to intrathecal bupivacaine for caesarean section on the duration and quality of analgesia and the reduction of local anesthetic dose requirement. Methods: This study compared the effects of two types of spinal anesthesia in women who had caesarean deliveries, as one group received both fentanyl and bupivacaine while the other group received only bupivacaine. Results: a significant differences in the duration of analgesia between the two groups (P-value = 0.02) was determined. The mean duration of analgesia in the bupivacaine only received group was (3:43) hours, while in the bupivacaine and fentanyl group was (5:2) hours. The pain relief also started faster for the group that received Bupivacaine and fentanyl than for the group that received only Bupivacaine. Conclusion: Fentanyl, when added to bupivacaine for spinal anesthesia in cesarean section surgery, enhances the duration of sensory and motor block and prolongs the postoperative analgesia.

A Comparative Study of Bupivacaine and Bupivacaine with Fentanyl for Subarachnoid Block

Introduction: Subarachnoid block (SAB) is the anesthesia of choice for lower abdominal and lower limb surgeries. The objective of the study was to evaluate and compare the onset, duration, recovery of neural blockade, hemodynamic changes and side effects of bupivacaine alone with fentanyl added to bupivacaine.Materials and methods: This cross sectional comparative study was conducted in Department of Anaesthesia at National Medical College in 82 patients from April 2023 to September 2023 . Patients of either sex as per American Society of Anaesesiologists, Physical Status I-II between age 20- 60 years were randomly allocated to one of two groups of 41 each.Results: This study showed that there was highly significant difference in the highest level of sensory block achieved between mthe two groups (p &lt; 0.001 ) and motor blockade. Most of patients receiving bupivacaine alone (Group B) had achieved T6 dermatomal sensory level block and Bromage score of 4, while patients receiving fentanyl with bupivacaine (Group F) achieved T8 and also Bromage score of 3 respectively. The mean duration for highest sensory level in group F and group B was 7.76 and 9.66 minutes, respectively. The mean duration for 2 segment regression in group F and group B was 95.28 and 67.24 minutes respectively. Hypotension was significantly high in Group B.Conclusion: Fentanyl added to bupivacaine has an earlier onset of action, prolonged sensory analgesia but earlier motor recovery compared to bupivacaine alone but a comparatively lower sensory dermatomal level without complete motor blockade, adequate for surgical procedures.

A comparative study of the analgesic efficacy of intraperitoneal instillation of diluted bupivacaine versus non-diluted bupivacaine after laparoscopic cholecystectomy, a prospective single-blinded controlled randomized study

ABSTRACT Intraperitoneal (IP) bupivacaine instillation for postoperative analgesia after laparoscopic cholecystectomy (LC) has been reported in many studies as either diluted or non-diluted, with conflicting results and no standard recommendations. Objective Our study aims to compare the analgesic efficacy of intraperitoneal instillation of diluted versus non-diluted bupivacaine after laparoscopic cholecystectomy. Methods In this prospective, single-blinded, controlled and randomized study, we included 50 patients undergoing LC. They were randomly divided into two groups, with 25 patients each. At the end of surgery, the first group received intraperitoneal 20 ml bupivacaine 0.5% (100 mg), added to 480 ml normal saline, diluted bupivacaine group (DBG) and the second group received intraperitoneal 20 ml bupivacaine 0.5% (100 mg); non-diluted bupivacaine group (NBG). Pain was assessed and recorded using the visual analog scale (VAS) for 24 h. Time to the first analgesic request, total analgesic consumption in 24 h, incidence of negative effects after LC, such as nausea, vomiting and shoulder pain, any side effects due to local anesthetic used as hypotension, bradycardia or respiratory depression and hemodynamic parameters were also recorded. Results Postoperative VAS values were significantly lower in DBG than NBG in the 1st 24 h (P value ≤ 0.003). The duration of analgesia (the 1st time analgesic request) was significantly longer in DBG (20.16 ± 3.52 h) than that in NBG (6.19 ± 2.93 h) (P value = 0.0001). Also, the total amount of postoperative analgesic consumption (tramadol) was less in DBG (7.2 ± 19.9 mg) than NBG (63 ± 31.16 mg) (P value = 0.0001). In relation to negative effects after LC, side effects due to analgesic drugs and hemodynamic parameters, the results were comparable in both groups. Conclusion Intraperitoneal instillation of diluted bupivacaine at the end of laparoscopic cholecystectomy decreases postoperative pain, delays request for rescue analgesia and reduces the amount of analgesics in the 1st 24 h postoperatively, more than non-diluted bupivacaine, with comparable results in incidence-negative effects after LC, side effects due to analgesic drugs and comparable hemodynamic parameters.

Comparison Of Hemodynamic Effect Caused By Intrathecal Low Dose Administration Of 0.5% Against 0.75% Hyperbaric Bupivacaine In Patients Undergoing Lower Limb Surgery Under Unilateral Spinal Anaesthesia.

Spinal anaesthesia has its unique place in modern anaesthetic practice. In past, most of the surgeries, irrespective of the site of surgery, were performed in general anaesthesia but now in the modern anaesthetic field, spinal anaesthesia has markedly replaced general anaesthesia, specifically in obstetrics, lower limbs, and abdominal surgeries. A total of 100 patients fit to undergo lower limb surgery between the ages of 20 to 70 years were included in the study. 50 patients were in 0.5% hyperbaric bupivacaine (Group A) while 50 patients were in the 0.75% hyperbaric bupivacaine group (Group B). Patients with a history of allergies to local anaesthetics, ischemic heart disease and contraindications to spinal anaesthesia were excluded. At the end of the injection, the patient was immediately laid down and tilted to 30 degrees lateral on the operative side for unilateral anaesthesia. Mean arterial pressure at baseline, 15, 30, 45 and 60 minutes was recorded by trainee anaesthesia. A baseline was taken of mean arterial pressure measured 15 minutes before induction of spinal anaesthesia in a lying position. The mean baseline arterial pressure of patients in group A was 88.72±1.71 mmHg and in group B was 88.94±1.95 mmHg. Mean arterial pressure MAP at 15, 30, 45 and 60 minutes in both groups was as follows; 86.22±2.55 vs 81.78±1.52 mmHg, 83.72±3.36 vs 75.84±1.34 mmHg, 80.02±3.40 vs 70.90±0.97 mmHg and 77.14±4.24 vs 66.06±1.62 mmHg respectively (p-value <0.05). This study concluded that the hemodynamic parameters in terms of mean arterial pressure remained more stable by deviating less from the baseline value with the use of a low dose of 0.5% hyperbaric bupivacaine instead of 0.75% hyperbaric bupivacaine in patients undergoing lower limb surgery under unilateral spinal anaesthesia.

Comparison of 0.5% Hyperbaric Bupivacaine with Midazolam Versus 0.5% Hyperbaric Bupivacaine Alone Intrathecally: Prospective Observational Study

Context: Neuraxial anesthesia is the preferred choice for infraumbilical surgeries due to its advantages. The incorporation of midazolam alongside local anesthetic drugs in spinal anesthesia has demonstrated positive outcomes. This study was undertaken to assess the effectiveness of midazolam in terms of analgesic and anesthetic efficacy, as well as potential adverse effects, in patients undergoing infraumbilical surgeries. Aims: To compare the analgesic and anaesthetic effect of mixture of midazolam - bupivacaine as compared to bupivacaine alone in patients undergoing infra-umbilical surgeries under spinal anaesthesia. Settings and Design: The present study is a prospective, observational study. Methods and Material: Fifty patients posted for elective infra-umbilical surgery were randomly divided into two groups of 25 each for intrathecal drug administration. (n=25). After administration of block, patients were assessed for analgesic and anesthetic effect of the drug. Statistical Analysis used: The study analyzed through the statistical programming software SPSS-22 and it involved the application of the student’s t-test, with a significance threshold set at a P value of &lt;0.05. Results: Analgesic duration of patients in Midazolam Group was signiÞcantly longer compared to Bupivacaine Group for sensory block. More patients in the midazolam group were sedated and easily arousable. Conclusions: This study concludes that the addition of intrathecal preservative-free midazolam to hyperbaric bupivacaine improved intra - operative anaesthesia and prolonged duration of analgesia. Also, it was observed that there was a significant reduction in the consumption of analgesics during the postoperative period in patients undergoing infra-umbilical surgeries without causing any significant haemodynamic changes.