Continuous Infusion Of Bupivacaine Research Articles

Apelin-13 reverses bupivacaine-induced cardiotoxicity: an experimental study

IntroductionCardiac arrest or arrhythmia caused by bupivacaine may be refractory to treatment. Apelin has been reported to directly increase the frequency of spontaneous activation and the propagation of action potentials, ultimately promoting cardiac contractility. This study aimed to investigate the effects of apelin-13 in reversing cardiac suppression induced by bupivacaine in rats. MethodsA rat model of cardiac suppression was established by a 3-min continuous intravenous infusion of bupivacaine at the rate of 5 mg.kg−1.min−1, and serial doses of apelin-13 (50, 150 and 450 μg.kg−1) were administered to rescue cardiac suppression to identify its dose-response relationship. We used F13A, an inhibitor of Angiotensin Receptor-Like 1 (APJ), and Protein Kinase C (PKC) inhibitor chelerythrine to reverse the effects of apelin-13. Moreover, the protein expressions of PKC, Nav1.5, and APJ in ventricular tissues were measured using Western blotting and immunofluorescence assay. ResultsCompared to the control rats, the rats subjected to continuous intravenous administration of bupivacaine had impaired hemodynamic stability. Administration of apelin-13, in a dose-dependent manner, significantly improved hemodynamic parameters in rats with bupivacaine-induced cardiac suppression (p < 0.05), and apelin-13 treatment also significantly upregulated the protein expressions of p-PKC and Nav1.5 (p < 0.05), these effects were abrogated by F13A or chelerythrine (p < 0.05). ConclusionExogenous apelin-13, at least in part, activates the PKC signaling pathway through the apelin/APJ system to improve cardiac function in a rat model of bupivacaine-induced cardiac suppression.

The efficacy of continuous pre-peritoneal bupivacaine infusion in cesarean section

We evaluate the efficacy of local continuous subperitoneal infusion of bupivacaine (On-Q pump) in postoperative pain relief and reduce the requirement of opioids and other analgesics in women with cesarean section.

Continuous local anaesthetic wound infusion of bupivacaine for postoperative analgesia in neonates: a randomised control trial (CANWIN Study)

ObjectiveTo determine the effect of continuous wound infusion of local anaesthetic drug (bupivacaine) on total amount of systemic opioid use in the first 72 hours in newborn infants undergoing laparotomy.DesignA...

Quadratus Lumborum Block with Laparoscopic Assisted Catheter Placement Technique in Donor Nephrectomy: A Preliminary Report

Quadratus lumborum block (QLB) is a new fascial plane block that may be helpful for laparoscopic surgeries. In this present study, we aim to evaluate the analgesic efficacy of QLB in laparoscopic living related donor nephrectomy (LLRDN) applied continuously via a catheter that was placed under laparoscopic vision by the surgeon. Following the approval of the Clinical Research Ethics Committee of Istanbul University, Istanbul Medical Faculty (2019/1552), 9 study (Group QLB) and 26 control (Group M) patients that underwent LLRDN were enrolled in this retrospective study. All donors underwent left nephrectomy via transperitoneal laparoscopic approach. An epidural catheter was placed between the QL and psoas major (PM) fascial plane intraoperatively by the surgeon under laparoscopic direct vision, and bupivacaine 0.25% 20 mL was injected through the catheter. After the operation, for group QLB, we used a continuous infusion of bupivacaine 0.1% 7 mL/h over 24 hours. Group M patients received intravenous morphine patient controlled analgesia for 24 hours, postoperatively. Pain scores, total morphine consumption, and complications during the first 24 hours after surgery were recorded. During the first postoperative 24 hours, morphine requirement decreased by more than 70% in Group QLB (Group QLB: 5.11 ± 1.16 mg vs Group M: 16.8 ± 7.1 mg) (P < .0001). Postoperative Numeric Rating Scale (NRS) values at the 45th minute and first hour were both significantly lower in Group QLB than Group M (P < .01). This preliminary report showed that QL catheter placement technique provides good postoperative analgesia in patients undergoing LLRDN. However, further randomized controlled studies with extended patient numbers are required to test the efficacy of the technic.

A prospective randomised trial comparing the analgesic efficacy of postoperative infusion of epidural bupivacaine and ropivacaine in orthopaedic surgeries

Background: Epidural administration of local anaesthetic provides effective pain relief. Commonly used epidural local anaesthetics are bupivacaine and ropivacaine. Most studies compared these drugs along with an opioid or any other adjuvants like clonidine, dexmedetomidine etc. Our aim was to compare the analgesic efficacy and safety of continuous infusion of epidural ropivacaine and bupivacaine without any adjuvants in postoperative patients. Materials and methods: A prospective randomized clinical study was conducted in a tertiary care hospital in 60 patients between the age groups of 20-years and 60-years undergoing elective lower limb orthopaedic procedures. Total patients were divided into two groups (A and B) of 30 each. Continuous epidural infusion was started with 6ml per hour of 0.125% bupivacaine in Group A and 6ml per hour of 0.2% ropivacaine in Group B postoperatively. After the commencement of epidural infusions, heart rate, blood pressure, Visual Analogue Score (VAS) and supplementary analgesic requirement were monitored postoperatively for 48 hrs. Results: Our observations showed no significant difference in haemodynamic parameters like heart rate and blood pressure. VAS showed a statistically significant difference with higher mean VAS score in Group B patients at one hour (p value = 0.0126), 12 hrs (p value = 0.031) and 24 hrs (p value = 0.0421) as compared to Group A. Add on analgesic requirement was also higher for Group B patients. Conclusions: Both bupivacaine and ropivacaine can be used effectively for postoperative analgesia but bupivacaine has a superior analgesic efficacy than ropivacaine with similar safety profile.

Effects of prolonged peri-neural bupivacaine infusion in rat sciatic nerves (axon and myelin).

Peripheral-nerve blocks (PNBs) using continuous-infusion of local anesthetics are used to provide perioperative analgesia. Yet little research exists to characterize the histopathological effects of continuous long-duration PNBs. Herein we test the hypothesis that continuous peri-neural bupivacaine infusion (3-day vs. 7-day infusion) contributes to histologic injury in a duration-dependent manner using an in vivo model of rat sciatic nerves. We placed indwelling catheters in 22 rats for infusion with low-dose (0.5mg/kg/hr) bupivacaine or normal saline proximal to the right sciatic nerves for 3 or 7 consecutive days. Hind-limb analgesia was measured using Von-Frey nociceptive testing. At infusion end, rats were sacrificed, bilateral nerves were sectioned and stained with hematoxylin and eosin and CD68 for evaluation of inflammatory response, and eriochrome to assess damage to myelin. Animals receiving continuous infusion of bupivacaine maintained analgesia as demonstrated by significant decrease (50% on average) in nociceptive response in bupivacaine-infused limbs across time points. Both 7-day saline and bupivacaine-infused sciatic nerves showed significantly-increased inflammation by H&E staining compared to untreated native nerve controls (P = 0.0001, P < 0.0001). Extent of inflammation did not vary significantly based on infusate (7-day saline vs. 7-day bupivacaine P > 0.99) or duration (3-day bupivacaine vs 7-day bupivacaine P > 0.99). No significant change in sciatic nerve myelin was found in bupivacaine-infused animals compared to saline-infused controls, regardless of duration. Long-duration (7-day) bupivacaine infusion provided durable post-operative analgesia, yet contributed to equivalent neural inflammation as short duration (3-day) infusion of bupivacaine or saline with no evidence of demyelination.

Optimal Perioperative Pain Management in Esophageal Surgery: An Evaluation of Paravertebral Analgesia

BackgroundFor esophagectomy, thoracic epidural analgesia (TEA) is the standard of care for perioperative pain management. Although effective, TEA is associated with moderate to serious adverse events such as hypotension and neurologic complications. Paravertebral analgesia (PVA) may be a safe alternative. The authors hypothesized that TEA and PVA are similar in efficacy for pain treatment in thoracolaparoscopic Ivor Lewis esophagectomy.MethodsThis retrospective cohort study compared TEA with PVA in two consecutive series of 25 thoracolaparoscopic Ivor Lewis esophagectomies. In this study, TEA consisted of continuous epidural bupivacaine and sufentanil infusion with a patient-controlled bolus function. In PVA, the catheter was inserted by the surgeon under thoracoscopic vision during surgery. Administration of PVA consisted of continuous paravertebral bupivacaine infusion after a bolus combined with patient-controlled analgesia using intravenous morphine. The primary outcome was the median highest recorded Numeric Pain Rating Scale (NRS) during the 3 days after surgery. The secondary outcomes were vasopressor consumption, fluid administration, and length of hospital stay.ResultsIn both groups, the median highest recorded NRS was 4 or lower during the first three postoperative days. The patients with PVA had a higher overall NRS (mean difference, 0.75; 95% confidence interval 0.49–1.44). No differences were observed in any of the other secondary outcomes.ConclusionFor the patients undergoing thoracolaparoscopic Ivor Lewis esophagectomy, TEA was superior to PVA, as measured by NRS during the first three postoperative days. However, both modes provided adequate analgesia, with a median highest recorded NRS of 4 or lower. These results could form the basis for a randomized controlled trial.

Effect of tramadol as a local anesthetic adjuvant in epidural labor analgesia: Randomized controlled study

ABSTRACT Background: Epidural analgesia has been established to be the best modality for painless labor. This study hypothesized to evaluate the effect of adding tramadol as an adjuvant to bupivacaine in epidural labor analgesia. Methods: Sixty parturients were allocated into two equal groups. Group B received a total volume of 10 ml bupivacaine 0.25% in normal saline. Group BT received a total volume of 10 ml bupivacaine 0.25% plus tramadol 5 mg/ml in normal saline as a loading dose, followed by continuous infusion of bupivacaine 0.125% at rate 10 ml/h 15 min after a loading dose for both groups. The onset of analgesia, degree of motor block, sedative effect, hemodynamic parameters, visual analogue scale (VAS), number of top-up doses, fetal outcomes, any related side effects, and maternal satisfaction were recorded. Results: Faster onset of analgesia was achieved in BT group compared to B group (7.9 ± 2.68 vs 15.3 ± 3.3, respectively: P < 0.001). BT group has a longer duration of analgesia (181.1 ± 44.3 min) than B group (89.6 ± 32.6 min) (P < 0.001). VAS was significantly decreased at 10, 15, 60, 120 and 180 min in BT group compared to B group (P < 0.001, < 0.001, 0.001, < 0.001, and 0.006, respectively). Motor block was comparable between both groups. Higher levels of sedation were reached in group BT. Conclusion: Tramadol in epidural labor analgesia as an adjuvant to bupivacaine can provide a better quality of analgesia with faster onset, and prolonged duration with no relevant adverse effects Pan African Clinical Trial registration: (PACTR201804003261749)

A randomized controlled double blind study comparing the efficacy of epidural ropivacaine and bupivacaine with fentanyl for labor analgesia

Introduction and Aim: Ropivacaine and bupivacaine have been found to provide adequate labor analgesia when given epidurally. The aim of this randomized double blind study was to compare the onset of sensory block in epidural ropivacaine and bupivacaine with Fentanyl for labor analgesia and to assess the maternal and fetal outcome. Materials and Methods: In this prospective double blind study, 60 ASA II parturients with singleton vertex presentation were randomly allocated to two groups of 30 each. Group R received 5 ml 0.2% ropivacaine with 50mcg Fentanyl as bolus, followed by continuous infusion of ropivacaine 0.1% with Fentanyl 1 mcg/ml at 6 ml/hr. Group B received 5 ml 0.125% bupivacaine with 50 mcg Fentanyl as bolus, followed by continuous infusion of bupivacaine 0.0625% with Fentanyl 1 mcg/ml at 6 ml/hr. Onset and regression of sensory level, degree of motor block, hemodynamic effects, mode of delivery, neonatal outcome and patient satisfaction were compared. The statistical analysis was done using the Mean, Standard Deviation and the student ‘t’ test. Results: There was a significantly faster onset of sensory block with ropivacaine (5.67±0.99min) compared to bupivacaine (6.67±1.39min) (p Conclusion: Ropivacaine provides effective analgesia with faster onset of sensory block in comparison to bupivacaine and is safe for mother and fetus. Keywords: Labor analgesia, Epidural, Bupivacaine, Ropivacaine, Fentanyl.

Continuous local bupivacaine wound infusion reduces oral opioid use for acute postoperative pain control following myelomeningocele repair

For pregnancies complicated by fetal myelomeningocele who meet the established criteria, prenatal closure is a viable management option. Prenatal closure is an open procedure, with some techniques requiring greater dissection of maternal tissue than cesarean delivery; pain control is an important postoperative goal. Given the rising rates of opioid dependence and concerns regarding the fetal and neonatal effects of opioid use, our practice has turned to nonopioid pain management techniques. This study aimed to compare postoperative opioid use and pain scores in women undergoing open fetal myelomeningocele repair with and without continuous local bupivacaine wound infusion. This was a retrospective, single-center chart review of all consecutive patients who underwent open myelomeningocele repair from March 2013 to December 2019. Women were enrolled at the time of referral and locally followed for 2 weeks postoperatively. The control group received patient-controlled epidural analgesia for 48 hours with acetaminophen and oral and intravenous opioids as needed. The treatment group received patient-controlled epidural analgesia for 24 hours with acetaminophen, oral and intravenous opioids, and continuous local bupivacaine infusion. Pain scores, medication use, and postoperative milestones and complications through discharge were abstracted from the chart and compared. Of 72 subjects, 51 were in the control group and 21 in the treatment group. Total opioid use, including intravenous doses (165 vs 52.5 mg; P=.001) and daily average oral opioid use (30 vs 10.5 mg; P=.002) were lower in the treatment group. In addition, 24% of women in the treatment group used no opioid postoperatively, compared with 4% in the control group. There was no difference in postoperative day 1 to 4 pain scores, antiemetic use, or bowel function; the treatment group was discharged significantly earlier. Postoperative opioid use was reduced in women who received continuous local wound infusion of bupivacaine for incisional pain control after prenatal myelomeningocele repair. Pain control is paramount following open myelomeningocele repair; local bupivacaine wound infusion is an important adjunct to reduce opioid use postoperatively.

COMPARATIVE STUDY OF ULTRASOUND GUIDED TRANSVERSUS ABDOMINIS PLANE BLOCK USING BUPIVACAINE WITH AND WITHOUT HYALURONIDASE IN LAPAROSCOPIC BARIATRIC SURGERY

Background: Transversus abdominis plane (TAP) block is atechnique of regional anesthesia, which reduces the pain derived from abdominal wall incisions, decreases general anesthesia requirements, and increases hemodynamic stability. Hyaluronidase is an enzyme considered as the “spreading factor”, facilitating the spread of local anesthetic solutions. It has been shown to produce reliable blockade with better spread and therefore better quality of block when used with local anesthetics.Aim of the work: The aim of this study is to compare the efficacy of Injection of Bupivacaine 0.25% and Injection of Bupivacaine 0.25% with Hyaluronidase 1500 Uin ultrasound guided transversus abdominis plane block.Patients and methods: This double blinded randomized controlled clinical trial study was conducted in the Department of anesthesia, Faculty of Medicine, Ain Shams University and general hospitals during the period from 1st January 2018 to 31stDecember 2018 after being approved by the department ethical Committee. The study population included 60 bariatric patients which were randomly divided into 2 groups (30 patients in each group);Group A: TAP block with Bupivacaine 0.25% 19 ml+1 ml normal saline (loading dose) followed by continuous infusion of Bupivacaine 0.25% at a rate of 4ml/hr.; i.e., 96 ml/24hrs.Group B: TAP block with Bupivacaine 0.25% 19 ml+ Hyaluronidase 1500 U 1ml (loading dose) followed by continuous infusion of Bupivacaine 0.25%+ Hyaluronidase 50 U at a rate of 4ml/hr.; i.e., 96 ml/24hrs.Results: the group of TAP block with Bupivacaine and Hyaluronidase (Group B) had statistically lower NRS 2nd, 4th, 6th, 8th,16th, 22ndand 24th postsurgical day (p=0.28, 0.42,0.018, 0.003, 0.003, 0.004 and 0.041 respectively). Also Group B had statistically lower mean of opioid consumption in 2nd, 4th, 6th, 8th,16th, 22th and 24th postsurgical day with overall lower mean of opioid consumption among group B (p=0.002).Regarding vital data among both groups was non-significant (p≥ 0.2).Conclusion: Our findings support the use of ultrasound guided TAP block using liposomal bupivacaine with hyaluronidase as part of multimodal analgesia for bariatric surgery based on decreased postoperative opioid requirements.

Erector spinae plane (ESP) block for pain management caused by acute herpes zoster during pregnancy: A case report

Clinical Case: The case of a 27-year-old patient is presented, with 19 weeks of gestation, with a clinical picture of 3 days of severe and neuropathic pain secondary to thoracic herpes zoster and given the restriction in the use of analgesics and neuromodulators in pregnancy, was only treated with acetaminophen, without clinical improvement. Therefore, an ESP block was performed at the left T3 level and a catheter was implanted for continuous infusion of bupivacaine 0.25% for 15 days. Pain scales VAS, DN4, satisfaction, SPADI scale mobility, medication consumption, before and after the procedure were measured. The patient reported complete resolution of pain, had no need for opioid use, and there were no adverse effects or complications related to the procedure.

The Analgesic Efficacy of Continuous Sub-fascial Bupivacaine Infusion and Lidocaine Patches in Post-cesarean Patients With Opiate Use Disorder: A Comparative Efficacy Analysis

The Analgesic Efficacy of Continuous Sub-fascial Bupivacaine Infusion and Lidocaine Patches in Post-cesarean Patients With Opiate Use Disorder: A Comparative Efficacy Analysis

An Analysis of the Efficacy of Continuous Bupivacaine Infusion Pump (On-Q® Pump) in Bariatric Surgery Patients

With an increasing obese population nationwide, there has been an increase in the number of laparoscopic surgeries performed. However, few studies have evaluated different methods to reduce pain in bariatric patients after laparoscopic surgery. Bupivacaine infusion pumps (On-Q® pumps) have shown efficacy in reducing postoperative pain in other surgical populations, such as orthopedic patients. Therefore, the purpose of this study was to investigate whether infusion pain pumps improve postoperative pain control and decrease length of hospital stay in bariatric patients. Between January 2015 and August 2016, 125 charts were retrospectively reviewed. Patients were divided into two groups: those who received infusion pain pumps and those who did not. The primary endpoints were hospital length of stay and the amount of postoperative narcotic use. Secondary endpoints included postoperative pain score, use of non-narcotics, and complications due to opioids or bupivacaine. There were 82 patients in the infusion pain pump group and 43 patients in the control group. Baseline characteristics were similar between both groups. There were no statistically significant differences in length of hospital stay (p = 0.39) or postoperative opioid use (p = 0.48) between the two groups. Although the median postoperative pain score was significantly reduced in the infusion pain pump group (3.5) compared to the control group (5) for the first 48 h (p = 0.002), this difference was not statistically significant for the first 24 h (p = 0.06). The use of infusion pain pumps did not significantly reduce the length of hospitalization and use of narcotics postoperatively.

Continuous local bupivacaine wound infusion with neuraxial morphine reduces opioid consumption after cesarean delivery

Background: As a part of a quality improvement program, maternal postoperative opioid use and pain scores were compared between those receiving continuous infusion of bupivacaine for local incisional pain control with multimodal pain management and neuraxial morphine versus multimodal pain management with neuraxial morphine alone.Objective: We compared postoperative opioid use and pain scores between the multimodal pain management group with neuraxial morphine and the group receiving multimodal pain management, neuraxial morphine, and continuous infusion of bupivacaine for local incisional pain control.Study design: A retrospective cohort analysis of cesarean deliveries from January of 2015 through March of 2016 was undertaken. Deliveries were grouped by utilization of continuous infusion of bupivacaine for local incisional pain control. For each postoperative day, the average daily opioid use, antiemetic use and pain scores were determined. Patients received 1–2 tablets oxycodone–acetaminophen (5–325 mg) every 4 h as needed with oxycodone 5–10 mg immediate release tablets every 4 h as needed for breakthrough pain in addition to acetaminophen and ibuprofen. Total dose of narcotic, antiemetic use, and pain scores was compared between groups utilizing t-test for continuous variables and chi square for categorical data. A linear mixed model with unstructured covariance was utilized to analyze the daily dose of narcotic and pain scores from postoperative day 1 through day 4.Results: Patients in the standard multimodal group with neuraxial morphine used more opioids versus those receiving continuous wound infusion of bupivacaine in total postoperative dosing (122.79 ± 61.92 mg versus 89.88 ± 51.38 mg, p = .0063). There was a statistically significant difference between the standard group and local infusion of bupivacaine group on postoperative days 1 and 2 (32.79 ± 15.56 mg versus 22.13 ± 15.73 mg, p = .0011 and 40.25 ± 19.84 mg versus 29.13 ± 14.58 mg, p = .0018, respectively). There was no difference in narcotic use for postoperative days 3 and 4. There was a higher mean number of antiemetic doses in the standard group (0.31 ± 0.70 versus 0.10 ± 0.30, p = .0396). Pain scores did not differ between groups, although there was a correlation between opioid dosing and pain scores. The standard group received more IV ketorolac (87.72 ± 42.01 mg versus 64.50 ± 53.3 mg, p = .0165) and more IV acetaminophen (634.89 ± 706.42 mg versus 375.0 ± 490.29 mg, p = .0315) within the first 24 h postoperatively. In addition, the standard group received more oral acetaminophen (6969.67 ± 3230.14 mg versus 5248.75 ± 2711.71 mg, p = .0064). No difference was seen in regard to ibuprofen between groups. These results remained constant when adjusted for differences in gestational age, variation in intraoperative opioid dosing, as well as differences in uterine incision type.Conclusion: We found a significant reduction in postoperative opioid use when continuous infusion of bupivacaine for local incisional pain control was added to our standard pain management with neuraxial morphine after cesarean delivery. As a result of this quality improvement initiative, we have implemented this intervention universally as a part of our multimodal postoperative pain management strategy.

Comparison of Postoperative Analgesic Efficacy between Continuous Transversus Abdominis Plane Block, Lumbar Paravertebral and Epidural Blocks after Abdominal Surgeries

Background: The study was done to assess the postoperative analgesic efficacy of ultrasound-guided continuous transverses abdominis plane block, continuous lumbar paravertebral block and a continuous lumbar epidural block in patients undergoing lower abdominal surgeries (unilateral inguinal hernia repair). We compared their analgesic efficacy over the first 48 hour postoperative, in a randomized, single-blind study in 120 patients divided into four equal groups, 30 patients in each group. Methods: 120 patients randomly assigned into four equal groups, with 30 patients in each group. Group T received ultrasound-guided transverses abdominis plane block with 20 ml of bupivacaine 0.25% followed by continuous infusion of bupivacaine 0.125% (0.1 ml/kg/hr) and group P received ultrasound-guided continuous lumbar paravertebral block with bupivacaine 0.25% bolus dose 20 ml, followed by continuous infusion of bupivacaine 0.125% (0.1 ml/kg/hr). Group E received continuous lumbar epidural infusion of bupivacaine 0.25% bolus dose 20 ml, followed by continuous infusion of bupivacaine 0.125% (0.1 ml/kg/hr) and group C received normal saline bolus dose 20 ml, followed by continuous infusion of normal saline (0.1 ml/kg/hr). General anesthesia induced with fentanyl 1 - 2 μg/kg and propofol 1 - 3 mg/kg followed by atracurium 0.5 mg/kg. At the end of the surgical procedure, we activated the regional block with recording of parameters in the postoperative period each patient was assessed for visual analog scale (VAS) at rest and on movement, analgesic consumption, vital signs and presence of complications (nausea, vomiting, sedation), and postoperative patient satisfaction all data collected postoperatively by a blinded investigator at one, two, 6, 12, 24 and 48 hours postoperatively. Results: Postoperative analgesic efficacy is more in group E than group P and group T, the latter is least effective in pain control. Also in group E the postoperative analgesic consumption is lower than in group P and group T, re-garding complications as nausea and vomiting more recorded in epidural than the other two groups. Conclusion: Regarding postoperative analgesic efficacy, the continuous lumbar epidural block is more effective than continuous paravertebral and continuous transverses abdominis plane block, but regarding complications, there was a higher incidence in epidural group than other two groups.

Motor-sparing continuous median nerve block for hand surgery: A pediatric case

Here is described a successful perioperative pain control with continuous median nerve block after flexor tendon repair surgery on 2nd finger of a child. A 9-year-old patient was admitted for reconstruction surgery. The combination of median nerve block and lateral/medial antecubital cutaneous nerve blocks were performed before the surgery to cover all the surgical incision including the 2nd finger, palm, the graft site proximal to the wrist, and Kleinert traction at the nail bed. At the end of the surgery, the infusion catheter was inserted at the distal one-third to spare the muscle strength of flexor digitorum muscles. Continuous bupivacaine infusion provided complete analgesia until the postoperative day 4 without interfering the postoperative physiotherapy. The continuous median nerve block at the distal one-third of the forearm spared finger flexion, and supported effective postoperative early mobilization after zone 2 flexor tendon repair surgery.

Transversus Abdominis Plane Blocks with Single-Dose Liposomal Bupivacaine in Conjunction with a Nonnarcotic Pain Regimen Help Reduce Length of Stay following Abdominally Based Microsurgical Breast Reconstruction.

Side effects associated with use of postoperative narcotics for pain control can delay recovery after abdominally based microsurgical breast reconstruction. The authors evaluated a nonnarcotic pain control regimen in conjunction with bilateral transversus abdominis plane blocks on facilitating early hospital discharge. A retrospective analysis was performed of consecutive patients who underwent breast reconstruction using abdominally based free flaps, with or without being included in a nonnarcotic protocol using intraoperative transversus abdominis plane blockade. During this period, the use of locoregional analgesia evolved from none (control), to continuous bupivacaine infusion transversus abdominis plane and catheters, to single-dose transversus abdominis plane blockade with liposomal bupivacaine solution. Demographic factors, length of stay, inpatient opioid consumption, and complications were reported for all three groups. One hundred twenty-eight consecutive patients (182 flaps) were identified. Forty patients (62 flaps) were in the infusion-liposomal bupivacaine group, 48 (66 flaps) were in the single-dose blockade-catheter group, and 40 (54 flaps) were in the control group. The infusion-liposomal bupivacaine patients had a significantly shorter hospital stay compared with the single-dose blockade-catheter group (2.65 ± 0.66 versus 3.52 ± 0.92 days; p < 0.0001) and the control group (2.65 ± 0.66 versus 4.05 ± 1.26 days; p < 0.0001). There was no significant difference in flap loss or major complications among groups. When used as part of a nonnarcotic postoperative pain regimen, transversus abdominis plane blocks performed with single injections of liposomal bupivacaine help facilitate early hospital discharge after abdominally based microsurgical breast reconstruction. A trend toward consistent discharge by postoperative day 2 was seen. This could result in significant cost savings for health care systems. Therapeutic, III.

70: The impact of continuous bupivacaine infusion via the ON-Q pump on postoperative pain in women undergoing abdominal hysterectomy

70: The impact of continuous bupivacaine infusion via the ON-Q pump on postoperative pain in women undergoing abdominal hysterectomy

Comparison of continuous interscalene block and subacromial infusion of local anesthetic for postoperative analgesia after open shoulder surgery

This study compared the efficacy of continuous interscalene block (CISB) and subacromial infusion of local anesthetic (CSIA) for postoperative analgesia after open shoulder surgery. This randomized, prospective, double-blinded, single-center study included 40 adult patients undergoing open shoulder surgery. All patients received a standardized general anesthetic. The patients were separated into group CISB and group CSIA. A loading dose of 40 mL 0.25% bupivacaine was administered and patient-controlled analgesia was applied by catheter with 0.1% bupivacaine 5 mL/h throughout 24 h basal infusion, 2 mL bolus dose, and 20 min knocked time in both groups postoperatively. Visual analog scale (VAS) scores, additional analgesia need, local anesthetic consumption, complications, and side effects were recorded during the first 24 h postoperatively. The range of motion (ROM) score was recorded preoperatively and in the first and third weeks postoperatively. A statistically significant difference was determined between the groups in respect of consumption of local anesthetic, VAS scores, additional analgesia consumption, complications, and side effects, with lower values recorded in the CISB group. There were no significant differences in ROM scoring in the preoperative and postoperative third week between the two groups but there were significant differences in ROM scoring in the postoperative first week, with higher ROM scoring values in the group CISB patients. The results of this study have shown that continuous interscalene infusion of bupivacaine is an effective and safe method of postoperative analgesia after open shoulder surgery.