Difference In Duration Of Analgesia Research Articles

Comparison of nalbuphine and fentanyl as adjuvants to bupivacaine in unilateral spinal anaesthesia in patients undergoing lower limb orthopaedic surgeries

Unilateral spinal anaesthesia is a technique used to avoid hemodynamic changes and early recovery. Adjuvants are added to prolong post operative analgesia, this study was done to compare nalbuphine (0.8mg) and fentanyl (20µg) as adjuvants to 0.5% bupivacaine Heavy in unilateral spinal anaesthesia for patients undergoing lower limb orthopaedic surgeries. Randomized double blind study in patients posted for lower limb orthopaedic surgery in a teritiary care center.Unilateral spinal anaesthesia was given to 68 eligible patients undergoing lower limb orthopaedic surgery with nalbuphine (0.8mg) and fentanyl (20µg) as adjuvants to 0.5% bupivacaine Heavy. Block characterstics, unilaterality, hemodynamic changes and recovery were noted. Independent sample t-test was used to compare continuous variables with normal distribution and chi square test for categorical variablesUnilateral block was seen in 60 of 68 patients enrolled. Time to achieve T 10 level was comparable between both the groups in nalbuphine and fentanyl group (4.33±0.99 and 4.77 ± 0.89 respectively). Duration of sensory block was significantly lesser in nalbuphine group as compared to fentanyl group (170.67±15.34 and 178.83±15.04 respectively). However, there was no significant difference in duration of analgesia, 265.17 ± 17.73 in nalbuphine group and 260.23 ±31.03 in fentanyl group (p=0.45).Nalbuphine due to its easy availability can be used as effective alternative to fentanyl as adjuvant in unilateral spinal anaesthesia.

A DOUBLE BLIND COMPARATIVE STUDY BETWEEN INTRATHECAL BUPIVACAINE AND INTRATHECAL FENTANYLAS THE INITIAL DOSE OF COMBINED SPINAL EPIDURAL TECHNIQUE FOR LABOUR ANALGESIA

Introduction: Labour pain is among the most severe pain a woman can experience in her lifetime. Painful labour has decrimental effects on both mother and fetus leads to severe physical and psychological stress. Maternal hyperventilation in response to pain reduces fetal oxygenation and hypoventilation between contractions combined with decreased blood ow worsens fetal hypoxemia. It has been suggested that conning women to bed during labour may cause the labour to be longer and more painful with increase in abnormal presentation, instrumental deliveries and fetal distress. Aims And Objectives:The onset, quality and duration of their analgesic action. Incidence of unwanted effects like muscle weakness, hypotension, pruritus, nausea/vomiting, fetal bradycardia by the individual drugs. Materials And Methods: The study was conducted in the department of anesthesia, Darbhanga Medical College & Hospital, Laheriasarai, Bihar. Methods of collection of data (including sampling procedure if any) : After institutional committee approval and written informed consent from parturients and their relatives for the procedure the study was conducted and data were collected. Results: Duration of analgesia was found varying widely. It was 55±12.34 minutes in Group I whereas 75 ±14.36 minutes in Group II. The incidence of pruritus almost mild or negligible in both groups. The incidence of motor weakness in group II was 24 (80%) whereas in group I it was 10(33%). There was signicant statistics difference in motor weakness between two groups (p< 0.001) by Chi square test 9 with yate's correction. Other side effects differences between two groups were not statistically signicant. Summary And Conclusion:Both the drugs provided excellent quality of analgesia to the parturient in pain. The difference in duration of analgesia was signicant between the two groups statistically. Mean duration of analgesia lasted for 55 minutes in group I whereas in group II, it lasted for 75 minutes. Main side effects encountered in this study were motor weakness of longer duration in group II than in group I. Other side effects like nausea-vomiting were comparable to each other and were minimal in nature.

Ultrasound guided quadratus lumborum block and transversus abdominis plane block for postoperative analgesia after lower segment caesarean section under spinal anesthesia: A prospective observational study

Caesarean section being a major surgical procedure is associated with substantial postoperative discomfort and moderate to severe pain for 48 hours postoperatively. This prospective study was undertaken to observe the ultrasound guided quadratus lumborum block and transversus abdominis plane block for postoperative analgesia after lower segment caesarean section under spinal anesthesia. Hundred patients belonging to ASA class I & II and a normal singleton pregnancy with a gestation of at least 37 weeks posted for elective caesarean delivery under spinal anesthesia were selected. The patients who had received either TAP block or QL block were assigned two groups. The patients who had received TAP block were assigned group A and the patients who had received QL block were assigned group B. : The overall VAS score in group B was lower than in group A. The duration of analgesia in Group A ranged from 6-12 hours with a mean duration of 8.5±1.998 hours. In Group B the duration ranged from 9-24 hours with a mean duration of 16.5±3.096 hours. The difference in duration of analgesia between the two groups was statistically significant. In group A the mean analgesic consumption dose was 1.07±0.264 grams at 12 hours, 2.11±0.317 grams at 24 hours and 2.67±0.673 at 48 hours. In group B it was 0.43±0.501 grams at 12 hours, 1.35±0.567 grams at 24 hours and 1.65±0.604 grams at 48 hours. The difference was statistically significant It can be concluded that Ultrasound Guided nerve blocks (TAP block and QL block) can be used as a part of multimodal analgesia for better postoperative pain relief in lower abdominal surgeries like LSCS especially when given before the resolution of spinal anaesthesia. Further it was observed that QLB was superior to TAP block in terms of better pain control (duration and quality) as shown by lower VAS score, demand for the first rescue analgesia which was delayed and total consumption of rescue analgesia was less in the first 48 hours.

COMPARISON OF INTRATHECAL BUPIVACAINE WITH OR WITHOUT CLONIDINE FOR PERIOPERATIVE ANALGESIA IN LOWER LIMB ORTHOPEDICS SURGERIES

Background: The newer adjutants for spinal anaesthesia (SA) have seen numerous modifications over the last two decades. Various doses of clonidine have been tried in past but optimal dose which balances the ill effects has to be discovered. Therefore, this study was designed to study the effect of clonidine as an adjuvant in SA in terms of duration and complication.
 Methods: Two groups I and II ( with 60 patients each) received either 3.0 ml of Bupivacaine 0.5% heavy + 0.5 ml of normal saline and 2.5 ml of bupivacaine 0.5% heavy + 0.5 ml (75µg) of preservative free clonidine respectively. Various haemodynamic parameters and complication were recorded at baseline than 30 min, 1,2,4,6 and 8 hours after SA.
 Results: Group II shows that addition of clonidine had altered the heart rate and blood pressure significantly for initial two hour duration(p<0.05). No difference in the onset of sensory and motor blockade in both groups. Majority of patients in both group had level of sensory block upto T7 level. Mean VAS score was significantly lower in group II (p<0.001). Group II has prolonged duration of motor blockade (p< 0.00l). The difference in mean duration of analgesia among both the groups was significant indicating that addition of clonidine prolongs the duration of analgesia (p<0.0001). In group II incidence of hypotension and bradycardia is more as compared to group I.
 Conclusion: Intrathecal clonidine in the dose of 75 µg along with bupivacaine 0.5% heavy prolonged postoperative analgesia and motor blockade. It produces sedation in which patients were asleep and easily arousal and haemodynamic changes which could be easily managed.
 Keywords: Intrathecal, Bupivacaine, Clonidine, Orthopedics surgeries, VAS score

Postoperative analgesia of ultra-low-dose naloxone versus dexmedetomidine with local anesthetic in peribulbar block in cataract surgery

Background and aim Regional anesthesia in eye surgery is a preferred technique and widely used in all eye surgery centers. It is safe, inexpensive, simple, and reliable and provides efficient ocular anesthesia. It is associated with less complications than general anesthesia. Among regional blocks, peribulbar block is safer in comparison with retrobulbar block owing to lesser incidence of complications such as retrobulbar hemorrhage, globe perforation, and brain stem anesthesia, but it has some disadvantages such as incomplete orbital and eyelid akinesia and decrease time of analgesia in which the patient need pain relief postoperatively, so many adjuvant drugs have been added to local anesthetic to overcome these disadvantages. Dexmedetomidine is a central-acting drug, a highly selective α2-agonist, that has been used as an additive to local anesthetic, whereas the mechanism of action of ultra-low-dose naloxone includes inhibition of impulses of the excitatory opioid receptors and release of encephalin. The goal of this study was to assess the effect of ultra-low-dose naloxone and dexmedetomidine as adjuvants for local anesthetic on duration of analgesia as primary outcome and akinesia of the globe and eyelid and occurrence of complications as a secondary outcome. Patients and methods A total of 60 patients were included in this prospective randomized double-blind clinical study scheduled for elective cataract surgery, who were randomly divided into two groups: N group (n=30) received 3.5 ml of lidocaine 2%, 3.5 ml of bupivacaine 0.5% with 15 IU/ml hyaluronidase for both lidocaine and bupivacaine, and 100 ng naloxone in 1 ml normal saline. D group (n=30) received 3.5 ml of lidocaine 2%, 3.5 ml of bupivacaine 0.5% with 15 IU/ml hyaluronidase for both lidocaine and bupivacaine and 25 μg of dexmedetomidine in one-ml normal saline. The assessment includes duration of analgesia (h), which is the time from injection till visual analog scale of more than 4 or request of analgesia by the patient, akinesia of the globe and eyelid assessed every 2 min using a three-point scale, and occurrence of complications (pain during injection, chemosis, diplopia, bradycardia, and hypotension). Results A total of 60 cataract surgery patients were included in the study. Regarding primary outcome (duration of analgesia), we found a highly statistically significant difference in duration of analgesia, with longer duration of analgesia in N group of patients compared with D group (P Conclusion The addition of ultra-low-dose naloxone to local anesthetic in cataract surgery shows longer duration of analgesia.

Efficacy of intrathecal midazolam in potentiating the analgesic effect of intrathecal fentanyl in patients undergoing lower limb surgery.

Introduction:The intrathecal administration of combination of drugs has a synergistic effect on the subarachnoid block characteristics. This study was designed to study the efficacy of intrathecal midazolam in potentiating the analgesic duration of fentanyl along with prolonged sensorimotor blockade.Materials and Methods:In a double-blind study design, 75 adult patients were randomly divided into three groups: Group B, 3 ml of 0.5% hyperbaric bupivacaine; Group BF, 3 ml of 0.5% hyperbaric bupivacaine + 25 mcg of fentanyl; and Group BFM, 3 ml of 0.5% hyperbaric bupivacaine + 25 mcg of fentanyl + 1 mg of midazolam. Postoperative analgesia was assessed using visual analog scale scores and onset and duration of sensory and the motor blockade was recorded.Results:Mean duration of analgesia in Group B was 211.60 ± 16.12 min, in Group BF 420.80 ± 32.39 min and in Group BFM, it was 470.68 ± 37.51 min. There was statistically significant difference in duration of analgesia between Group B and BF (P = 0.000), between Group B and BFM (P = 0.000), and between Group BF and BFM (P = 0.000). Both the onset and duration of sensory and motor blockade was significantly prolonged in BFM group.Conclusion:Intrathecal midazolam potentiates the effect of intrathecal fentanyl in terms of prolonged duration of analgesia and prolonged motor and sensory block without any significant hemodynamic compromise.

Duration of analgesia is similar when 15, 20, 25 and 30 mL of ropivacaine 0.5% are administered via a femoral catheter

This dose-response study was designed to determine the most appropriate dose of ropivacaine 0.5% injected via an indwelling femoral catheter for perioperative peripheral analgesia for total knee replacement (TKR). 84 patients were allocated randomly to four groups and received, via a femoral catheter, either 15, 20, 25 or 30 mL of ropivacaine 0.5% in a double-blind fashion. An anterior sciatic block with 20 mL bupivacaine 0.5% was also performed. The evolution of sensory block of femoral, obturator and lateral femoral cutaneous nerves and motor block of femoral nerve were tested every five minutes during the first 30 min. The percentage of patients with complete sensory block of both femoral and obturator nerves determined success rate. General anesthesia was then induced. After surgery, patient-controlled analgesia (PCA) with ropivacaine 0.2% was available via the femoral catheter. The interval between the initial injection and the first PCA administration determined duration of action. The duration of action was not different between the four solutions tested i.e., 534 +/- 379 min for 15 mL, 799 +/- 364 min for 20 mL, 624 +/- 342 min for 25 mL and 644 +/- 266 min for 30 mL. The percentage of patients with complete sensory femoral and obturator blocks was, respectively, 60%, 95%, 85% and 70% for 15, 20, 25 and 30 mL (P = 0.008/15 mL vs 20 mL). Although there is no difference in duration of analgesia, because of better sensory spread, 20 mL of ropivacaine 0.5% appears to be the most appropriate dose for peripheral analgesia after TKR.

A Comparison of Median Effective Doses of Intrathecal Levobupivacaine and Ropivacaine for Labor Analgesia

The study was designed to determine and compare the median effective doses (MEDs) of intrathecal ropivacaine with levobupivacaine for labor analgesia. In this double-blind study, 100 parturients in early labor were randomized to receive either intrathecal ropivacaine or levobupivacaine. For each drug, the patients were assigned to receive one of the five doses studied, namely 1, 1.5, 2, 2.5, or 3 mg. Effective analgesia was defined as a pain score (0-100 visual analog scale) of less than 10 within 15 min of injection, lasting for 45 min or more after the induction of analgesia. MEDs were derived from probit analysis. The duration of analgesia rendered by the two drugs at 2.5 and 3 mg was also compared. The MED for levobupivacaine was 1.07 mg (95% confidence interval, 0.88-1.25 mg), and the MED for ropivacaine was 1.40 mg (95% confidence interval, 1.20-1.61 mg). Levobupivacaine was found to be 1.31 (95% confidence interval, 1.04-2.01) times more potent than ropivacaine. At doses of 2.5 mg or greater, there was no significant difference in duration of analgesia between levobupivacaine (median, 63.5 min; range, 46-123 min) and ropivacaine (median, 59.0 min; range, 47-93 min; P = 0.18). We detected no difference in the incidence of hypotension, nausea and vomiting, motor block, or abnormal fetal heart tracing between the two drugs. The MED of intrathecal ropivacaine for labor analgesia was significantly greater than levobupivacaine experimentally, but this significance was reduced when the comparison was based on molar potency. There was no difference in the duration of analgesia or adverse effects between the two drugs at higher doses (2.5 mg or greater).

Caudal additives for postoperative pain management in children: S(+)‐ketamine and neostigmine

The aim of the present pilot study was to compare the analgesic efficacy of S(+)-ketamine either alone or in combination with neostigmine for caudal blockade in pediatric surgery. A total of 40 children were randomly assigned to receive after induction of general anesthesia either caudal S(+)-ketamine 1 mg.kg(-1) (group K, n = 20) or caudal S (+)-ketamine 0.5 mg.kg(-1) plus neostigmine 10 microg.kg(-1) (group KN, n = 20). Anesthesia was maintained with sevoflurane and a laryngeal mask airway (LMA), no additional analgesics were administered. Postoperative pain and sedation were assessed by the Children's Hospital of Eastern Ontario Pain Score and Ramsay scale for 24 h. No statistical difference in duration of analgesia and sedation was found. Mean duration of postoperative analgesia was 18 +/- 9.4 h in group K and 21.8 +/- 6.7 h in group KN. There was a significantly higher incidence of postoperative vomiting after administration of caudal ketamine with neostigmine (30% group KN Vs 0% group K; P < 0.05). This pilot study demonstrates equianalgesic effects on postoperative pain relief in children with both caudal S(+)-ketamine 1 mg.kg(-1) and caudal S(+)-ketamine 0.5 mg.kg(-1) plus neostigmine 10 microg.kg(-1). Further studies are required to confirm adoption of caudal neostigmine into routine clinical practice.

DETERMINATION OF DOSE RESPONSE FOR INTRATHECAL ROPIVACINE IN LABORING PARTURIENTS

S268 INTRODUCTION: Using the combined spinal epidural (CSE) technique, intrathecal injections of low doses of local anesthetics and/or opioids are being increasingly used for labor analgesia. Ropivacaine, a newly introduced amide local anesthetic, has been shown to be minimally cardiotoxic and results in less motor block than the traditional bupivacaine, [1,2] when used epidurally. Intrathecal ropivacaine has been recently used for general surgery [3] and labor analgesia. [4] The purpose of this study was to determine the ideal intrathecal dose of ropivacaine which would provide adequate labor analgesia with minimal or no motor blockade, and without adversely affecting the mother, fetus, or progress of labor. METHODS: Following institutional approval and written informed consent, twenty healthy, term parturients aged 15-35 years who requested analgesia for labor, participated in the study. All parturients received pulmonary aspiration prophylaxis and 200 cc bolus of lactated Ringer's solution intravenously. The parturients were randomized into five groups in a double blinded manner: Group A - fentanyl 15 mcg (n = 4), Group B - ropivacaine (ropi) 0.5 mg + fentanyl 15 mcg (n = 3), Group C - ropi 1.0 mg + fentanyl 15mcg (n = 6), Group D - ropi 1.5 mg + fentanyl 15mcg (n = 4), Group E - ropi 2.0 mg + fentanyl 15mcg (n = 3). Using the needle through needle technique {Tuohy 17 gauge and Whitacre 27 gauge (11.9cm)}, all parturients received fentanyl 15 mcg intrathecally (with or without ropivacaine), followed by epidural catheter insertion. The epidural block was maintained with ropivacaine 0.1 % and fentanyl 2 mcg/ml infusion after patient's request for further analgesia. Visual analog pain scores (VAS) were assessed before and after the intrathecal dose, and epidural block. Sensory and motor blockade were assessed by pinprick and modified Bromage scale, respectively. Hemodynamic parameters, onset and duration of analgesia, duration of first and second stages of labor, and neonatal Apgar scores were recorded. Parturients were assessed twenty-four hours postpartum for satisfaction with analgesia, and for side effects. RESULTS: There were no demographic differences in the five study groups. All subjects had satisfactory analgesia at 5 minutes after the block. The mean duration of analgesia with intrathecal fentanyl was 80 +/- 10.8 minutes, while in combination with ropivacaine, it was 151.93 +/- 34.45 minutes (p = 0.001), which is statistically significant according to the independent sample T-test. One way ANOVA on the five treatment groups showed significant difference in duration of analgesia across groups (p = 0.001), while multiple comparison analysis determined a significant difference between groups A and C (p = 0.004). The mean duration of the first and second stages of labor were 458.10 +/- 169.77 minutes (p = 0.614) and 35.35 +/- 8.76 minutes (p = 0.328), respectively, with no significant difference across groups. Average time interval between intrathecal injection and delivery was 302.75 +/- 130.61 minutes. Neither the VAS pain scores at 1 and 5 min (p = 0.107, 0.835) nor the changes in VAS pain scores at 1 and 5 min (p = 0.349, 0.883) were significantly different across groups. Fisher's exact test showed no significant difference in motor blockade (detectable weakness of hip flexion) between fentanyl and fentanyl/ropivacaine groups (p = 0.587). Sensory blockade to pin prick was not discernible in 50% of subjects. No significant differences in hemodynamic parameters, umbilical cord gases, or neonatal Apgar scores were noted between the five groups. Two parturients {group C, n=1, group E, n=1} required cesarean section for failure at progression of labor. All patients were satisfied with labor analgesia. None of the parturients experienced postpartum headache, neurological problems, or urinary retention. CONCLUSION: In this ongoing study, our findings suggest that intrathecal ropivacaine (0.5 to 2.0 mg) with fentanyl 15 mcg provides instantaneous analgesia for laboring parturients, without compromising maternal or fetal safety. Our preliminary data, statistically and clinically, suggests that the combination of fentanyl and low dose ropivacaine prolongs the duration of labor analgesia. The addition of ropivacaine does not produce any motor block and may allow ambulation. We recommend the use of low dose ropivacaine and fentanyl 15 mcg intrathecally in the combined spinal epidural technique for labor analgesia.

Comparison of intrathecal and epidural diamorphine for elective caesarean section using a combined spinal-epidural technique

To assess calculated equivalent doses of intrathecal and epidural opioids for elective Caesarean section in terms of quality and duration of analgesia, and incidence of side effects, we have compared 50 patients, allocated randomly to one of two groups to receive either diamorphine 0.25 mg intrathecally (group 1) or 5 mg epidurally (group 2), in addition to intrathecal bupivacaine 10 mg, using a combined spinal-epidural technique. There was no significant difference in duration of analgesia between groups (group 1 mean 14.6 (SD 5.9) h, group 2 14.2 (6.5) h; mean difference 0.8 h; 95% Cl -2.8-4.5; P = 0.65) or quality of analgesia (VAPS and VRS scores). The degree of pruritus was similar in both groups (80-88%) but the incidence of postoperative nausea and vomiting was significantly higher in the epidural group (24% vs 4%; P < 0.05). Intrathecal diamorphine 0.25 mg produced the same duration and quality of postoperative analgesia as epidural diamorphine 5 mg for elective Caesarean section but with significantly less nausea and vomiting.

Duration of analgesia following application of eutectic mixture of local anaesthetics (EMLA) on genital mucosa.

The topical anaesthetic formulation EMLA cream (eutectic mixture of local anaesthetics) is increasingly used prior to minor painful procedures performed on genital mucosa. The aim of the present study was to gain knowledge about the correlation between duration of application of EMLA and duration of analgesia. Three different application times--5, 10 and 20 min--were investigated in 12 healthy young women. Pin-prick pain thresholds to argon laser stimulation were measured before and after application of EMLA. Repeated measurements were performed until normal sensitivity returned. No significant difference in duration of analgesia was seen between the three application times. However, 10 min application time tended to produce the longest mean duration of analgesia (22.2 min). Surprisingly, a large inter-individual variation in duration of analgesia was seen. Thus, after 10 min application time the shortest duration of sufficient analgesia was 5 min, while the longest was 46 min. On the basis of this work, it seems advisable to start minor surgery on genital mucosa after about 10 min application time, and it is recommended to bear in mind that the duration of analgesia varies and may be very short in some patients.

Intradural morphine and diamorphine. Dose response studies.

This open study of 81 patients having major orthopaedic surgery reviews the duration of analgesia and side-effects of 0.625, 1.25 or 2.5 mg of morphine or 1.25 or 2.5 mg of diamorphine given intradurally in combination with 7.5 mg of cinchocaine at induction of anaesthesia. A significant dose-response relationship for duration of analgesia measured by time to first requirement of postoperative analgesic was found with morphine; 1.25 and 2.5 mg of morphine produced analgesia of longer duration than 0.625 mg. No such dose-response was found for side-effects. There was no significant difference in duration of analgesia between diamorphine 1.25 and 2.5 mg, and the duration was similar to that seen with the higher doses of morphine. An intradural dose of between 0.625 mg and 1.25 mg of either morphine or diamorphine used with cinchocaine and without additional parenteral opiate, may be appropriate.