Duration Of Complete Analgesia Research Articles

COMPARISON OF BUPIVACAINE VERSUS BUPIVACAINE WITH FENTANYL INTRATHECALLY IN CESAREAN SECTION

Objectives: The objectives of the study were to evaluate the efficacy and safety of fentanyl with hyperbaric bupivacaine in spinal anesthesia for caesarean section. Methods: This prospective observational study was conducted in anesthesia department of tertiary care teaching hospital of Gujarat. Group A was given 2.0 ml of 0.5% hyperbaric bupivacaine with 0.25 ml of normal saline and Group B received 2.0 ml of 0.5% hyperbaric bupivacaine with 0.25 ml of injection fentanyl (12.5 μg). Characteristics of sensory blockade, motor blockade, analgesia, APGAR score, surgical variables, hemodynamic parameters, and complications were noted and compared in both the groups. Results: There was no significant difference in onset of sensory block in both groups (p>0.05) but there was statistically significant difference present regarding duration of regression of sensory blockade (p<0.05). Time of motor onset and time to get Grade 0 from Grade 3 block were comparable in both groups (p>0.05). Duration of complete analgesia and duration of effective analgesia were significantly prolonged in Group B as compared to Group A (p<0.001). There was also no statistically significant difference observed in mean pulse rate, systolic blood pressure and diastolic blood pressure, and mean arterial pressure in both the groups during entire period of time (p>0.05). Conclusions: The present study concluded that intrathecal fentanyl 12.5 μg with bupivacaine produce prolonged sensory block as well as post-operative analgesia compared to bupivacaine alone for cesarean section with insignificant hemodynamic changes without affecting neonatal outcome.

Clinical Comparison of Epidural Clonidine and Verapamil with Ropivacaine in Abdominal Hysterectomy; A Prospective, Randomized, Controlled Study.

Background: Adjuvants, when combined with local anaesthetics, increase duration of block, improve quality of blockade and accelerate onset of block. The aim of this study is to assess the analgesic properties and postoperative analgesia of Clonidine and verapamil in the epidural block for abdominal hysterectomy.Subjects and Methods:Ninety patients were divided into three groups Group l- patient were given ropivacaine (0.75%) in the dose of 20 ml, Group II -0.75% ropivacaine 20 ml with verapamil in the dose of 2.5 ml, Group III -0.75% ropivacaine 20 ml with Clonidine in the dose of 1mcg/kg body weight. Patients were assessed for onset, degree, level, duration of sensory and motor block, duration of complete analgesia and postoperative analgesia, rescue analgesic requirement, sedation score and adverse effects.Results:When groups I and II were compared, onset of sensory and motor block was found to be statistically insignificant (p>0.05), while it was early in group III in comparison to groups I and II and statistically significant ( p<0.05). The duration of sensory block in group III was more in comparison to groups I and II and were statistically significant ( p<0.05). The mean duration of analgesia in group I was 184.03 + 5.20 mins, in group II was 300.46 + 5.80 mins and in groups, III was 538 + 12.80 mins.Conclusion:Verapamil does not enhance the onset, duration of the sensory and motor block, though Clonidine in the dose of 1ug/kg enhances the onset of sensory block. The duration of postoperative analgesia with verapamil was more and much higher compared to Clonidine.

Analgesic and sedative effects of caudal epidural tramadol in dromedary camels

This study aimed to investigate the analgesic efficacy of caudal epidural administration of tramadol in dromedary camels (Camelus dromedarius). A total of 10 dromedary camels of both sexes were selected and randomly assigned to one of two groups to receive epidurally either 1 mg/kg or 2 mg/kg of tramadol hydrochloride. The injections were made into the epidural space at first intercoccygeal junction. Using a pinprick method, analgesia was tested. Duration and onset of complete perineal analgesia were determined. Ataxia and sedation were also assessed and recorded. Clinical parameters including heart rate, respiratory rate and rectal temperature were measured. The lower dose (1 mg/kg) of tramadol induced analgesia only in the tail but the higher dose produced complete antinociception in the tail, anus and perineum. Analgesia of the hind limbs was not achieved after either doses of tramadol. The mean times to onset and duration of complete analgesia in camels receiving epidural tramadol at a dose of 2 mg/kg were 22±2.55 min and 65±8.66 min, respectively. Various degrees of ataxia occurred in all camels. Mild to deep sedation was observed following both doses. Mean heart rate, respiratory rate, and rectal temperature tended to increase for the first 15 or 30 min after injection. Based on the results of this study, analgesic effects of caudal epidural tramadol were dose dependent. Epidural tramadol at a dose of 2 mg/kg would provide suitable postoperative analgesia for various manipulations in the tail, anus and perineum in standing dromedary camels.

A Comparative Study of Levobupivacaine and Levobupivacaine with Dexmeditomidine in USG Guided Axillary Block for Elbow, Forearm and Hand Surgeries

BACKGROUND AND OBJECTIVES: The present clinical study was conducted to evaluate the onset of analgesia, degree of sensory and motor blockade, duration of analgesia and complications between Levobupivacaine and Levobupivacaine with Dexmeditomidine in USG guided axillary brachial plexus block. METHODS: The study was conducted on 60 ASA 1 and 11 patients of either sex posted for various elective or emergency surgeries of the upper limb involving elbow, forearm and hand surgeries. The subjects were divided into two groups, group A receiving axillary brachial plexus block with 0.25% Levobupivacaine alone and group B receiving Levobupivacaine with Dexmeditomidine 0.5μg /kg. Patients’ vital parameters were monitored throughout the procedure and in the post-operative period for 48 hours. A thorough observation was made on onset, quality, duration of analgesia, degree of motor blockade and complications. RESULT: The onset of sensory blockade (mean difference 0.04 minutes, p-value <0.001) and motor blockade (mean difference 0.03 minutes, p-value <0.001) were quicker in group B compared to group A. Both these findings were statistically significant. Both the duration of sensory blockade (mean difference 4.7 hours, p value <0.001), and motor blockade (mean difference 1.8 hours, p value <0.001) were longer in group B compared to group A and both these findings were statistically significant. Time taken for starting of regression (mean difference -1.37 minutes, p-value <0.108) was more in group B compared to Group A, but this finding was not statistically different. All other parameters related to duration of anesthesia including time taken for full motor and sensory recovery were longer in Group B compared to Group A. These differences were statistically significant. There were statistically significant differences in the duration of complete analgesia, duration of effective analgesia and time of first pain medication between the study groups. All these parameters were longer in Group B compared to Group A. The average post anesthesia hemodynamic parameters like heart rate, systolic and diastolic pressures were higher in Group A compared to Group B. The difference in the heart rate and diastolic blood pressure were statistically significant. The post anaesthetic respiratory parameters were almost similar in both the study groups. INTERPRETATION AND CONCLUSION: In this prospective randomized double blinded case control study, Levobupivacaine with Dexmeditomidine seems to be advantageous over plain levobupivacaine in terms of onset, quality and intensity of sensory and motor blockade. The duration of analgesia is both clinically and statistically significantly prolonged in Levobupivacaine with Dexmeditomidine group.

Comparative study to assess the quality of analgesia of bupivacaine and bupivacaine with dexmedetomidine in ultrasound-guided pectoral nerve block type I and II in breast surgeries.

Background and Aims:Dexmedetomidine has been demonstrated to be safe and efficacious in prolonging the duration of peripheral nerve blocks. This study was designed to compare the duration, quality of postoperative analgesia, hemodynamic stability, and patient's satisfaction with addition of dexmedetomidine to bupivacaine versus plain bupivacaine in pectoral nerve block (Pecs) type I and II in breast surgeries.Material and Methods:This prospective randomized double-blind study was carried out in 60 American Society of Anesthesiologists grade I–III female patients, aged 18–70 years randomly allocated into two equal groups. Group A received 10 ml 0.25% bupivacaine for pecs I block and 20 ml 0.25% bupivacaine for pecs II block. Group B received 10 ml 0.25% bupivacaine with dexmedetomidine for pecs I block and 20 ml 0.25% bupivacaine with dexmedetomidine in pecs II block, keeping a total dose of dexmedetomidine of 1 μg/kg body weight and the volume constant in both the groups.Results:Numerical rating scores at rest and on abduction of arm were significantly lower in Group B. There was a 40% increase in duration of complete analgesia in dexmedetomidine group (1024.0 ± 124.9 min) compared to plain bupivacaine (726.4 ± 155.3 min; P < 0.001). Total consumption of injection diclofenac sodium in 24 h was 23% less in Group B (77.5 ± 13.6 mg) compared to Group A (100.0 ± 35.9 mg, P = 0.003). Patient satisfaction score was significantly better in dexmedetomidine group. No adverse effects were noted in either group.Conclusion:Dexmedetomidine as an adjunct to bupivacaine helps prolong the duration and improves the quality of postoperative analgesia in pecs I and II block without serious side effects.

Effect of lose doses ropivacaine and sufentanil in spinal anesthesia of women with severe preeclampsia for casarean delivey

Objective To evaluate whether low-dose ropivacaine in combination with sufentanil could produce effective spinal anaesthesia for severe preeclamptic parturients during cesarean section. Methods 40 severe preeclampsia parturients undergoing elective caesarean delivery under combined spinal-epidural anaesthesia were randomly divided into two groups based on a computer-generated grouping number sheet, each group in 20 cases.Group A received intrathecal ropivacaine 15mg (1.5mL)+ 10% dextrose 1mL with normal saline 0.5mL.Group B received intrathecal ropivacaine 10mg (1mL) + sufentanil 5μg(1mL) + 10% dextrose 1mL.Blood pressure, heart rate and oxygen saturation were documented at 2 min intervals for 10 min after local anaesthetic was administered.Sensory and motor block were assessed at 2.5 min intervals after spinal injection.The side effects such as hypotension, nausea and vomiting during surgery were recorded. Results The onset of motor block was longer[(4.8±2.1) min vs.(4.2±1.5) min, t=-2.83, P<0.01], and the duration was shorter[(75.9±25.2) min vs.(115.4±29.5)min, t=10.75, P<0.01] in group B than those in group A. The number of patients who had Bromage score 3 in group A was more than that in group B. Compared with group A, the duration of complete analgesia[(180±35) min vs.(120±27) min, t=15.48, P<0.001]and effective analgesia[(245±29)min vs.(184±34)min; t=16.21, P<0.001] increased in group B. More patients were sleepy but easily rousable in group B than in group A (9cases vs.0cases, χ2=8.53, P<0.01). The incidence rate of hypotension was significantly higher(45.0% vs.20.0%, χ2=4.29, P<0.05) in group A than that in group B. Compared with group A, the incidence rate of hypotension(45.0% vs.20.0%, χ2=4.29, P<0.05), vomiting(30.0% vs.5.0%, χ2=4.33, P<0.05) and shivering (50.0% vs.10.0%, χ2=7.62, P<0.01) were lower in group B. The incidence of pruritus was significantly higher in group B (χ2=10.16, P<0.01). Conclusion Hyperbaric ropivacaine 10 mg with sufentanil 5μg could produce effective spinal anaesthesia for severe preeclamptic parturients during cesarean section with less hypotension, vomiting and shivering, and longer lasting analgesia than hyperbaric ropivacaine 15 mg. Key words: Pre-eclampsia; Cesarean section; Ropivacaine; Sufentanil; Anaesthesia, spinal

Effectiveness of Intrathecal Morphine for Analgesia following Elective Caesarean Section

Aims: This study evaluates the effectiveness of usage of 0.2 mg intrathecal morphine as post-operative analgesia and its effect on activity of mother after elective cesarean section. Methods: This hospital based prospective, randomized, double-blinded and placebo controlled study was carried out at Nagarik Community Teaching Hospital, Bhaktapur between 2012 January to 2014 November after the approval was taken from the hospital authority and the written informed consent from the participating patients. Fifty women of ASA I or II physical status undergoing cesarean section under sub-arachnoid block was randomized into two groups – P group (placebo group, n = 25) and M group (Treatment group, n = 25). P Group received hyperbaric bupivacaine 2.3ml, 0.5% bupivacaine (11.5 mg) and M Group received morphine 0.2 ml (0.2 mg) plus bupivacaine 2.3ml, 0.5% (11.5 mg) intrathecally. All subjects received 8 mg ondansetron intravenously 30 minutes before surgery to prevent possible drug-induced pruritus and post-operative nausea and vomiting. 1000 mg rectal acetaminophen suppository was given at the end of the surgery. Pain, nausea and pruritus during the first 24 hours using visual analog scale were recorded by a trained nurse or attending doctor who was not involved in the study. Results: Duration of complete analgesia and the time to request for additional analgesics was longer in M Group than in P Group. Similarly, the active movement is earlier in M Group than in P Group. There were no significant differences in adverse effects between the groups. Conclusions: Addition of morphine 0.2 mg to heavy bupivacaine intrathecally reduced post-operative pain and analgesic requirements without any significant difference in adverse effects.

Comparison of bupivacaine, xylazine and buprenorphine with ketamine combination for spinal analgesia in buffalo calves

Aim: The study was undertaken to compare the clinical efficacy of lumbosacral spinal analgesia produced using bupivacaine, xylazine and buprenorphine with ketamine combination in buffalo calves Materials and Methods: 36 male buffalo calves of seven to eight months of age and weighing 60 to 75 kg were used to evaluate the efficacy and safety of lumbosacral spinal analgesia produced by bupivacaine 0.25mg/kg, xylazine 0.05 mg/kg and buprenorphine 20 µg/kg in combination with ketamine 2.5mg/ kg and divided into groups A, B and C, respectively with 12 animals in each group. Results: The onset of analgesia in animals of group A (bupivacaine + ketamine) was 3.0±0.3 min, group B (xylazine + ketamine) was recorded as 2.6±0.4 min and group C (buprenorphine + ketamine) 4.0±0.4 min. Ketamine-bupivacaine in animals of group A produced complete analgesia of almost all the dermatomes for varying lengths of time. So also the group B except that it produced only moderate analgesia of thorax, abdomen and flank. Animals of group C produced only mild analgesia of thorax, abdomen and flank and moderate analgesia of digits , perineum, inguinal, himd limbs and tail region. The longest (>180 min.) duration of complete analgesia was recorded in animals of group A. The heart rate and respiration rate significantly decreased in group A and B than group C, so also the rectal temperature. Sedation recorded was maximum in group B fallowed by group A and least sedation scores were given by group C animals. Similiarly the scores of motor incordination was higher in group B and group A than group C. Conclusion: It was concluded that the combinations viz. Bupivacaine+ Ketamine and Xylazine + ketamine when given intraspinally at the lumbosacral space have similar analgesic potency on spinal administration in buffaloes. The synergism is more pronounced in xylazine-ketamine combination,whereas Buprenorphine +ketamine combination in the above said dose is a poor analgesic agent when used intraspinally at the lumbosacral space in buffalo calves.

Intrathecal sufentanil (1.5 µg) added to hyperbaric bupivacaine (0.5%) for elective cesarean section provides adequate analgesia without need for pruritus therapy

We compared the effects of different doses of intrathecal sufentanil when administered together with hyperbaric bupivacaine for elective caesarean section. This was a prospective, randomized, double-blind, controlled trial involving 100 pregnant women, American Society of Anesthesiologists (ASA) I-II, who were scheduled for elective caesarean section under spinal anesthesia. The patients were assigned to four groups according to the dose of sufentanil used: no sufentanil (group I; placebo) or 1.5, 2.5, or 5.0 microg sufentanil (groups 2-4, respectively). In every group, the local anesthetic used was hyperbaric bupivacaine 0.5% (12.5 mg), and the total volume of the solution was 3.5 ml. The duration of complete analgesia, maternal side effects, and maternal/fetal outcomes were recorded. The duration of complete analgesia was defined as the time from intrathecal injection to a vernal analogue score (VAS) of more than 0. No patient experienced intraoperative pain. The duration of complete analgesia was prolonged in all groups receiving opioids. The duration of the analgesia and the 0- to 6-h intravenous analgesic requirements were similar in the sufentanil groups. Moreover, the sufentanil groups had longer durations of complete analgesia than the placebo group. Pruritus was more frequent in the 2.5- and 5-microg sufentanil groups than in the 1.5-microg sufentanil and placebo groups. There were no differences among the groups in umbilical cord blood gases on in neonatal Apgar scores. The addition of sufentanil 1.5 and 2.5 microg to hyperbaric bupivacaine provided adequate anesthesia for caesarean delivery and good postoperative analgesia. In addition, the incidence of pruritus was significantly lower in the 1.5-microg sufentanil group when compared with that in the 2.5- and 5-microg groups.

Intrathecal fentanyl as adjunct to hyperbaric bupivacaine in spinal anesthesia for caesarean section.

To compare the effect of adding fentanyl to intrathecal bupivacaine on the onset, duration and quality of spinal anesthesia and its effect of mother and neonate. Single blind randomized controlled clinical trial. Department of Anesthesiology, Surgical Intensive Care Unit and Pain Management, Dow University of Health Sciences and Civil Hospital, Karachi, from January 2003 to June 2004. Sixty young adult females, ASA physical status I and II, with singleton pregnancy undergoing elective or emergency cesarean section under spinal anesthesia were randomly allocated to receive spinal anesthesia either by using 0.75% hyperbaric bupivacaine 1.5 ml with 0.25 ml normal saline or 0.75% hyperbaric bupivacaine 1.5 ml with 0.25 ml fentanyl (12.5 microg). Blood pressure, heart rate, respiratory rate, oxygen saturation, sensory level, motor block, pain score and side effects were observed every 2 minutes for first 20 minutes, then at-5 minute interval throughout the surgery, thereafter at 30 minutes interval until the patient complained of pain. Comparing the bupivacaine group, time to achieve highest sensory level was significantly shorter in fentanyl group (*p < 0.05), while the duration of complete analgesia (time from injection to first report of pain) lasted significantly more longer in fentanyl group (184+/-20 minutes) than bupivacaine group (126+/-10 minutes). Duration of effective analgesia was also significantly more prolonged in fentanyl group (p < 0.05). There was no significant difference in the incidence of side effects between the two groups. Addition of fentanyl to intrathecal bupivacaine results in faster onset with improved peri-operative anesthesia without increasing the side effects.

Medetomidine with Ketamine and Bupivacaine for Epidural Analgesia in Buffaloes

The efficacy of ketamine and bupivacaine in enhancing the epidural analgesia induced by medetomidine was evaluated in 10 buffalo calves utilized repeatedly after a gap of 10 days so that each drug combination was tested in 4 randomly selected animals. In group A, medetomidine (15 microg/kg), in group B ketamine (2.0 mg/kg), in group C bupivacaine (0.125 mg/kg), in group D medetomidine and ketamine (15 microg/kg and 2.0 mg/kg), and in group E medetomidine and bupivacaine (15 microg/kg and 0.125 mg/kg) was administered epidurally. Onset of analgesia was significantly earlier in animals of groups B and D compared to the animals of groups A, C and E. Medetomidine alone or in combination with ketamine/bupivacaine produced complete analgesia of the tail, perineum, inguinal region and upper parts of hind limbs. Ketamine produced a very short duration of complete analgesia at the tail and perineum. Bupivacaine alone produced only mild to moderate analgesia. Both ketamine and bupivacaine prolonged the duration of analgesia. Motor incoordination was mild to moderate in animals of all the groups, but animals remained standing throughout the period of observation. Animals of groups A, D and E showed mild to moderate sedation during the observation period. Ruminal movements decreased nonsignificantly in animals of groups A and E. Mild salivation was observed in animals of all the groups except group C. Significant decrease in heart rate (HR) was recorded after epidural administration of medetomidine or bupivacaine; however, ketamine caused short duration of tachycardia. The administration of ketamine with medetomidine caused lesser decrease in HR compared to medetomidine alone or in combination with bupivacaine. Significant fall in respiratory rate (RR) was recorded after epidural administration of medetomidine or bupivacaine alone, but an increase in RR was recorded after ketamine administration. The fall in RR was less pronounced in animals in which medetomidine was used with ketamine compared to the animals in which medetomidine was used alone or in combination with bupivacaine. Mean arterial pressure (MAP) decreased and central venous pressure (CVP) increased significantly after epidural administration of medetomidine in combination with ketamine or bupivacaine. The ECG changes included tall T wave, QS pattern, RS pattern and ST elevation and heart blocks at different intervals, which were more frequent and pronounced in animals given bupivacaine with medetomidine. It can be concluded that epidural administration of medetomidine can produce complete analgesia of the tail, perineum, inguinal region and upper hind limbs in buffaloes. However, significant depression of cardiovascular parameters was recorded. Administration of ketamine along with medetomidine resulted in significantly early onset and slightly longer duration of analgesia with lesser cardiopulmonary side-effects compared to medetomidine alone or medetomidine with bupivacaine. Addition of ketamine to medetomidine thus seems to be useful for producing epidural analgesia; however, addition of bupivacaine failed to provide any advantage over medetomidine alone.

Efficacy of Intrathecal Morphine for Analgesia Following Elective Cesarean Section: comparison with Previous Delivery

To determine the effect of intrathecal injection of morphine 0.2 mg on postoperative analgesia, activity and satisfaction after elective cesarean section. Forty-five parturients who had previously undergone cesarean section with spinal anesthesia without intrathecal morphine were enrolled in this randomized, double-blinded study. Group 1 received hyperbaric bupivacaine 10 mg intrathecally (IT) and group 2 received morphine 0.2 mg IT in addition to hyperbaric bupivacaine 10 mg IT. All subjects received 20 mg piroxicam rectally at the end of surgery and 18 hours after surgery. Side effects in the first 24 hours after delivery were recorded by a trained nurse. Pain, nausea, pruritus, and satisfaction during the first 24 hours were self-rated using a visual analog scale. Subjects also recorded their memories of these symptoms after their previous cesarean sections. The time to first request for additional analgesics (30 mg pentazocine intramuscularly), total dose of pentazocine within 24 hours postoperatively and nurse observations of walking status within 24 hours postoperatively were also recorded. In the present cesarean sections, the duration of complete analgesia and the time to first request for additional analgesics were longer in group 2 than in group 1. Group 2 had higher satisfaction scores than group 1 in spite of their more severe pruritus and nausea during the first 24 hours after surgery. The percentage of patients who could not walk during the first 24 hours after cesarean section was higher in group 1 than in group 2. The addition of morphine 0.2 mg to hyperbaric bupivacaine 0.5% by intrathecal injection reduced postoperative pain and analgesic use, and increased patient satisfaction following cesarean section. The combination of intrathecal injection of morphine and preventive NSAIDs can be easily administered in most hospitals, and is substantially less expensive than the new pain management technologies currently in use.

Intrathecal fentanyl added to hyperbaric ropivacaine for cesarean delivery

Background and Objectives: Hyperbaric ropivacaine produces adequate spinal anesthesia for cesarean delivery. Addition of opioid to local anesthetics improves spinal anesthesia. We assessed the effect of fentanyl added to hyperbaric ropivacaine for spinal anesthesia for cesarean delivery. Methods: Fifty-nine healthy, full-term parturients scheduled for elective cesarean delivery under spinal anesthesia were randomly assigned in a double-blind fashion to receive either fentanyl 10 μg or normal saline 0.2 mL added to 0.5% hyperbaric ropivacaine 18 mg. Characteristics of spinal block, intraoperative quality of spinal anesthesia, side effects, complete analgesia (time to first feeling of pain), and effective analgesia (time to first request of analgesics) were assessed. Results: Duration of sensory block was prolonged in the fentanyl group (P < .05). Duration of motor block was similar in both groups. The quality of intraoperative analgesia was better in the fentanyl group (P < .05). Incidence of side effects did not differ between groups. Duration of complete analgesia (143.2 ± 34.2 minutes v 101.4 ± 21.4 minutes; P < .001) and effective analgesia (207.2 ± 32.2 minutes v 136.3 ± 14.1 minutes; P < .001) were prolonged in the fentanyl group. Conclusions: Adding fentanyl 10 μg to hyperbaric ropivacaine 18 mg for spinal anesthesia for cesarean delivery improves intraoperative anesthesia and increases the analgesia in the early postoperative period. Reg Anesth Pain Med 2002;27:600-603.

A Comparison of Analgesic Effects and Side Effects of Intrathecal Morphine, Nalbuphine and a Morphine-Nalbuphine Mixture for Pain Relief during a Cesarean Section

Background: The purpose of this study was to find additional effects of intrathecal nalbuphine 1 mg to morphine 0.1 mg for pain relief during a cesarean section. Methods: Sixty healthy patients at full term who were scheduled for an elective cesarean delivery with spinal anesthesia were enrolled in the study. They received 0.5% bupivacaine 10 mg with either morphine 0.1 mg (group M), or nalbuphine 1 mg (group N), or morphine 0.1 mg + nalbuphine 1 mg (group M + N). Analgesic effects were evaluated by a verbal rating scale on the duration of complete analgesia (time from the intrathecal injection to the first pain report), effective analgesia (time from the intrathecal injection to the first analgesic request), and cumulative doses of additional analgesics. Hemodynamic changes and adverse effects were also observed. Results: The duration of complete analgesia increased significantly in group M, compared with group N and group M + N. Effective analgesia was longer in group M and group M + N, compared with group N. The incidence of pruritus was significantly lower in group N, compared with group M and M + N. The incidence of nausea and vomiting was the same among all groups. Conclusions: We concluded that intrathecal addition of nalbuphine 1mg to morphine 0.1 mg during spinal anesthesia for a cesarean delivery reinforced intraoperaitive analgesia compared with intrathecal morphine 0.1 mg. However, it reduced the duration of complete analgesia and had no effect on the incidence of pruritus.

Intrathecal labor analgesia with bupivacaine and sufentanil: The effect of adding 2.25 μg epinephrine

Background and Objectives: Epinephrine, 25 μg and 200 μg, has been found to prolong the duration of intrathecal labor analgesia when added to an opioid. In our hospital we use the standard epidural mixture, prepared by the pharmacist, containing epinephrine 1:800,000; i.e., 1.25 μg/mL for both spinal and epidural labor analgesia. We wanted to evaluate whether such a low dose, depending on its effect on duration or quality of analgesia, should be maintained or deleted in future mixtures. Methods: Forty-five term parturients were randomly assigned to receive 1.8 mL intrathecally of a mixture containing bupivacaine 0.125% and sufentanil 0.75 μg/mL with or without epinephrine 1.25 μg/mL. The quality and duration of analgesia, side effects, and obstetric/neonatal outcome were compared. Results: For both combinations, the onset until the first painless contraction was between 5 and 6 minutes. Most patients were pain free during the second uterine contraction. The duration of complete analgesia was 93.2 ± 24.2 minutes in the epinephrine group and 79.3 ± 18.1 minutes for patients not receiving epinephrine ( P = .014). The quality of the block, bupivacaine consumption, side effects, and obstetric/neonatal outcome were not different between groups. Conclusions: It was concluded that epinephrine in a dose as low as 2.25 μg significantly prolonged the duration of intrathecal analgesia of bupivacaine-sufentanil by 15 minutes. No other differences were noticed. Diluting the commercially available bupivacaine 0.5% with epinephrine 1:200,000 may avoid the need of freshly prepared epinephrine solutions. Reg Anesth Pain Med 2001;26:473-477.

Evaluation of the analgesic effects of epidurally administered morphine, alfentanil, butorphanol, tramadol, and U50488H in horses.

To evaluate and compare effects of epidurally administered morphine, alfentanil, butorphanol, tramadol, and U50488H on avoidance threshold to noxious electrical stimulation over the dermatomes of the perineal, sacral, lumbar, and thoracic regions in horses. 5 healthy adult horses. Using a Latin square complete repeated-measures design, horses were randomly assigned to receive 1 of 6 treatments (morphine, alfentanil, butorphanol, tramadol, U50488H, or sterile water) at intervals of at least 7 days. Agents were injected epidurally at the first intercoccygeal epidural space, and electrical stimulation was applied at repeated intervals for 24 hours to the dermatomes of the perineal, sacral, lumbar, and thoracic regions. Avoidance threshold to electrical stimulation was recorded. Administration of butorphanol, U50488H, and sterile water did not induce change in avoidance threshold. Alfentanil increased avoidance threshold during the first 4 hours, but not significantly. Tramadol and morphine significantly increased threshold and analgesic effects. Complete analgesia (avoidance threshold, >40 V) in the perineal and sacral areas was achieved 30 minutes after tramadol injection, compared with 6 hours after morphine injection. Duration of complete analgesia was 4 hours and 5 hours after tramadol and morphine injections, respectively. Epidural administration of tramadol and morphine induces long-lasting analgesia in healthy adult horses. Epidural administration of opioids may provide long-lasting analgesia in horses without excitation of the CNS.

Alpha(2)-adrenergic agonists for regional anesthesia. A clinical review of clonidine (1984-1995).

alpha(2)-adrenergic agonists for regional anesthesia. A clinical review of clonidine (1984-1995).

Caudal epidural morphine for control of pain following open heart surgery in children

The safety and efficacy of epidural morphine injected into the caudal space for control of postoperative pain following open cardiac surgery in children was studied. Thirty-two children between the ages of 2-12 yr for whom early postoperative tracheal extubation was anticipated were randomly assigned to control and study groups. Study subjects received a caudal injection of preservative free morphine sulfate (0.075 mg/kg) in preservative-free normal saline (5-10 ml) following completion of surgery, but prior to awakening and extubation of the trachea. Supplemental intravenous morphine administration and pain scores were recorded for 24 h. Patients in the study group received significantly less (P less than 0.03) morphine (0.32 mg.kg-1.24 h-1) and had significantly lower pain scores than did patients in the control group (0.71 mg.kg-1.24 h-1). The mean duration of complete analgesia in patients receiving caudally administered morphine was 6 h (range 2-12), but decreased analgesic requirements were noted for the entire 24 h. No respiratory depression was evident by clinical variables or repeated arterial blood gas values. Nausea without vomiting occurred in 4/16 patients in the study group. No patient described pruritus. The authors were unable to evaluate the occurrence of urinary retention because all patients had indwelling urinary catheters. They found caudal epidural morphine to be safe and effective in the treatment of postoperative pain in children following open heart surgery.