Duration Of Sensory Analgesia Research Articles

Intrathecal Fentanyl to Bupivacaine Intensify Sensory and Motor Block without Prolonging Recovery Time for Urosurgeries

Introduction: Spinal anesthesia is the most commonly used technique for lower abdominal surgeries postoperative pain control is a major problem because spinal anesthesia using only local anesthetics is associated with relatively short duration of action, and thus early analgesic intervention is needed in the postoperative period. Short acting spinal anaesthesia may help to prevent complications associated with delayed immobilization. Objective: To examine whether adding intrathecal Fentanyl to bupivacaine intensify sensory and motor block without prolonging recovery time for urosurgeries. Materials and Methods: A prospective observational study was contact at dept. of Anaesthesia, Shaheed Tajuddin Ahmad Medical College Hospital, Gazipur, Bangladesh from March to August 2021. Seventy five (75) patients included in our study. American Society of Anaesthesiologists physical status I and II scheduled for elective urological procedures were studied in a double-blinded, randomized prospective manner. Random allocation was done as, Group A (n=25) receiving intrathecal bupivacaine 12.5 mg; Group B (n=25) bupivacaine 10 mg with 25 μg of fentanyl; and Group C (n=25), bupivacaine 5 mg with 25 μg of fentanyl. Assessment of sensory, motor block and duration of sensory analgesia was done. Results: In our study the demographic data were comparable in all the three groups. The time for two segment regression was statistically significant between all three groups (p<0.001). The mean time for two segment regressions for group A was 104.8 minutes whereas for group B mean time was 161.8 min and for group C mean time was 80.37 minutes. It was longest for group B and shortest for group C. The total duration of motor block was compared among the three groups after initiation of the SAB. There was statistically significant difference regarding total duration of motor block, time for two segment regression and duration of sensory analgesia between each pair of groups. The duration of motor

Characteristics of Block and Post-Operative Analgesia of Low Dose Intrathecal Fentanyl and Midazolam Combined With Hyperbaric 0.5% Bupivacaine in Patients Undergoing Lower Limb Orthopaedic Surgeries

Aim: To investigate characteristics of block and post-operative analgesia of low dose intrathecal Fentanyl and Midazolam combined with hyperbaric 0.5% bupivacaine in patients undergoing lower limb orthopaedic surgeries. Material and method: Selected consented 60 patients scheduled for orthopaedic surgeries under subarachnoid blockade were randomized into two comparable equal groups of 30 patients each i.e. Group A(Sub arachnoid block with addition of 25 μg (0.5 ml available preservative free) fentanyl to 3ml of 0.5% Bupivacaine hydrochloride (hyperbaric) and Group B: (Sub arachnoid block with addition of 1 mg (0.2 ml preservative free) midazolam (+ 0.3 ml normal saline) to 3ml of 0.5% Bupivacaine hydrochloride (hyperbaric).The motor block of the lower extremities was evaluated bilaterally by modified Bromage scale (0-3). Duration of sensory analgesia was taken from onset of spinal anesthesia to time of administration of first rescue analgesic, reflected on visual analogue scale (VAS). Results: The mean time required to achieve Complete Sensory blockade was 142.77±8.73 sec in patients of Group A and 138.57±7.65 sec in patients of Group B.Sedation score was recorded every 30 min for 90 mins (using Ramsay sedation score) considering the time of study drug given as zero in both groups.The mean sedation score at 30 mins in patients of Group A was 2.10±0.31 and in patients of Group B it was 2.27±0.45. Conclusion: It can be concluded that intrathecal midazolam can be used as an adjuvant to local anesthetics if fentanyl is not available or contraindicated.

Clinical evaluation of intravenous dexmedetomidine and intravenous midazolam for hysterectomy under subarachnoid blockade with 0.5% hyperbaric bupivacaine

Background The excellence of subarachnoid blockade (SAB) can be improved with a variety of adjuvants, used either intrathecally or intravenously. Objective The present study aimed to compare the clinical efficacy of intravenous dexmedetomidine with midazolam for hysterectomy under SAB with 0.5% hyperbaric bupivacaine. Materials and methods After approval, 90 adult consenting middle-aged female patients of American Society of Anesthesiologists (ASA) physical status I and II scheduled for hysterectomy under SAB were blindly randomized into three groups of 30 patients each, to receive either intravenous dexmedetomidine 0.5 μg/kg (group I) or intravenous midazolam 0.05 mg/kg (group II) or normal saline (group III), 20 min after the SAB. Patients were assessed for the onset and duration of sensory and motor blockade, maximum cephalic spread, and intraoperative hemodynamic changes as primary endpoints. The study also evaluated the sedation level and visual analogue scale score for postoperative pain as secondary outcome. Results Patients in the dexmedetomidine group showed a higher cephalic level of sensory blockade. Time for two dermatomes’ sensory regression (144.33±19.2 min) and duration of sensory analgesia (270.10±16.6 min) in the dexmedetomidine group was extended, with a statistically highly significant difference among the groups and no hemodynamic variability. Ramsay sedation score was higher in the dexmedetomidine and midazolam groups than in the saline group. Respiratory depression was not observed in any patient. The incidence of postspinal shivering was low in patients of the dexmedetomidine group. Conclusion Midazolam provided only sedation, whereas dexmedetomidine extended the duration of sensory analgesia of SAB, maintained hemodynamic stability, and also provided arousable sedation without respiratory depression.

Dexmedetomidine versus fentanyl as adjuvant to epidural 0.5% levobupivacaine for transurethral prostate resection in elderly patients: a comparative evaluation

Background Regional anesthesia is the technique of choice for patients undergoing transurethral resection of the prostate (TURP), but anesthetic management of elderly patients is challenging due to compromised organ function. The present study aimed to evaluate the relative efficacy and safety of dexmedetomidine versus fentanyl in the enhancement of the quality and duration of epidural anesthesia with 0.5% levobupivacaine and hemodynamic stability during TURP in elderly patients. Patients and methods Sixty elderly consented patients were randomized into two equal groups of 30 patients each in a double-blind manner. They were given 15 ml of 0.5% levobupivacaine (75 mg) either with 1 ml (50 μg) dexmedetomidine (group LD) or with 1 ml (50 μg) fentanyl (group LF) using an epidural catheter. The primary endpoints were the onset and duration of sensory and motor blockade, duration of sensory analgesia, hemodynamic variability, respiratory adequacy, and any adverse effect. Results Demographic data were comparable in both groups. Onset of sensory and motor blockade was faster in patients of group LD than in patients of group LF, with a statistically significant difference ( P P Conclusion Dexmedetomidine as an adjuvant to epidural levobupivacaine for TURP has shortened onset time of anesthesia and prolonged duration of sensory analgesia. The surgical field vision was improved due to reduced bleeding.

Comparison of intrathecal bupivacaine with or without fentanyl for urosurgeries

Introduction: Spinal anaesthesia has been widely used for urological operations because it permits early recognition of symptoms caused by overhydration, transurethral resection of prostate syndrome and bladder perforation. Short acting spinal anaesthesia may help to prevent complications associated with delayed immobilization. Our study was undertaken to examine whether adding 25?g fentanyl to bupivacaine would intensify sensory and motor block without prolonging recovery time.Materials and Methods: Ninety American Society of Anaesthesiologists physical status I and II scheduled for elective urological procedures were studied in a double-blinded, randomized prospective manner. Random allocation was done as , Group I (n=30) receiving intrathecal bupivacaine 12.5 mg; Group II (n=30) bupivacaine 10 mg with 25 ?g of fentanyl; and Group III (n=30), bupivacaine 5 mg with 25 ?g of fentanyl. Assessment of sensory, motor block and duration of sensory analgesia was done.Result: There was statistically significant difference regarding total duration of motor block, time for two-segment regression and duration of sensory analgesia between each pair of groups. The duration of motor block, time for two segment regression and duration of sensory analgesia was found to be longest in Group II and shortest in Group III. There were no significant differences in the incidence of complications.Conclusion: Addition of 25 ?g fentanyl to 5 mg bupivacaine resulted in short-acting motor block whereas with 10 mg of bupivacaine, it increased the intensity and duration of motor block, prolonged sensory analgesia and two segment regression time.Journal of Society of Anesthesiologists 2014 1(1): 18-21

Comparison of epidural butorphanol and fentanyl as adjuvants in the lower abdominal surgery: A randomized clinical study.

Background:Epidural opioids acting through the spinal cord receptors improve the quality and duration of analgesia along with dose-sparing effect with the local anesthetics. The present study compared the efficacy and safety profile of epidurally administered butorphanol and fentanyl combined with bupivacaine (B).Materials and Methods:A total of 75 adult patients of either sex of American Society of Anesthesiologist physical status I and II, aged 20-60 years, undergoing lower abdominal under epidural anesthesia were enrolled into the study. Patients were randomly divided into three groups of 25 each: B, bupivacaine and butorphanol (BB) and bupivacaine + fentanyl (BF). B (0.5%) 20 ml was administered epidurally in all the three groups with the addition of 1 mg butorphanol in BB group and 100 μg fentanyl in the BF group. The hemodynamic parameters as well as various block characteristics including onset, completion, level and duration of sensory analgesia as well as onset, completion and regression of motor block were observed and compared. Adverse events and post-operative visual analgesia scale scores were also noted and compared. Data was analyzed using ANOVA with post-hoc significance, Chi-square test and Fisher's exact test. Value of P < 0.05 was considered significant and P < 0.001 as highly significant.Results:The demographic profile of patients was comparable in all the three groups. Onset and completion of sensory analgesia was earliest in BF group, followed by BB and B group. The duration of analgesia was significantly prolonged in BB group followed by BF as compared with group B. Addition of butorphanol and fentanyl to B had no effect on the time of onset, completion and regression of motor block. No serious cardio-respiratory side effects were observed in any group.Conclusions:Butorphanol and fentanyl as epidural adjuvants are equally safe and provide comparable stable hemodynamics, early onset and establishment of sensory anesthesia. Butorphanol provides a significantly prolonged post-operative analgesia.

Neuraxial opioids in geriatrics: A dose reduction study of local anesthetic with addition of sufentanil in lower limb surgery for elderly patients

Background and Objectives:Neuraxial anesthesia in the elderly is associated with exaggerated responses to conventional doses of local anesthetics, thereby increasing the incidence of hemodynamic complications. A double-blind prospective study was carried out in our institute with an aim to compare the hemodynamic stability and quality of the conventional dose of hyperbaric bupivacaine (LA) with low dose of LA and sufentanil in elderly patients scheduled for lower limb surgery, randomized to receive combined spinal epidural anesthesia.Methods:A total of 50 elderly patients of ASA grade I and II, divided randomly into groups I and II, of either sex undergoing lower limb surgery under combined spinal epidural anesthesia at our institute attached to a Government Medical College were enrolled for study. Group I received 2.5 ml of intrathecal hyperbaric bupivacaine (LA), while group II received 1.5 ml of intrathecal LA+0.1 ml sufentanil (5 μg). Both initial and postoperative subarachnoid block characteristics, hemodynamic and respiratory parameters, duration of analgesia, and side effects were observed and recorded. Statistical analysis was carried out using Chi-square and paired t test.Results:Demographic profile was comparable in both groups. Group I had a greater incidence of hypotension and, consequently, higher use of vasopressors (P<0.05). Onset of sensory analgesia, time to achieve peak sensory level, and recovery from motor blockade were significantly earlier in group II (P<0.05). Postoperative consumption of LA through epidural route was significantly higher in group I (P<0.05). The side effect profile was similar, except for a significantly higher incidence of shivering in group I (P<0.05).Conclusions:The study established that the dose of a local anesthetic can be safely and significantly lowered by 40%, with addition of low-dose sufentanil, thereby avoiding the hemodynamic fluctuation and providing a stable perioperative and postoperative period in the geriatric population. In addition, duration of sensory analgesia is prolonged and postoperative requirement for the epidural top-up also decreases.

Isobaric Ropivacaine 5 mg/mL for Spinal Anesthesia in Children

In this clinical trial, we evaluated the clinical effects of ropivacaine for spinal anesthesia in children. An open, prospective study was performed on 93 children, aged 1-17 yr, undergoing elective lower abdominal or lower limb surgery. A plain solution of ropivacaine 5 mg/mL at a dose of 0.5 mg/kg body weight (up to 20 mg) was administered via the L3-4 or L4-5 interspace with the patient in the lateral decubitus position. After injection, the patients were placed supine. The spread and duration of sensory analgesia and the degree of motor block were recorded. Satisfactory surgical anesthesia was achieved in 92 of the 93 children. Three children received general anesthesia; in one child spinal anesthesia failed, and in two cases surgery outlasted the duration of the sensory block. Four children received supplemental analgesia for skin incision. The mean highest level of sensory block was T6 (range, T2 to T12), and the mean time to the regression of sensory block to T10 was 96 min (range, 34-210 min). One child developed transient bradycardia and one hypotension. After discharge four children developed mild transient radiating neurologic symptoms and one epidural blood patch was performed for persistent position-dependent headache. We conclude that the block performance of intrathecal isobaric ropivacaine in children (>1 yr) is similar to that obtained in adults but the safety of the larger dose used in children warrants further studies.

Prolonged local anesthetic effect of bupivacaine liposomes in rats

The purpose of the present study was to develop a sustained release local anesthetic formulation that would localize the local anesthetic drug at target sites and produce a prolonged sensory block by a single usual dose. Bupivacaine aqueous solution was encapsulated in multilamellar vesicles (MLV) of liposomes by mechanical shaking method. Wister rats (240±30 g body weight) were given an injection of 0.2 ml liposomal bupivacaine (5 mg/ml), bupivacaine solution (5 mg/ml) or blank liposome. The duration of sensory analgesia was quantified using the tail flick test, and compared among the three preparations. Blank liposomes did not show any sensory block action. The duration of sensory block and the antinociceptive index (AI) in the rats treated with liposomal bupivacaine were 447±19.6 min and 54±5%, respectively, and that in the rats treated with bupivacaine solution was 87±6.7 min and 30±8%, respectively. Liposomal bupivacaine significantly ( p<0.01) prolonged the duration and enhanced the intensity of local anesthesia as compared with bupivacaine solution. The results suggest that liposomes are candidates for the formulation of ultra-long lasting local anesthetics with enhanced effect in a single normal dose.

Spinal anaesthesia with 0.25% hyperbaric bupivacaine for Caesarean section: effects of volume

To investigate the safety and efficacy of 0.25% hyperbaric bupivacaine for spinal anaesthesia in Caesarean section, we studied 60 parturients allocated randomly to one of three groups. According to the patient's height, groups 1, 2 and 3 received 3.2-3.6 ml (8-9 mg), 3.6-4.0 ml (9-10 mg) and 4.0-4.4 ml (10-11 mg) of 0.25% bupivacaine in 5% glucose, respectively. Subarachnoid injection was performed in the right lateral decubitus position, and parturients were then turned immediately supine with left uterine displacement. Mean spread of sensory analgesia was significantly higher in group 3 (T2-3) than in groups 1 and 2 (T4-5 in each group). Duration of sensory analgesia was significantly longer in groups 2 and 3 than in group 1. Complete motor block of the lower extremities occurred in all patients but in only one in group 1. Onset time and duration of motor block were not significantly different between the three groups. The incidence of hypotension was significantly higher in group 3 (75%) than in groups 1 and 2 (40% in each group). The efficacy of intraoperative analgesia was significantly greater in groups 2 and 3 than in group 1. The incidence of patients requiring analgesics during operation was significantly lower in groups 2 (25%) and 3 (10%) than in group 1 (70%). There was no difference in neonatal condition between the three groups. Spinal anaesthesia with 3.6-4.0 ml of 0.25% bupivacaine in 5% glucose was satisfactory for Caesarean section.

UNPREDICTABILITY OF REGRESSION OF ANALGESIA DURING THE CONTINUOUS POSTOPERATIVE EXTRADURAL INFUSION OF BUPIVACAINE

Twenty-four otherwise healthy patients scheduled for elective major abdominal surgery received general anaesthesia plus lumbar extradural analgesia. A loading dose of 0.5% plain bupivacaine was given to produce sensory analgesia (pin prick) from T4 to S5 and followed by a continuous infusion of 0.5% plain bupivacaine 8 ml h-1. Pain, scored on a 5-point scale, and sensory analgesia were assessed hourly for 16 h after skin incision. If sensory analgesia decreased by more than 5 segments from its preoperative level, or if the pain score reached 2 (moderate pain), the patients were removed from the study, and pain was treated otherwise. Only three patients maintained their initial levels of sensory analgesia and a pain score of less than 2. In the remaining patients sensory analgesia decreased at least 5 segments or pain score reached 2 between 4 and 16 h after skin incision. We found a weak correlation between increasing age and the duration of sensory analgesia (r = 0.46, P less than 0.05), but no significant correlations between duration of sensory analgesia and sex, weight, height, body surface area, serum albumin concentration, duration or site of operation.

Prolongation of Lidocaine Spinal Anesthesia with Phenylephrine

The effect of added phenylephrine on the duration of sensory analgesia during lidocaine spinal anesthesia was determined in 65 ASA class I-III patients randomly divided into three groups. Group 1 (n = 25) received 62.5 mg lidocaine in 7.5% glucose; group 2 (n = 21) received lidocaine with 2 mg phenylephrine; and group 3 (n = 19) received lidocaine with 5 mg phenylephrine. The level of analgesia to pin prick was assessed by an anesthesiologist unaware of the drug combination used. The mean +/- SD cephalad level of analgesia did not differ among the groups. In group 1, the times for two- and for four-segment regression of the level of analgesia, and the time for regression of analgesia to the T-12 dermatome, were 77 +/- 19 (1 SD), 99 +/- 24, and 109 +/- 26 min, respectively. The corresponding values were 98 +/- 25, 118 +/- 27, and 130 +/- 36 min in group 2 and 124 +/- 32, 142 +/- 31, and 162 +/- 35 min in group 3. All the regression times in group 2 were significantly longer than those in group 1 (P less than 0.05). All the regression times in group 3 were significantly longer than those in group 2 (P less than 0.02). It is concluded that clinically useful prolongation of sensory analgesia may be obtained by addition of phenylephrine to lidocaine during spinal anesthesia.

SPINAL ANAESTHESIA WITH 0.75% BUPIVACAINE AND 0.5% AMETHOCAINE IN 5% GLUCOSE

Three millititre of 0.75% plain bupivacaine and 0.5% amethocaine 3 ml in 5% glucose were used for spinal anaesthesia and compared in a double-blind study of 20 patients undergoing urological surgery. The onset time to maximum cephalad spread of sensory analgesia was approximately 45 min for bupivacaine and approximately 30 min in the amethocaine group (ns). The mean maximum spread of sensory analgesia was similar for both agents: T6-7 180 min after injection, although the cephalad spread of sensory analgesia with bupivacaine persisted for longer at a significantly higher level than that of amethocaine. Duration of sensory analgesia was significantly longer in the bupivacaine group from S3 to S5 and from T12 to L2 levels. Onset time to complete motor blockade of the lower limbs was similar for both agents. Nine of 10 bupivacaine patients and seven of the 10 patients receiving amethocaine had complete motor blockade of the lower limbs. Duration of motor blockade was significantly longer for all degrees in the bupivacaine group.