Duration Of Sensory Anesthesia Research Articles

Effect of Fentanyl as an Adjuvant to Brachial Plexus Block for Upper Extremity Surgeries: A Systematic Review and Meta-Analysis of RCTs.

Objective To assess if the addition of fentanyl to brachial plexus block has an impact on anesthetic outcomes and complication rates in patients undergoing upper extremity surgeries. Methods We explore the PubMed, Embase, ScienceDirect, CENTRAL, and Google Scholar databases for all randomized controlled trials (RCTs) comparing adjuvant fentanyl with placebo/no drug for patients undergoing upper extremity surgery under brachial plexus block. Outcomes assessed were onset, duration of sensory and motor anesthesia, complications, and postoperative analgesia scores. Meta-analysis was conducted utilizing a random-effects model. The risk of bias was assessed using the Cochrane Collaboration's risk of bias assessment tool 2. Certainty of evidence was assessed using GRADE. Subgroup analysis was conducted depending upon the approach of brachial plexus block and type of local anesthetic. Results Twelve RCTs with 660 patients were included. Addition of fentanyl had no effect on onset of sensory anesthesia (11 studies; MD: 0.48; 95% CI: −1.81, 0.85; I2 = 96%; p=0.48) but significantly shortened onset of motor anesthesia (8 studies; MD: −2.36; 95% CI: −3.99, −0.74; I2 = 96%; p=0.48). Duration of sensory anesthesia (9 studies; MD: 82.81; 95% CI: 41.81, 123.81; I2 = 99%; p < 0.0001) and motor anesthesia (7 studies; MD: 93.41; 95% CI: 42.35, 144.46; I2 = 99%; p=0.0003) was significantly increased with addition of fentanyl. The certainty of evidence-based on GRADE was deemed to be moderate for both onset and duration of anesthesia. The incidence of overall complications (nausea/vomiting and pruritis) was significantly higher in the fentanyl group (7 studies; OR: 2.14; 95% CI: 1.04, 4.40; I2 = 8%; p=0.04) but with low certainty of evidence. Conclusions Adjuvant fentanyl with brachial plexus block improves the onset of motor anesthesia but not sensory anesthesia. The duration of both sensory and motor anesthesia is significantly prolonged with fentanyl by around 83–93 minutes. However, clinicians should be aware that complications such as nausea/vomiting and pruritis are increased twofold with the addition of the drug. Current evidence is limited risk of bias in the RCTs and high heterogeneity in the meta-analyses.

Epidural Clonidine as an Adjuvant to Local Anesthetic in Lower Abdominal and Lower Limb Surgeries: A Randomised Controlled Study

Background: Acute pain leads to adverse physiological and psychological disturbances. Hence, this study was done to evaluate and compare the onset and duration of sensory anesthesia, motor paralysis and duration of analgesia using 0.5% plain bupivacaine, with clonidine (2μg/kg) in patients posted for lower abdominal and lower limb surgeries under epidural anaesthesia. Materials and methods: 62 Patients posted for elective lower abdominal, gynaecological and lower limb surgeries under epidural anesthesia, aged 18 to 60 years, height more than 150 cms of ASA physical status 1 or 2 were included. All patients were randomized into two groups of 31 individuals each. Results: Clonidine in the dose of 2μg/kg added to bupivacaine injected into epidural space significantly prolonged the duration of analgesia when compared to bupivacaine alone. No effect on the onset of sensory and motor blockade was observed. However, it increases the duration of motor blockade. Clonidine also has effect on sedation level, pulse rate and mean arterial blood pressure. Conclusion: Clonidine causes increased sedation; fall in pulse rate and mean arterial blood pressure, which however, did not require active intervention in this study.

Effect of clonidine added to lidocaine for sub-Tenon’s (episcleral) anesthesia in cataract surgery

We aimed to evaluate the duration of anesthesia, analgesia and ocular akinesia of clonidine added to lidocaine in sub-Tenon's anesthesia in patients undergoing cataract surgery. Forty patients were prospectively enrolled. They were randomized to two sub-Tenon's anesthesia groups: group L (6 ml of lidocaine 2 %, 1 ml of 0.9 % saline and 25 UI/ml of hyaluronidase), and group C (6 ml lidocaine 2 %, clonidine 1 μg/kg, 1 ml of 0.9 % saline and 25 UI/ml of hyaluronidase). Duration of sensory anesthesia, ocular akinesia in all directions, akinesia of the levator palpebrae superioris and orbicularis oculi muscles, the duration of analgesia (time to the first postoperative use of analgesics), the overall use of analgesics and the presence of adverse effects were recorded . The duration of sensory anesthesia and akinesia of the four rectus, levator palpebrae superioris, and orbicularis oculi muscles was significantly longer in group C (p < 0.05). The number of patients who required analgesics was similar between the groups but the duration of analgesia was longer in group C (p < 0.05). No significant adverse effects were observed. The addition of clonidine 1 μg/kg to 2 % lidocaine in sub-Tenon's anesthesia for cataract surgery increased the duration of sensory anesthesia, ocular akinesia, and the duration of analgesia.

Intrathecal Ropivacaine for Ambulatory Surgery: A Comparison Between Intrathecal Bupivacaine and Intrathecal Ropivacaine for Knee Arthroscopy

GAUTIER, PH. E.; DE KOCK, M.; VAN STEENBERGE, A.; POTH, N.; LAHAYE-GOFFART, B.; FANARD, L.; HODY, J. L. Author Information

Spinal anesthesia with meperidine as the sole agent for cesarean delivery.

Meperidine is an opioid with local anesthetic properties that produces spinal anesthesia after subarachnoid injection for surgical procedures. The aim of this study was to evaluate the clinical relevance of spinal meperidine for cesarean delivery. Twenty-eight ASA I-III parturients scheduled for cesarean delivery were included in the study. Meperidine 1 mg/kg was administered subarachnoid. Patients were monitored for appropriate anesthesia and side effects. Cesarean delivery was successfully performed under spinal meperidine in 22 cases: two cases required general anesthesia before incision and the duration of sensory anesthesia was too short in four cases. Side effects included moderate hypotension (decrease in arterial blood pressure > 30 mm Hg in 36% of the cases), nausea (32%), and pruritus (10.7%). No respiratory depression was documented in mothers and newborns. Although short-acting, meperidine can be used as a substitute for local anesthetics for cesarean delivery, especially when local anesthetics are not available.

Warming 0.5% Bupivacaine to 37 ?? C Increases Duration of Spinal Anesthesia

The effect of warming glucose-free 0.5% bupivacaine to 37°C before injection for spinal anesthesia was studied in 20 patients having total knee replacement. Twenty additional patients having spinal anesthesia for the same procedure were given glucose-free 0.5% bupivacaine at room temperature (approximately 20°C). Onset, maximum cephalad spread, quality of sensory anesthesia, and duration and degree of motor blockade were the same in both groups. However, the duration of sensory anesthesia was significantly prolonged in patients who received bupivacaine at 37°C. The mechanism by which warming bupivacaine prolongs the duration of sensory spinal anesthesia is uncertain. However, a decrease in the dissociation constant (pKa) of bupivacaine owing to increasing the temperature to 37°C may account for some of this effect.

Tourniquet Pain During Spinal Anesthesia

The incidence of tourniquet pain was evaluated in 40 patients having orthopedic surgery of the lower extremities during spinal anesthesia using 15 mg of a plain solution of either 0.5% tetracaine or 0.5% bupivacaine. The drugs were administered in a randomized fashion, and measurement of the levels of sensory anesthesia to pinprick and motor blockade as well as the occurrence of tourniquet pain were made by an independent blinded observer. The onset and maximum cephalad spread of sensory anesthesia and the onset and degree of motor block were similar in both groups of patients. However, the duration of sensory anesthesia was significantly longer in patients in whom tetracaine was used. The incidence of tourniquet pain was significantly greater in patients given tetracaine (60%) than in patients given bupivacaine (25%). The occurrence of tourniquet pain was not related to the level of sensory anesthesia, because patients in the tetracaine group had a higher level of sensory anesthesia (mean T6) than did patients in the bupivacaine group (mean T10) at the onset of tourniquet pain. It is speculated that during spinal anesthesia both A and C fibers (mediating fast and slow pain, respectively) are initially equally inhibited. However, as the concentration of local anesthetic in the cerebrospinal fluid declines, C fibers may become unblocked earlier with tetracaine than A fibers, resulting in tourniquet pain in the presence of an otherwise satisfactory spinal anesthetic.

SERUM LIDOCAINE LEVELS FOLLOWING SPINAL ANESTHESIA WITH LIDOCAINE AND LIDOCAINE AND EPINEPHRINE IN DOGS

Arterial lidocaine concentrations and the duration of motor anesthesia following the subarachnoid injection of 30 or 40 mg of lidocaine with or without epinephrine 0.3 mg were measured in 10 sedated dogs. As the dogs were sedated with ketamine, the duration of sensory anesthesia was not evaluated. Each dog served as its own control with alternating treatments at a 7-day interval. The maximum arterial lidocaine concentration occurred 15 minutes after subarachnoid injection and was not different (p > 0.05) with lidocaine (820 ng/ml) or lidocaine-epinephrine (990 ng/ml). However, the mean duration of motor anesthesia was prolonged 46 percent ( p

Bupivacaine Compared with Etidocaine for Vaginal Delivery

A comparison of 0.5 percent etidocaine with 0.25 and 0.5 percent bupivacaine, using continuous (intermittent) caudal block in 60 vaginal deliveries, showed the latter two solutions to be the agents of choice. All solutions contained a final concentration of 1:2000,000 epihephrine. In 40 parturients given either 0.25 or 0.5 percent bupivacaine, all had pain relief after the initial dose, while 5 of 20 given etidocaine required a refill dose within 30 to 50 minutes for complete pain relief. The duration of action of the initial dose with both concentrations of bupivacaine was longer than that of etidocaine. The degree of motor blockade with 0.5 percent etidocaine was greater than with 0.5 percent bupivacaine, and with 0.5 percent concentrations of either etidocaine or bupivacaine was greater than with 0.25 percent bupivacaine. The duration of motor blockade of 0.5 percent etidocaine and bupivacaine was comparable. The duration of motor blockade of the 0.25 percent concentration of bupivacaine was shorter than with the 0.5 percent concentration of both etidocaine and bupivacaine; and with both bupivacaine concentrations the duration of sensory anesthesia in the extremities was longer than motor blockade; with etidocaine, the opposite occurred.

A Double-Blind Study of Bupivacaine and Etidocaine For Epidural (Peridural) Block

In a double-blind comparison of two long-acting local anesthetic agents, 0.75 percent bupivacaine and 1 percent etidocaine, using epidural block for abdominal hysterectomy, no significant differences occurred in: (1) onset of sensory anesthesia, (2) time for establishment of maximum sensory anesthesia, (3) maximum dermatome level of sensory anesthesia, (4) relaxation of the abdominal musculature, or (5) degree of motor blockade of the extremities. However, the following significant differences between the two agents were noted: (1) satisfactory anesthesia occurred in 24 of 25 patients with 0.75 percent bupivacaine and in only 12 of 25 patients with 1 percent etidocaine; (2) motor anesthesia of the extremities occurred more rapidly with etidocaine; (3) duration of motor anesthesia of the extremities, time for regression of sensory anesthesia, and duration of sensory anesthesia were markedly longer with bupivacaine; and (4) the time from injection of local anesthetic solution into the epidural space until the patient requested a narcotic for pain in the operative site was also longer with bupivacaine.

Role of Epinephrine in Regional Block Anesthesia With Etidocaine

Fifty healthy females scheduled for abdominal hysterectomy were administered 1 percent etidocaine (20 ml.) for lumbar epidural block anesthesia. Use of a plain solution or a solution containing 1:200,000 epinephrine was pre-selected randomly and administered in a double-blind fashion. Measurements of onset and duration of sensory anesthesia did not vary significantly between the two groups. Motor anesthesia did have a faster onset in patients receiving solutions containing epinephrine but the duration or quality of motor anesthesia did not vary significantly. An additional five patients were given bilateral intercostal nerve block anesthesia with plain solutions of 0.5 percent etidocaine (60 ml.) for clinical comparison with previously studied patients who received similar blocks with solutions containing epinephrine. No apparent clinically significant difference was noted. Plasma levels of etidocaine were measured for both techniques. Although the plain solutions produced higher blood levels than the epinephrine containing solutions for both techniques, they were not significantly different. The conclusion of this study is that the addition of 1:200,000 epinephrine to solutions of etidocaine for lumbar epidural and intercostal nerve block may provide some protection against systemic toxicity but has little if any benefit on the clinical effects of the drug.