Effects Of Intrathecal Bupivacaine Research Articles

A Comparative Study on the Effect of Intrathecal Bupivacaine vs. Ropivacaine on Maternal and Neonatal Outcomes After Cesarean Section: A Systematic Review and Meta-analysis.

The type of anesthesia in cesarean section can affect the mother and baby. This study aimed to determine the comparative effect of intrathecal hyperbaric bupivacaine vs. hyperbaric ropivacaine on maternal and neonatal outcomes after cesarean section. PubMed, Web of Science, Embase, Google Scholar, IranDoc, MagIran, and Scopus databases were searched from 1 September 2022 to 1 November 2022. Eighteen clinical trials with 1542 patients were included in the analysis. There was no statistically significant difference in hypotension, bradycardia, and Apgar score between the 2 groups (P > 0.05). The risk of nausea (relative risk (RR), 1.526; 95% CI, 1.175 - 1.981; P = 0.001) and vomiting (RR, 1.542; 95% CI, 1.048 - 2.268; P = 0.02) caused by bupivacaine was 0.53% and 0.54% higher than that of ropivacaine. The incidence of shivering (RR, 2.24; 95% CI, 1.480 - 3.39; P = 0.00) was 2.24 times higher in the bupivacaine group than in the ropivacaine group. The average onset time of sensory block (standardized mean difference (SMD), -0.550; 95% CI, -1.054 to -0.045; P = 0.032) and motor block (SMD, -0.812; 95% CI, -1.254 to -0.371; P = 0.000) was significantly lower in the bupivacaine group than in the ropivacaine group. Despite the fact that ropivacaine and bupivacaine are effective in cesarean section, ropivacaine is more favorable because of less hemodynamic changes, less duration of sensory and motor block, and fewer side effects, which are effective in patient recovery.

Effects of Intrathecal Bupivacaine and Bupivacaine Plus Fentanyl in Elderly Patients Undergoing Total Hip Arthroplasty.

To determine and compare the clinical efficacy of spinal anesthesia with bupivacaine combined with fentanyl and bupivacaine alone in geriatric patients scheduled for total hip arthroplasty (THA). Experimental study. Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China, from April 2016 to April 2017. Sixty-five geriatric patients were randomised into two groups. Group B was anesthetised with 0.5% bupivacaine 10 mg and Group F with 0.5% bupivacaine 7.5 mg plus fentanyl 20 μg. Hemodynamic stability, effect and satisfaction of anesthesia, time to the first postoperative analgesic requirement, adverse effects, and incidence of postoperative indwelling catheter were compared. There was no significant difference in time to reach maximum sensory block level, maximum sensory block level, maximum motor block, duration of motor block, quality of anesthesia, adverse effects or the incidence of postoperative indwelling catheter between the two groups. However, Group F required less dosage of ephedrine for stable hemodynamics and longer time to use the primary postoperative analgesic in comparison to Group B (p<0.05). Adding 20 μg fentanyl to a lower dose of 7.5 mg bupivacaine can provide safe and effective spinal anesthesia for THA in geriatric patients.

Effect of intrathecal bupivacaine on sensor motor function and on expression of cysteinyl aspartate specific protease-9 in dorsal root ganglion in pregnant rats

Objective To investigate the effect of intrathecal bupivacaine on sensor motor function and on expression of caspase-9 and caspase-8 in dorsal root ganglion in pregnant or nonpregnant rats.Methods Eighteen female SD rats weighting 200 g220 g and eighteen late pregnant rats weighting 350 g-400 g were used in this study.All the pregnant rats in which PE-10 catheter were successfully placed without complication were divided into 3 groups randomly(n=6):normal pregnant control group (group PN),2％ bupivacaine group (group P2B) and 4％ bupivacaine group (group P4B).All the nonpregnant rats in which PE-10 catheter were successfully placed without complication were divided into 3 groups randomly(n=6),normal nonpregnant-control group (group N),2％ bupivacaine group (group 2B) and 4％ bupivacaine group(group 4B).The rats of group PN and group N received normal saline 30 μl intrathecal.The rats of group P2B and group 2B received 2％ bupivacaine 30 μl intrathecal.The rats of group P4B and group 4B received 4％ bupivacaine 30 μl intrathecal Tail-flick test and motor function were performed at 10,20,30 min,1,2,4 h,1,2,3 d and 4 d after intrathecal administration.TF latencies were converted to the percent of maximal possible effect (MPE).Four days later,the animals were sacrificed and the dorsal root ganglion were removed for determination of mRNA using reverse transcriptive polymerase chain reaction (RT-PCR).Results MPE were different among the groups according timepoints after intrathecal.Among in different groups have ainteraction.MPE in group P2B and P4B were significantly higher compared with those in group 2B and 4B after intrathecal 2,4 h and 1 d.MF scores were significantly different after intrathecal 10 min-4 h in rats,group 2B,4B,P2B and P4B motor block time was longer than group N and PN.Rats in group 2B,4B,P2B and P4B showed significantly increase the expression of caspase-9 mRNA in dorsal root ganglion compared with those in group N and PN.Conclusions Intrathecal injection of the same concentration and dosage of bupivacaine,pregnant rats sensory,motor nerve block lasted significantly longer than nonpregnant rats.The result indicated that the sensitivity of bupivacaine increased in pregnancy rats.Bupivacaine showed significantly increase the expression of caspase-9 mRNA in dorsal root ganglion cells. Key words: Bupivacaine ; Pregnancy; Neurotoxicity; Cysteinyl aspartate specific protease-9 ; Apoptosis

Combination of Intrathecal Opioids with Bupivacaine Attenuates Opioid Dose Escalation in Chronic Noncancer Pain Patients

The purpose of this study was to examine the effect of intrathecal (IT) coadministration of bupivacaine with opioids during the initial phase of opioid titration and up to 1 year after implantation of an IT drug delivery system (IDDS). The study was designed as a retrospective study. OUTCOMES ANALYZED: The outcomes analyzed for this study were pain relief, oral opioid consumption, IT opioid, and bupivacaine dosage. METHODS AND PATIENT POPULATION: The patient population for this study were consecutively implanted patients over a period of 6 years in a tertiary single center with multiple practitioners. In this retrospective study, 126 consecutive noncancer intractable pain patients were implanted with IDDS and initiated with an IT opioid (O) as a single medication or an IT opioid and bupivacaine (O + B). Pain intensity, amount of oral opioids, dose, rate, and concentration of IT opioids and bupivacaine, and number and type of IT medication used were recorded at preimplant, implant, and at 3, 6, and 12 months postimplant. The intervention used for the study was the IT delivery device implant. Significant reduction in pain intensity was observed in both groups at 12 months postimplant (O group: baseline 7.42 ± 2.1 to 5.85 ± 2.8 [n = 72, P < 0.001]; O + B group 7.35 ± 2 to 5.03 ± 2.4 (n = 54; P < 0.001]). The combination of opioids with bupivacaine from the start of IT infusion treatment resulted in a reduced progression of opioid dose escalation in comparison to patients started with opioids (O group). The rate of increase of IT opioids in the O group at 12 months was 535 ± 180%, whereas in the O + B, the dose increase was significantly lower at 185 ± 85% (P < 0.004). In both groups, there was a statistically significant decrease in oral opioid consumption compared with preimplant doses. Concomitant initial coadministration of IT bupivacaine with opioids blunts the rate of IT opioid dose escalation during the first year after implant of an IDDS. More studies are necessary to thoroughly examine IT opioid dose escalation and the effects of addition of bupivacaine to IT opioids. Blunting IT opioid dose escalation may be a beneficial long-term effect of IT bupivacaine.

The Effect of Intrathecal Bupivacaine Plus Sufentanil on Intraoperative Hemodynamics During Elective Coronary Artery Bypass Surgery

Introduction: Intrathecal opioids have been used for many patients undergoing surgical operations to improve clinical outcomes. Cardiopulmonary bypass in patients undergoing coronary artery bypass graft surgery carries a number of drawbacks, namely hemodynamic derangements. Several methods have been used to suppress this state; among them is sympathetic blockade by neuraxial anesthesia. This study assesses the effect of intrathecal adjuvant bupivacaine plus sufentanil on intraoperative hemodynamic changes in elective coronary artery bypass surgery. Methods: In a double-blind, randomized, placebo-controlled clinical trials, 80 patients scheduled for elective CABG were randomly assigned into 2 groups. One group received intrathecal sufentanil (S) and the other group received the same dose of sufentanil plus supplemental bupivacaine (SB). All the patients were similar regarding other items. Hemodynamic and clinical outcomes including blood pressure values were measured during and after the operation. Results: There were more stable hemodynamic parameters in the SB group. Also, the SB group patients were extubated sooner than the other patient group. Discussion: The administration of intrathecal sufentanil plus bupivacaine seems to keep the hemodynamic status of the patients more stable than intrathecal sufentanil alone.

Effects of intrathecal bupivacaine in conjunction with hypothermia on neuronal protection against transient spinal cord ischemia in rats

Excitotoxic neuronal injury from ischemia may be reduced by local anesthetics. We investigated the neuroprotective effects of intrathecally administered bupivacaine and hypothermia in a rat model of transient spinal cord ischemia. PE-10 intrathecal catheter-implanted male Sprague-Dawley rats were randomly assigned to one of four groups: normothermia (NT) and hypothermia (HT) groups (given 15 microl of normal saline) and bupivacaine (B) and bupivacaine-hypothermia (BHT) groups (given 15 mul of 0.5% bupivacaine). Transient spinal cord ischemia was induced by inflation of a 2F Fogarty catheter placed in the aortic arch for 12 min. The rectal temperature was maintained at 37.0 +/- 0.5 degrees C for the NT and B groups, and at 34.5 +/- 0.5 degrees C for the HT and BHT groups. Motor and sensory deficit scores were assessed 2 and 24 h after reperfusion. Lumbar spinal cords were harvested for histopathology and immunoreactivity of heat shock protein 70 (HSP70). After reperfusion, the motor and sensory deficit scores of the NT group were significantly higher than those of the HT (P < 0.05) and BHT (P < 0.001) groups. Significant differences were evident in the motor and sensory deficit scores between the HT and BHT groups at 24 h (P < 0.05). Neuronal cell death and immunoreactivity of HSP70 were frequently observed in the NT and BT groups, but not in the HT and BHT groups. These results collectively suggest that intrathecal bupivacaine does not provide neuroprotection during normothermic transient spinal cord ischemia in rats, but enhances the neuroprotective effects of hypothermia.

The effect of intrathecal bupivacaine with hypothermia on neuronal protection against transient spinal cord ischemia in rats

The effect of intrathecal bupivacaine with hypothermia on neuronal protection against transient spinal cord ischemia in rats

The Effect of Intrathecal Bupivacaine with Hypothermia on Neuronal Protection against Transient Spinal Cord Ischemia in Rats

Background: Local anesthetics can reduece excitotoxic neuronal injury from ischemia. We investigated neuroprotective effects of intrathecally administered bupivacaine and hypothermia in rat model of transient spinal cord ischemia. Methods: A PE-10 intrathecal catheter was implanted into thirty six male Sprague-Dawley rats through L4-5 interlaminar space. Animals of normothermia (N) and hypothermia (H) groups were administered 15l of normal saline, and 15l of 0.5% bupivacaine for bupivacaine (B) and bupivacaine-hypothermia (BH) groups. Transient spinal cord ischemia was induced by inflation of a 2 F Fogarty catheter placed into aortic arch for 12 minutes. During ischemia, rectal temperature was maintained to 37.0 0.5 for N and B groups, 34.5 0.5 for H and BH groups. Motor and sensory deficit score were assessed 2 and 24 hour after reperfusion. Lumbar spinal cords were harvested for histopathology, and for immunoreactivity of heat shock protein 70 (HSP70). Results: The motor and sensory deficit score of N and B group was significantly higher than H group (P

Intrathecal Cholinergic Agonists Lessen Bupivacaine Spinal-Block-Induced Hypotension in Rats

Hypotension is an important side effect of spinal anesthesia. Intrathecal (IT) cholinergic agonists, including neostigmine (NEO), increase arterial blood pressure by stimulating spinal sympathetic neurons. Therefore, we tested the ability of IT cholinergic agonists to prevent the hypotensive effect of IT bupivacaine (BUP) (430 nmol) in rats instrumented with IT and arterial catheters. The mean arterial pressure (MAP) decreased 35 +/- 4 mm Hg (n = 10) after IT-BUP alone. In contrast, MAP did not significantly change after IT-BUP + IT-NEO (12.5 and 25 nmol; n = 5 for each dose). Intramuscular (IM) NEO was not effective, and MAP decreased 38 +/- 4 mm Hg after IT-BUP + IM-NEO (25 nmol; n = 5). Three additional cholinesterase inhibitors, physostigmine, edrophonium, and ambenonium, as well as the direct-acting cholinergic agonists carbachol, oxotremorine, and arecoline, each lessened the hypotension seen after IT-BUP. Furthermore, the nonselective muscarinic antagonist, atropine, as well as the M2 receptor selective antagonist, methoctramine, prevented the vasopressor effect of IT-NEO in our model. Finally, the nicotinic antagonist, mecamylamine, and the M1 selective antagonist, pirenzepine, did not affect the pressor effects of NEO in our model. In conclusion, IT cholinergic agonists lessen BUP spinal-block-induced hypotension in rats by a muscarinic dependent pathway.

Effect of Intrathecal Bupivacaine on Somatosensory Evoked Potentials following Dermatomal Stimulation

The effect of spinal anesthesia with 3.6 +/- 0.1 ml (mean +/- SEM) of 0.5% bupivacaine on early (less than 150 msec) somatosensory evoked potentials (SEPs) with electrical stimulation of the L1 and S1 dermatomes was examined in 12 patients. The mean level of sensory analgesia (pinprick) was T8,9 +/- 1.0 (+/- SEM) and the mean degree of motor blockade was 1.3 +/- 0.1 (Bromage scale). Intrathecal bupivacaine significantly (P less than 0.05) decreased the amplitude of all SEP components after stimulation of the L1 dermatome and most components during stimulation of the S1 dermatome. Intrathecal bupivacaine also increased the latency of SEPs (P less than 0.05) of both dermatomes. The L1 SEP disappeared in 7 and the S1 SEPs in 5 of the 12 patients during neural blockade. In three patients the SEPs disappeared at both locations. Sensory thresholds increased significantly during blockade. We found no correlation between decrease of amplitude and degree of motor blockade or level of sensory analgesia. Thus, intrathecal plain bupivacaine has a strong depressant effect on the neural afferent transmission as assessed by SEPs. However, despite clinically effective blockade as assessed by pinprick and motor blockade nerve potentials after nociceptive stimulation within the area of sensory block were often able to pass to the cerebral cortex.

Comparative Effects of Intrathecal Bupivacaine and Tetracaine on Analgesia, Cardiovascular Function and Plasma Catecholamines

Comparative Effects of Intrathecal Bupivacaine and Tetracaine on Analgesia, Cardiovascular Function and Plasma Catecholamines