Effect Of Epidural Bupivacaine Research Articles

Evaluation of the effects of epidural bupivacaine on coagulation system by using thromboelastometry in women with gynecologic malignancies

Evaluation of the effects of epidural bupivacaine on coagulation system by using thromboelastometry in women with gynecologic malignancies

A comparative study of different adjuvants to augment the effect of epidural bupivacaine for lower abdominal surgeries

A comparative study of different adjuvants to augment the effect of epidural bupivacaine for lower abdominal surgeries

A Randomized Control Trial of Bupivacaine and Fentanyl Versus Fentanyl-Only for Epidural Analgesia During the Second Stage of Labor

Background:The purpose of this prospective, double-blinded, parallel-arm, randomized trial was to examine the effects of epidural bupivacaine on the length of the second stage of labor in nulliparous women.Methods:The authors assessed length of second-stage labor, degree of motor blockade, mode of d

COMPARATIVE EVALUATION OF THE EPIDURAL DEXMEDETOMIDINE, KETAMINE OR FENTANYL IN COMBINATION WITH BUPIVACAINE IN DOGS

Castration is one of the most common procedure. It is a potential source of mild to moderate pain which is enough to induce inflammatory process, necessitate the incorporation of analgesics. This study was designed to evaluate the effect of epidural bupivacaine alone or in association with fentanyl, ketamine or dexmedetomidine on analgesia for the first 24 h post surgical castration. Forty male mongrel dogs were randomly allocated into 4 groups received bupivacaine 0.25% (1.5 mg kg-1) alone or in combination with fentanyl citrate (2 µg kg-1) or ketamine hydrochloride (2 mg kg-1) or dexmedetomidine hydrochloride (1.13 µg kg-1) into the lumbosacral space. Dogs were scored for sedation using numeric descriptive scale. Analgesia was assessed subjectively through Modified University of Melbourne Pain Scale score and objectively by following up the circulating level of interleukins 6 and 10. The bupivacaine-dexmedetomidine group showed the greatest sedation score, the lowest pain score without neuroendocrine modulation in contrast with bupivacaine or bupivacaine-fentanyl groups. From these result, it is concluded that bupivacaine-dexmedtomidine group provide long term analgesia last for the first 24 h post operative without additional analgesics.

Effects of epidural bupivacaine (0,25%) on cough pressure

Servei d'Anestesiologia i Reanimacio, Hospital del Mar-Esperanca, IMIM, UAB, Barcelona, Catalunya, Spain

The effect of epidural bupivacaine on maintenance requirements of sevoflurane evaluated by bispectral index in children

Combined (local and general) anaesthesia or Balanced (intravenous analgesics and inhalational hypnotics) anaesthesia are commonly used in paediatrics. The authors have investigated the influence of both types of anaesthesia on the requirements of sevoflurane to maintain an adequate level of hypnosis as measured by Bispectral index (at around 50) monitoring in paediatric orthopaedic patients. Twenty-six orthopaedic surgery patients aged 2-15 yr were randomized to receive, during general sevoflurane anaesthesia, 5 microg kg-1 of intravenous fentanyl (Balanced anaesthesia group) or 1 mL kg-1 of caudal-epidural bupivacaine 0.25% (Combined anaesthesia group). The end-tidal sevoflurane concentration was adjusted every 5 min in order to maintain Bispectral index values at around 50. Patients showed very similar Bispectral index values (P > 0.05) in both the Combined and the Balanced groups before anaesthesia (96.7 +/- 2.7 vs. 96.9 +/- 1.8), after induction (48.5 +/- 2.9 vs. 49.8 +/- 3.6) and after administration of analgesia (50.9 +/- 3.8 vs. 50.3 +/- 4.3). The sevoflurane end-tidal concentration requirements were similar in both the Combined and Balanced groups before administration of analgesia (2.1 +/- 0.2 vs. 2.1 +/- 0.4, P = 0.9415), but lower end-tidal concentrations were required by the Combined group than by the Balanced group (0.81 +/- 0.4 vs. 1.5 +/- 0.5, P < 0.0001) in the first 20 min after administration of analgesia. Combined anaesthesia with epidural bupivacaine maintains the same Bispectral index values as Balanced anaesthesia during orthopaedic surgery in children without fentanyl and with a lower sevoflurane requirement.

Effect of epidural anaesthesia on intestinal blood flow.

The effect of epidural bupivacaine (5 mg/ml) on intestinal blood flow was studied with laser Doppler flowmetry in 15 patients during operations including various types of large bowel resection. In the colon, blood flow increased in 13 out of 15 patients, which was significant at the 1 per cent level. The average increase was 41 per cent. In the ileum an increase was found in eight out of eleven patients who could be studied, which was significant at the 5 per cent level. Bowel function was restored satisfactorily in all patients. It is concluded that epidural bupivacaine has a favourable effect on intestinal blood flow during colorectal surgery.

Effect of epidural bupivacaine vs combined epidural bupivacaine and morphine on gastrointestinal function and pain after major gynaecological surgery

In a double-blind study, we investigated the effects of postoperative epidural local anaesthetic, with or without addition of epidural morphine, on postoperative pain and gastrointestinal function in patients scheduled for radical hysterectomy and pelvic lymphadenectomy. Forty patients were randomized into two study groups: 48-h postoperative epidural 0.2% bupivacaine 8 ml h(-1) (bupi group) or 48-h postoperative epidural 0.2% bupivacaine/morphine 50 microg at 4 ml h(-1) (bupi/morph group). Patients were observed for at least 96 h after surgery. No differences in pain at rest, during cough or mobilization were observed. Patients in the bupi group requested a significant greater amount of supplementary analgesics, but times to first flatus and defaecation were reduced compared with patients in the bupi/morph group. Itching was a significant problem in patients in the bupi/morph group. No differences in postoperative nausea and vomiting, mobilization or time to discharge from hospital were observed between groups. The addition of morphine to postoperative epidural bupivacaine has only limited effect on pain relief and increases time to normalization of gastrointestinal function.

Effects of Epidural Bupivacaine on Pain Intensity in Infant Rats.

Effects of Epidural Bupivacaine on Pain Intensity in Infant Rats. Howard et al. (page 421)To examine the influence of postnatal age and presence of inflammation on efficacy of epidural bupivacaine at low doses, Howard et al. conducted a series of experiments using infant rats aged 3, 10, and 21 days. After determination of hind limb flexion withdrawal thresholds to mechanical stimulation, researchers induced inflammatory reactions in the right hind paw of each rat by local injection of 2% solution of carrageenan. Three hours after carrageenan injection, the rats were briefly anesthetized with halothane, and then epidural bupivacaine or saline was administered to the rats in dose ranges and volumes according to their postnatal age. All solutions contained 10% Evans Blue dye as a marker. Laminectomies were performed after the animals were killed to confirm intact dura and spinal cords free from staining.After full recovery from anesthesia and 15 min after injection of bupivacaine, sensory thresholds were again determined in both hind limbs at 15-min intervals for 90 min. Pain sensitivity thresholds increased slightly throughout the experiment in animals to which saline and systemic bupivacaine were administered. Inflammatory hypersensitivity (the difference in threshold between the inflamed and noninflamed sides) was selectively attenuated by very low doses of bupivacaine (concentration range, 0.004–0.0625%), which did not affect the sensory threshold in the contralateral uninflamed limb. The effects of epidural bupivacaine were age related: In 21-day-old rats, the inflammatory hypersensitivity was only reversed by 0.0625% bupivacaine, whereas in 3- and 10-day-old rats, the concentrations required to reverse hypersensitivity were lower. The investigation suggests that very young patients may be more sensitive to the therapeutic effects of epidural local anesthetics.

The Effects of Epidural Bupivacaine, Morphine, and Their Combination on Thermal Nociception with Different Stimulus Intensity in Rats

The Effects of Epidural Bupivacaine, Morphine, and Their Combination on Thermal Nociception with Different Stimulus Intensity in Rats

The effects of epidural bupivacaine, morphine, and their combination on thermal nociception with different stimulus intensity in rats.

The analgesic effect of drugs depends on the stimulus intensity as well as the potency of the drugs. We investigated the effects of stimulus intensity on antinociceptive potencies of epidural bupivacaine + morphine. Sprague-Dawley rats implanted with chronic lumbar epidural catheters were tested for paw withdrawal response to thermal stimulation after the epidural injection of bupivacaine, morphine, or bupivacaine + morphine. Two stimulation currents were used, 5.1 and 4.6 A, to provide baseline response latency of approximately 5.0 s (high intensity) and 10.0 s (low intensity), respectively. Increasing the dose of epidural morphine in a dose range that had a maximum effect on low-intensity stimulation was not effective for high-intensity stimulation. Bupivacaine, which alone had no effect, potentiated the antinociceptive effect of epidural morphine at both high- and low-intensity stimuli similarly. We concluded that bupivacaine potentiated the analgesic effect of epidural morphine at both weak and strong nociceptive stimuli similarly, whereas increasing the dose of epidural morphine was not as effective for strong nociceptive stimulation. Therefore, adding bupivacaine might be more effective than increasing the dose of epidural morphine for intense nociception. When patients have severe pain even when receiving epidural morphine, adding bupivacaine might be more effective than increasing the dose of epidural morphine.

The Effects of Epidural Bupivacaine and Morphine Mixture on Bowel Motility after Upper Abdominal Surgery

The Effects of Epidural Bupivacaine and Morphine Mixture on Bowel Motility after Upper Abdominal Surgery

The effect of epidural bupivacaine on vecuronium–induced neuromuscular blockade in children

The effect of epidural bupivacaine on potency and duration of action of vecuronium-induced neuromuscular blockade (NMB) was evaluated in 30 general surgical paediatric patients (ASA I-II) of three to ten years of age. Premedication was midazolam 0.5 mg kg-1 orally (max 15 mg). In addition to general anaesthesia, 15 of the children received a lumbar epidural block with 0.5% bupivacaine 2.5 mg kg-1. Anaesthesia was induced and maintained with N2O:O2 (2:1), propofol and alfentanil. NMB was monitored by adductor pollicis EMG with the train-of-four stimulus every 20 sec. Thirty minutes following the epidural bupivacaine injection (mean plasma concentration 0.86 micrograms ml-1) or induction of anaesthesia a cumulative dose-response curve of vecuronium was established to achieve a 95% depression of the twitch response. Thereafter, NMB was allowed to recover spontaneously. ED doses of vecuronium were 19-22% greater in the control group than in the epidural group. ED50 doses were 33.8 (s.e. mean 1.3) micrograms kg-1 and 28.4 (2.2) micrograms kg-1, respectively (P < 0.05). There were no differences in recovery times from NMB between control and epidural group, the recovery index (time of twitch height to recover from 25 to 75%) being 6.4 (0.4) min and 7.0 (0.9) min, respectively. However, a negative correlation was found between bupivacaine plasma concentration and an ED50 dose of vecuronium (P = 0.01). Our results indicate that vecuronium is slightly more potent in children with bupivacaine epidural block than in children without it.

Quantitative sensory examination of epidural anaesthesia and analgesia in man; dose-response effect of bupivacaine

Time and dose-response functions of 4 concentrations of epidural bupivacaine (0.075, 0.125, 0.25, and 0.5%; 20 ml) on somatosensory and motor functions were examined in 10 healthy volunteers. Every hour for 8 h the effect of epidural bupivacaine on perception of painful and non-painful stimuli was quantified with 12 psychophysical measures. In addition knee extension strength, reaction time and skin temperature were examined. The two lowest concentrations of bupivacaine induced hypoalgesia without impairment of motor function. Epidural bupivacaine produced differential blockade of non-painful somatosensory functions in the following order: warmth perception > cold perception > perception of electrical stimuli. Epidural bupivacaine induced more pronounced hypoalgesia for short-lasting than for prolonged stimuli. A modality-related blocking order was observed for prolonged painful stimuli: heat > mechanical > electrical. It is suggested that differential blockade of somatosensory functions is caused by differences both in conduction blockade of nerve fibres and in central integration of afferent nerve impulses.

Effects of Epidural Bupivacaine and Epidural Morphine on Bowel Function and Pain After Hysterectomy

A comparison was made of the effects of continuous analgesia with and intermittent on bowel function after abdominal hysterectomy. The duration of postoperative ileus was assessed as the time from the end of operation to the first postoperative passage of flatus and feces. Twenty-two patients were randomly allocated to two equal groups. An epidural morphine group received general anesthesia and for postoperative pain relief, and an epidural bupivacaine group was given combined general anesthesia and anesthesia with 0.5% intraoperatively and analgesia with 0.25% postoperatively. Epidural or was given for 42 h postoperatively. Pain intensity (visual analog scale) was low in both groups, but lower (P less than 0.05) in the group. The time to first passage of flatus was 22 +/- 16 h in the group and 56 +/- 22 h in the group (P less than 0.001). The time to first postoperative passage of feces was shorter (P less than 0.05) in the former than in the latter 57 +/- 44 h vs 92 +/- 22 h). The patients of the group started intake of oral fluids earlier (P less than 0.01) and to a greater extent (P less than 0.05) than those in the group. It is concluded that the duration of postoperative ileus after hysterectomy is shorter when is given for postoperative pain relief than when this is achieved by morphine.

Effect of Thoracic Epidural Bupivacaine on Somatosensory Evoked Potentials after Dermatomal Stimulation

The effect of epidural bupivacaine (9 ml 0.5%) analgesia on early (less than 500 msec) somatosensory evoked potentials (SEPs) with electrical stimulation of the T-10 and L-1 dermatomes was examined in eight patients. Cortical amplitudes decreased only insignificantly after stimulation of both dermatomes, despite the presence of sensory analgesia (pin prick) from T-3.5 +/- 0.4 to L-2.9 +/- 0.4 (mean +/- SEM). Latency of the SEP components remained unchanged and sensory threshold increased only insignificantly during blockade. We conclude that thoracic epidural analgesia with conventional doses of bupivacaine provides only a limited blockade of fast conducting afferent nerve fibers.

Safety and Efficacy of Epinephrine Added to Bupivacaine for Lumbar Epidural Analgesia in Obstetrics

The effects of epidural bupivacaine with and without 1:300,000 epinephrine on uterine activity, progress of labor, fetal heart rate, maternal blood pressure and heart rate, newborn Apgar scores, neonatal acid-base status, and Neurologic and Adaptive Capacity Scoring System (NACS) were compared in 32 parturients during labor and delivery. Patients in group I (n = 16) received 0.5% bupivacaine with 1:300,000 epinephrine and those in group II (n = 16) received 0.5% bupivacaine alone. Addition of epinephrine to bupivacaine had no significant effects on uterine activity, duration of first or second stages of labor, fetal heart rate and variability, or the incidence of abnormal fetal heart rate patterns. Maternal hypotension occurred less frequently in group I than in group II patients (P less than 0.05). Apgar scores, neonatal acid-base status, and the NACS were equally good in the two groups. Duration of analgesia was significantly longer in group I than in group II (186.8 +/- 11.6 vs 85.3 +/- 6.1 (mean +/- SEM) min, P less than 0.001). It is concluded that adding epinephrine to bupivacaine during epidural anesthesia in the normal parturient has no adverse effects on either mother, fetus, neonate, or the progress of labor; and that it significantly prolongs the duration of anesthesia and decreases the incidence of maternal hypotension.

Safety and Efficacy of Epinephrine Added to Bupivacaine for Lumbar Epidural Analgesia in Obstetrics

The effects of epidural bupivacaine with and without 1:300,000 epinephrine on uterine activity, progress of labor, fetal heart rate, maternal blood pressure and heart rate, newborn Apgar scores, neonatal acid-base status, and Neurologic and Adaptive Capacity Scoring System (NACS) were compared in 32 parturients during labor and delivery. Patients in group I (n = 16) received 0.5% bupivacaine with 1:300,000 epinephrine and those in group II (n = 16) received 0.5% bupivacaine alone. Addition of epinephrine to bupivacaine had no significant effects on uterine activity, duration of first or second stages of labor, fetal heart rate and variability, or the incidence of abnormal fetal heart rate patterns. Maternal hypotension occurred less frequently in group I than in group II patients (P less than 0.05). Apgar scores, neonatal acid-base status, and the NACS were equally good in the two groups. Duration of analgesia was significantly longer in group I than in group II (186.8 +/- 11.6 vs 85.3 +/- 6.1 (mean +/- SEM) min, P less than 0.001). It is concluded that adding epinephrine to bupivacaine during epidural anesthesia in the normal parturient has no adverse effects on either mother, fetus, neonate, or the progress of labor; and that it significantly prolongs the duration of anesthesia and decreases the incidence of maternal hypotension.