Μg Fentanyl Research Articles

Low-dose fentanyl reduces pain perception, muscle sympathetic nerve activity responses, and blood pressure responses during the cold pressor test.

Our knowledge about how low-dose (analgesic) fentanyl affects autonomic cardiovascular regulation is primarily limited to animal experiments. Notably, it is unknown if low-dose fentanyl influences human autonomic cardiovascular responses during painful stimuli in humans. Therefore, we tested the hypothesis that low-dose fentanyl reduces perceived pain and subsequent sympathetic and cardiovascular responses in humans during an experimental noxious stimulus. Twenty-three adults (10 females/13 males; 27 ± 7 yr; 26 ± 3 kg·m-2, means ± SD) completed this randomized, crossover, placebo-controlled trial during two laboratory visits. During each visit, participants completed a cold pressor test (CPT; hand in ∼0.4°C ice bath for 2 min) before and 5 min after drug/placebo administration (75 μg fentanyl or saline). We compared pain perception (100-mm visual analog scale), muscle sympathetic nerve activity (MSNA; microneurography, 11 paired recordings), and beat-to-beat blood pressure (BP; photoplethysmography) between trials (at both pre- and postdrug/placebo timepoints) using paired, two-tailed t tests. Before drug/placebo administration, perceived pain (P = 0.8287), ΔMSNA burst frequency (P = 0.7587), and Δmean BP (P = 0.8649) during the CPT were not different between trials. After the drug/placebo administration, fentanyl attenuated perceived pain (36 vs. 66 mm, P < 0.0001), ΔMSNA burst frequency (9 vs. 17 bursts/min, P = 0.0054), and Δmean BP (7 vs. 13 mmHg, P = 0.0174) during the CPT compared with placebo. Fentanyl-induced reductions in pain perception and Δmean BP were moderately related (r = 0.40, P = 0.0641). These data provide valuable information regarding how low-dose fentanyl reduces autonomic cardiovascular responses during an experimental painful stimulus.

Pharmacokinetic Characterisation and Comparison of Bioavailability of Intranasal Fentanyl, Transmucosal, and Intravenous Administration through a Three-Way Crossover Study in 24 Healthy Volunteers.

Background For more than 60 years, the synthetic opioid fentanyl has been widely used in anaesthesia and analgesia. While the intravenous formulation is primarily used for general anaesthesia and intensive care settings, the drug's high lipophilic properties also allow various noninvasive routes of administration. Published data suggest that intranasal administration is also attractive for use as intranasal patient-controlled analgesia (PCA). A newly developed intranasal fentanyl formulation containing 47 μg fentanyl, intravenous fentanyl, and oral transmucosal fentanyl citrate were characterised, and bioavailability was compared to assess the suitability of the intranasal formulation for an intranasal PCA product. Methods 27 healthy volunteers were enrolled in a single-centre, open-label, randomised (order of treatments), single-dose study in a three-period crossover design. The pharmacokinetics of one intranasal puff of fentanyl formulation (47 μg, 140 mL per puff), one short intravenous infusion of 50 μg fentanyl, and one lozenge with an integrated applicator (200 μg fentanyl) were studied, and bioavailability was calculated. Blood samples were collected over 12 hours, and plasma concentrations of fentanyl were determined by HPLC with MS/MS detection. Results 24 volunteers completed the study. The geometric mean of AUC0-tlast was the highest with oral transmucosal administration (1106 h ∗ pg/ml, CV% = 32.86), followed by intravenous (672 h ∗ pg/ml, CV% = 32.18) and intranasal administration (515 h ∗ pg/ml, CV% = 30.10). Cmax was 886 pg/ml (CV% = 59.38) for intravenous, 338 pg/ml (CV% = 45.61) for intranasal, and 310 pg/ml (CV% = 29.58) for oral transmucosal administration. tmax was shortest for intravenous administration (0.06 h, SD = 0.056), followed by intranasal (0.21 h, SD = 0.078) and oral transmucosal administration (1.20 h, SD = 0.763). Dose-adjusted absolute bioavailability was determined to be 74.70% for the intranasal formulation and 41.25% for the oral transmucosal product. In total, 38 adverse events (AEs) occurred. Fourteen AEs were potentially related to the investigational items. No serious AE occurred. Conclusion Pharmacokinetic parameters and bioavailability of the investigated intranasal fentanyl indicated suitability for its intended use as an intranasal PCA option.

Effects of Magnesium Sulphate (MgSO4) Versus Fentanyl as an Adjuvant to Epidural Bupivacaine in Lower Abdominal Surgeries

Background: In modern anaesthesia practice, a number of agents are used as adjuncts with epidural local anesthetics to achieve good perioperative hemodynamic stability as well as prolong the postoperative analgesia period. Among the different adjuvants, Fentanyl and Magnesium sulphate shows the promising results. Objectives: To study the effects of Magnesium Sulphate (MgSO4) versus Fentanyl as an Adjuvant to single-shot Epidural Plain Bupivacaine in Lower Abdominal Surgeries. Methods: It is a randomized controlled trail study, carried out in the Department of Anaesthesia, Analgesia, Palliative &amp; Intensive Care Medicine, Dhaka Medical College Hospital Dhaka. Study populations were patients of ASA Status I-II planned for lower abdominal surgery under single-shot epidural anaesthesia. Study populations were randomly allocated into one of the three groups, of 25 each- group C, M&amp;F. Group C-Patients received plain bupivacaine 0.5% 20 ml. Group M - Patients plain bupivacaine 0.5%(19 ml)+500 mg magnesium sulphate (1ml) and group F received plain bupivacaine 0.5% (19 ml)+50μg Fentanyl (1ml). Data were processed and analyzed by SPSS version 22.0. Results: It was found that the onset of sensory block at T8 was faster in Group M and F (14.2±2.5 min &amp; 13.8±2.2 min) than Group C (18.5±3.1 min). On comparison of the required time to achievement of sensory loss between groups, required time was 11-15 minutes in 12(48.0%) patients of Group-M, 15(60.0%) in group F versus 16-20 minutes in 12(48.0%) patients of Group-C. The result was significant (*p-value &lt; 0.05). In this study duration of sensory block was longer in Group-M ˃Group-F˃ group C. Result was significant between groups (p&lt;0.01). But the motor block was almost similar between groups. No statistically significant difference was seen in between groups. It was evident that intensity of pain was lower up to 6 hrs. After anaesthesia, following that pain increases and analgesic also required in all groups, comparatively ........

Safety Profile of Endoscopist-directed Balanced Propofol Sedation for Procedural Sedation: An Experience at a Hospital-based Endoscopy Unit.

Nurse-administered propofol sedation was restricted to anesthesiologists in 2009, a practice that has contributed to spiraling health care costs in the United States. The aim of this study was to evaluate the safety of endoscopist-directed balanced propofol sedation (EDBPS). We identified patients undergoing endoscopy with EDBPS from January 1, 2017, to June 20, 2017, and abstracted their medical records. Adverse events (AEs) included: hypoxia (oxygen saturation < 90%); hypotension [(a) systolic blood pressure < 90 mm Hg, (b) systolic blood pressure decline of >50 mm Hg, (c) decline in mean arterial pressure of >30%]; bradycardia (heart rate of < 40 beats/min). Logistic regression identified factors independently associated with AEs. A total of 1897 patients received EDBPS during the study period [mean age: 55 y (SD=11.4 y); 56.4% women]. Patients received median doses of 50 µg fentanyl, 2 mg of midazolam, and a mean propofol dose of 160±99 mg. There were no major complications (upper 95% confidence interval, 0.19%). Overall, 334 patients (17.6%) experienced a clinically insignificant AE: 65 (3.4%) experienced transient hypoxia, 277 patients (14.6%) experienced hypotension, 2 had transient bradycardia. In bivariate analysis, older age was associated with risk for hypotension, propofol dose was associated with transient hypoxemia, and procedure duration was associated with both hypotension and transient hypoxia. In multivariate analysis, only procedure length was associated with AEs (odds ratio scale 10; odds ratio=1.07; 95% confidence interval, 1.05-1.09, P<0.001). EDBPS is safe for endoscopic sedation. Given the higher cost of anesthesia-administered propofol, endoscopists should reinstate EDBPS by revising institutional sedation policies.

Bacterial meningitis without pyrexia after spinal anesthasia for caesarean section: A case report.

Introduction and importancyMeningitis happening in post spinal anesthesia is rare. But it has potentially life threatening or permanent neurological sequel if delayed or left untreated. The cause can be infectious or noninfectious. In this case, uncommon pathogen is described causing bacterial meningitis. Incidence varies from 0% to 0.04%.Case presentationA term pregnant lady came to the Operation room (OR) for an emergency caesarian section(C/S) because of cervical dystocia. She has no history of known medical illness. The anesthetist planned to administer spinal anesthesia. Under aseptic technique, the senior anesthetist wore a tight-fitting surgical mask, cap, and sterile gloves after hand hygiene with alcohol-based solutions.In sitting positioning between L(lumbar) 3 and L4 interspaces 10 mg bupivacaine +10 μg fentanyl was administered. Surgery and anesthesia were uneventful, 16 h into the postoperative period the mother develop severe headache, agitation, confusion, and forgetfulness.She has no fever but meningeal sign was positive. Lumbar puncture (LP) reveals purulent cerebrospinal fluid (CSF).Immediately, empirical treatment began. CSF sent for analysis and Culture, hematology, urinalysis, and organ function tests requested. Diagnosis was confirmed by clinical picture, low CSF glucose, and high body fluid protein, culture growth; showed Escherichia coli (E.coli). Treatment was instituted and patient has recovered fully.Clinical discussionE.coli is a very rare cause of bacterial meningitis but manifests a similar clinical picture like other bacterial meningitis but in our case no pyrexia. We believe there is a sterility breach somewhere in the process. The use of hospital sterilized spinal set, multidose antiseptics; institute sterility practice might be challenged.ConclusionThe use of modern packaging is recommended. Despite absent of pyrexia empiric treatment must start earlier besides the application of national guideline developed by the Joint Commission of different associations including America society of regional anesthesia (ASRA) is recommended.

Comparison of epidural, spinal, and saddle block for holmium laser enucleation of prostate (HoLEP): A prospective randomized, comparative study.

Background:Holmium laser enucleation of the prostate (HoLEP) has become an important treatment modality for benign prostate hypertrophy. The aim of the present study was to compare regional anesthesia methods for HoLEP operation and to determine the optimal technique.Methods:Sixty patients with American Society of Anesthesiologists scores of I-III were randomly allocated into 3 groups. Patients in group E received an epidural block with 75 mg of bupivacaine plus 50 μg of fentanyl. In group S, 15 mg of bupivacaine and 50 μg fentanyl were used for spinal anesthesia. In group SA, patients received saddle block with 15 mg of bupivacaine and 50 μg of fentanyl.Results:Time to T10 dermatome block and to maximal level block were longest in group E (P < .05), and maximal sensorial block level was higher in group E than group SA (P < .05). There was a significant difference in postoperative motor block, but no difference in systolic blood pressure and heart rate.Conclusion:Among 3 techniques, saddle block might be preferable in HoLEP because an adequate sensorial level was achieved with lower motor block and stable hemodynamics.

Cutoff Values for Providing the Ideal Intravenous Patient-Controlled Analgesia According to the Intensity of Postoperative Pain-A Retrospective Observational Study.

Background and Objectives: The cutoff values were analyzed for providing the ideal intravenous patient-controlled analgesia (PCA) that could reduce rescue analgesics or antiemetics requirements, based on the grades of postoperative pain intensity (PPI). Materials and Methods: PCA regimens of 4106 patients were retrospectively analyzed, and they were allocated into three groups with low, moderate, and high PPI grades (groups L, M, and H, respectively) based on numeric rating scores obtained 6 h postoperatively. Opioid and non-opioid analgesic doses were converted into fentanyl-equivalent doses (DOSE-FEN-OP and DOSE-FEN-NONOP, respectively). The primary endpoint was the cutoff values of these parameters. Results: With respect to the PCA settings to reduce rescue analgesic and antiemetic requirements, group L required a background infusion rate (BIR) of 1.75–3 mL/h, bolus volume of 0.5–1.25 mL, and lockout interval of ≤12.5 min. Group M required a BIR of 1.75 mL/h, bolus volume of 0.5–1.75 mL, and lockout interval of ≤5 min. Group H required a BIR of 1.75 mL/h, bolus volume of 0.5 mL, and lockout interval of ≤5 min. In assessments of the analgesic doses to reduce rescue analgesic requirement, the DOSE-FEN-OP was at least 950 μg of fentanyl regardless of group, while the DOSE-FEN-NONOP was ≥250 μg, ≥550 μg, and ≥700 μg for the L, M, and H groups, respectively. In assessments of the analgesic doses to reduce rescue antiemetic requirement, DOSE-FEN-OP was ≤950 μg for groups L and M and ≤850 μg for Group H, while DOSE-FEN-NONOP was ≤50 μg, ≤450 μg, and ≤700 μg for groups L, M, and H, respectively. Conclusion: The ideal PCA for reduction in rescue analgesics or antiemetics can be achieved by adjustment of PCA settings and drug dosages carefully with these cutoff values depending on the expected grades of PPI. Especially, the ideal PCA can be provided by adjusting the lockout interval and bolus volume rather than BIR and by applying smaller bolus doses and shorter lockout intervals with an increasing PPI grade.

Demographic and clinical factors associated with variations in opioid administration using conscious sedation during HDR brachytherapy for cervical cancer

PURPOSE/OBJECTIVES To examine patient characteristics that predispose to higher opioid administration during tandem and ovoid (T&O) high-dose rate (HDR) brachytherapy. METHODS A single-institution retrospective review was performed on patients who underwent brachytherapy for cervical cancer. Patients were included if they received at least one fraction of HDR T&O brachytherapy with analgesia administration recorded in the Medication Administration Record. Fentanyl dose was dichotomized as "low" (mean <125 μg per fraction), or "high" (mean ≥ 125 μg per fraction). Descriptive statistics and multiple logistic regression analysis were performed comparing mean opioid dose per fraction with demographic and clinical information. RESULTS From July 2014 through May 2020, 113 patients underwent 531 T&O HDR brachytherapy fractions with oral benzodiazepine and intravenous opioid fentanyl for conscious sedation. The median opioid dose per fraction was 100 μg fentanyl (range 0-250 μg). Using multiple logistic regression analysis, younger age (OR 1.071, p = 0.002) and higher BMI (OR 1.091, p = 0.019) were associated with increased opioid administration during brachytherapy. Black women received less opioid during brachytherapy when compared to White women (OR 0.296, p = 0.047). FIGO stage, ECOG score, smoking status, prior narcotic use, prior illicit drug use, parity, prior cervical procedure, Smit sleeve placement, and distance to treatment center were not associated with high opioid dose. CONCLUSION Cervical cancer patients who are younger or have higher BMI receive more narcotic analgesia during HDR brachytherapy whereas Black women received less narcotic analgesia, irrespective of age and BMI. This underscores the immediate need to address how pain is assessed and managed during brachytherapy.

Comparison of nalbuphine versus fentanyl as intrathecal adjuvant to bupivacaine for orthopedic surgeries: A randomized controlled double-blind trial.

Background and Aims:Intrathecal adjuvants are used with local anesthetics to prolong the duration and provide postoperative pain relief while minimizing the dose of local anesthetic. Nalbuphine is an agonist-antagonist opioid and provides prolonged duration of analgesia with fewer side effects of fentanyl such as pruritus, nausea, and vomiting. The aim of this study was to evaluate and compare the onset and duration of sensory and motor blockade, hemodynamic effects, duration of postoperative analgesia, and adverse effects of nalbuphine and fentanyl given intrathecally with hyperbaric 0.5% bupivacaine in orthopedic lower limb surgeries.Material and Methods:Sixty six patients classified in American Society of Anesthesiology (ASA) classes I and II scheduled for orthopedic lower limb surgeries were enrolled. Patients were randomly allocated to receive 15 mg of hyperbaric bupivacaine with either 1 mg nalbuphine (group N), 25 μg fentanyl (group F) or 0.9% normal saline (group C) intrathecally.Results:Patients who received intrathecal nalbuphine (group N) had a significantly delayed onset of sensory and motor block as compared to patients who received fentanyl (group F). The time to two segment regression was significantly prolonged in group F (122.05 ± 10.65 minutes) as compared to group N (114.55 ± 10.90 minutes) [P < 0.05]. The mean duration of motor blockade was significantly prolonged in group F (197.73 ± 15.09 minutes) as compared to group N (180.68 ± 15.68 minutes) [P < 0.05]. Duration of spinal analgesia was comparable in group N (323.18 ± 57.39 minutes) and group F (287.05 ± 78.87 minutes), both significantly more than group C (224.32 ± 42.54 minutes). Hemodynamic effects, 24-h rescue analgesic requirements, and incidence of side effects were comparable among group N and F.Conclusion:Intrathecal nalbuphine in a dose of 1 mg is an equally useful alternative to fentanyl in a dose 25 μg when used as an intrathecal adjuvant to bupivacaine for lower limb surgeries. The prolonged duration of analgesia and no adverse effects makes it a good choice for the orthopedic procedures of lower limb.

A Comparative Study between Intrathecal Fentanyl and Dexmedetomidine as Adjuvants to Hyperbaric Levobupivacaine 0.5% in Patients Undergoing Infra Umbilical Surgeries

Abstract Background Spinal anesthesia is a common technique for lower abdomen and lower limb surgery, but the use of local anesthetics alone may produce unwanted side effects such as prolonged motor and autonomic block, limited duration of action, besides, excessive local anesthetics can cause cardiac toxicity and central nervous system side effects. For these reasons, local anesthetics combined with other drugs, to utilize their synergistic analgesia and to reduce the dose of local anesthetics, has become a new option for anesthesiologists. Objectives This study is designed to assess and compare the effect of intrathecal Fentanyl and Dexmedetomidine as adjuvants to hyperbaric Levobupivacaine 0.5% regarding the onset, duration of sensory and motor block, duration of post operative analgesia and possible side effects in patients undergoing infra umbilical surgeries. Materials and Methods The study was performed at Ain Shams university hospitals. After obtaining ethical committee approval and informed consent from the patients. The study protocol was obtaining an informed consent; 75 patients admitted for infraumbilical surgeries in Ain Shams University hospitals operation theatre, were blindly randomized into three groups, using their medical record number (MRN) and subjected to a comparative study. A for Fentanyl group, group B for Dexmedetomidine group and group C for Levobupivacaine control group in the duration of 6 months from March to August 2019. Results The study showed that the quality of intraoperative analgesia was significantly better with dexmedetomidine than fentanyl group, and the requirement for opioids was significantly lower with dexmedetomidine than fentanyl group. The degree of motor block and postoperative analgesia was significantly denser with dexmedetomidine than fentanyl group. Conclusion From the current study we can conclude that using intrathecal 5 µg dexmedetomidine seems to be a suitable alternative to 25 µg fentanyl as adjuvants to 0.5% hyperbaric levobupivacaine in spinal anaesthesia. Its associated with prolonged motor and sensory block and provides good quality of intraoperative analgesia and extended duration of post operative analgesia as compared to fentanyl.

English

BACKGROUND Isobaric levobupivacaine has minimal effect on positional variation of sensory and motor blockade given intrathecally. Also, it has lesser cardiotoxic and neurotoxic effects. Present study was done to compare efficacy, analgesia haemodynamic effects and any adverse effects after spinal anaesthesia with isobaric levobupivacaine with nalbuphine and fentanyl as adjuvants in transurethral endoscopic surgeries. METHODS 60 male adult patients of American Society of Anaesthesiologists (ASA class I-III) of age group 40 - 80 years were randomized into 2 groups (n = 30) in this prospective, double blinded study. 10 mg of 0.5 % levobupivacaine with 25 µg fentanyl in group LF and 10 mg of 0.5 % levobupivacaine with 0.8 mg nalbuphine in group LN. Parameters assessed were sensory and motor blockade characteristics and hemodynamic variables in both the groups. Adverse effects were recorded if any. RESULTS Onset of sensory and motor blockade were significantly faster in group LF compared to group LN. In both the groups, time for two segment regression was comparable. Statistically significant prolonged analgesic duration was noticed in group with nalbuphine than fentanyl as adjuvant to isobaric levobupivacaine. Difference in haemodynamic variation was not significant in both the groups. CONCLUSIONS Intrathecal nalbuphine 0.8 mg as an adjuvant with isobaric levobupivacaine 0.5 % 10 mg is as efficacious as fentanyl 25µg in transurethral endoscopic surgeries in elderly population with better hemodynamic stability. KEY WORDS Levobupivacaine; Fentanyl; Nalbuphine; Spinal anaesthesia.

Laryngeal mask ventilation in patient with Treacher Collins syndrome

Introduction: Treacher Collins syndrome (TCS) is an autosomal dominant disorder of craniofacial development. Case description: A 5-year-old female patient (weight 16.8 kg, height 106 cm), ASA III, was admitted to our hospital for plastic surgery of the ears. The preoperative evaluation revealed no significant personal or family history for adverse reaction to anesthetics. A general anesthesia was scheduled for this patient. Fentanyl 0.05 mg, propofol 50 mg and succinylcholine 20 mg were administered for anesthesia induction. After intubation 2.5% sevoflurane was used for anesthesia maintenance. Additional 0.025 mg of fentanyl was administered for pain relief. The operation finished successfully within 55 min. The vital signs had been stable during the operation. Ventilation through the operation was successfully performed through laryngeal mask classic № 2. Discussion: Management of patients with Treacher Collins syndrome is complicated and involves multiple disciplines working in concert to achieve a common outcome. When difficult intubation is anticipated, several alternatives to routine intubation are possible. In our study during maintenance of anesthesia, there was no evidence of instability of the LMA or increased contamination of the lower respiratory tract. During emergence from anesthesia, our results indicate that, compared with endotracheal anesthesia, airway management was easier using the LMA. Conclusion: The laryngeal mask airway has become an important adjunct to airway management since its introduction. Ventilation through LMA can be safely used during operations in patients with Treacher Collins syndrome.

Ventilation through laryngeal mask in patient with severe laryngeal stenosis

Introduction: Patients with an advanced airway obstruction and inspiratory stridor at rest comprise some of the most feared and complicated cases for the anesthesiologist. Case description: A 45-year-old female patient (weight 54 kg, height 166 cm), ASA III, was admitted to our hospital for tracheostomy and microlaryngeal surgery because of stenosis of the larynx. A general anesthesia was scheduled for this patient. Fentanyl 0.3 mg, propofol 200 mg and succinylcholine 100 mg were administered for anesthesia induction. After intubation 2.5% sevoflurane was used for anesthesia maintenance. Additional 0.15 mg of fentanyl was administered for pain relief. Muscle relaxation was provided with 40 mg of atracurium besilate. The operation finished successfully within 80 min. Ventilation for tracheostomy was successfully performed through flexible laryngeal mask airway (FLMA) № 3. Discussion: Patients presenting for microlaryngeal surgery frequently have a difficult airway. The chosen approach to this airway depends on the pathology and the patient’s symptoms. Acceptance of the LMA as a safe practical alternative to tracheal intubation for laryngeal stenosis requires that placement be relatively facile, that position of the mask be stable throughout surgery, and that the airway be protected from the risk of aspiration. In our study during maintenance of anesthesia, there was no evidence of instability of the LMA or increased contamination of the lower respiratory tract. Conclusion: Ventilation through LMA can be safely used during tracheostomy in patients with severe laryngeal stenosis.

Comparison of Dexmedetomidine and Fentanyl as Adjuvants to Intrathecal Levobupivacaine in Lower Segment Cesarean Section

Objective: To determine the effectiveness of dexmedetomidine on the spinal anaesthesia as an adjuvant to the hyperbaric levobupivacaine in patients undergoing cesarean section. Study Design: Comparative/Observational Place &amp; Duration: The study was conducted at Anesthesiology/Obstetrics and Gynaecology departments of Mayo hospital, Lahore for duration of six months i.e from 1st November 2020 to 30th April 2021. Methods: This analysis included a total of 120 cases. After the informed consent the patients had received comprehensive demographics. Three equal classes of patients were divided into groups A, B and C. Group I had 40 patients and received 2.5 ml isobaric levobupivacane, group II with 40 patients and received 2.5 ml isobaric levobupivacaine and 5μg dexmedetomidine, and group III received 2.5 ml isobaric levobupivacaine and 25 μg fentanyl intrathecally. The outcomes of these groups were analysed in which sensory and motor blockage period were measured from the time the intrathecal drugs were administered. The full SPSS 26.0 version was used to analyze the results. Results: The mean age of the patients in group I was 27.44 ± 7.64 years with BMI 23.19±8.44, mean age in group II was 27.22 ±7.42 years with BMI 24.44 ± 6.16 and in group III mean age was 26.99 ±9.61 years with BMI 24.72 ±4.34. Duration of sensory and motor blockade was observed and resulted that it was earlier in group III as compared to group I and II. Prolonged duration of sensory and motor blockade was observed in group II as compared to groups I and III with significantly P value&lt; 0.001. Conclusion: We concluded that for an adjuvant of 0.5 percent isobaric levobupivalacaine, Intrathecal dexmedetomidine induces both prolonged motor blockage and post operative analgesia than fentanyl. Key words: Levobupivacaine; Spinal anesthesia, Fentanyl, Intrathecal analgesia, Cesarean section; Dexmedetomidine.

Effects on newborns of applying bupivacaine combined with different doses of fentanyl for cesarean section.

BACKGROUNDThe choice of anesthesia for cesarean section is very important.AIMTo compare the effects of applying bupivacaine combined with different doses of fentanyl on newborns after cesarean section. METHODSWe randomly divided one hundred and twenty patients undergoing cesarean section into the following 4 groups: group B (bupivacaine group), group BF10 (bupivacaine combined with 10 µg fentanyl), group BF30 (bupivacaine combined with 30 µg fentanyl) and group BF50 (bupivacaine combined with 50 µg fentanyl). The heart rate, mean arterial pressure, block plane fixation time and sensory block time were recorded. Umbilical artery blood was then collected immediately after fetal delivery for blood gas analysis and qualitative detection of fentanyl. Additionally, data on the neonatal 1-min and 5-min Apgar scores, results of umbilical artery blood gas analysis and qualitative detection of fentanyl in umbilical artery blood were recorded.RESULTSAlthough the mean arterial pressure decreased in all four groups at 3 min after anesthesia, the percentage of the decrease was less than 20% of the baseline. In addition, there were no significant differences in the 1-min or 5-min Apgar scores or the umbilical artery blood gas analysis among the four groups (P > 0.05). Moreover, the concentration of fentanyl in umbilical artery blood was qualitatively detected using an ELISA kit, and the results in the four groups were negative.CONCLUSIONBupivacaine combined with fentanyl spinal anesthesia is effective in cesarean section.

End-tidal capnographic monitoring during flexible bronchoscopy under fentanyl and midazolam sedation.

Bronchoscopic examination including endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is well established for lung cancer diagnosis and staging. Sedation using fentanyl and midazolam is recommended during bronchoscopic examinations. Meanwhile, inadvertent oversedation is a clinical problem. The objective of this research was to estimate the frequency of apnea episodes by end-tidal capnography under fentanyl and midazolam sedation during bronchoscopy. Eighty-five patients were enrolled retrospectively between August 2017 and March 2018 at Okayama Medical Center. Apnea was defined as the cessation of airflow for more than 10 seconds. We reviewed medical records, including capnographic data, by cap-ONE YG-227T (NIHON KOHDEN, Tokyo, Japan) during flexible bronchoscopy under fentanyl and midazolam sedation. Patients received 49.4±20.6 µg of fentanyl [mean ± standard deviation (SD)] and 4.35±2.0 mg of midazolam (mean ± SD). The patients included 52 males and 33 females; the median age was 71 (range, 31-88) years were enrolled. Apnea episodes were recorded (median duration 18 seconds) in 85 patients (100%). Prolonged apnea episodes with more than 30 seconds occurred in 56 patients (65.8%). Furthermore, the median time was 32 (range, 5-102) seconds whose delay between the onset of an apnea episode and decline in the SpO2 level of ≥4% from baseline. End-tidal capnography, cap-ONE YG-227T was effective for detecting the occurrence of apnea in patients undergoing a bronchoscopic examination under fentanyl and midazolam sedation. Monitoring might be useful for preventing inadvertent oversedation.

ESP-block in thoracic surgery: a case report

This report presents a clinical case of combined anesthesia in a patient with videothoracoscopic atypical resection of the right lung. In the operating room, the patient underwent ultrasound-assisted blockade in the plane of the m. erector spinae (ESP block) using 20 mL of 0.375% levobupivacaine solution, after which general anesthesia was induced. Opioid consumption per surgery was 0.3 mg of fentanyl. In the postoperative period, high-quality multimodal pain relief was achieved without the use of opioids. Within 7 h after the operation, the patient could actively expectorate with minimal discomfort. The article demonstrates the possibility of the effective application of the ESP block to reduce the risk of respiratory complications during lung surgery and to prevent the development of neuropathic post-thoracotomy pain syndrome.

A Comparison between Intrathecal Nalbuphine and Fentanyl for Intraoperative Pain Management during Uterine Exteriorization in Cesarean Section: A Randomized Controlled Trial

BACKGROUND: Uterine exteriorization during cesarean section is linked to an increased incidence of visceral pain. AIM: This study explored the ability of intrathecal nalbuphine to alleviate this accompanied pain to be used as an effective safer alternative to fentanyl, as there is almost no study compared between these agents to alleviate visceral pain induced by uterine exteriorization. METHODS: This double-blinded randomized controlled research was done on 135 cases subjected to cesarean section with exteriorization of the uterus. Patients were randomized equally into F, N, and C groups which received 25 μg fentanyl, 800 μg nalbuphine, and 0.5 ml saline, respectively, added to intrathecal 0.5% hyperbaric bupivacaine. The occurrence of visceral and shoulder pain and their VAS, the need for rescue IV fentanyl, adverse events, hemodynamics, and Apgar scores were evaluated. RESULTS: The incidence of visceral pain was 22.2%, 24.4%, and 66.7% for Groups F, N, and C, respectively. Patients who needed rescue IV fentanyl were 6.7%, 11.1%, and 60% for Groups F, N, and C, respectively. The statistical difference regarding these parameters was highly significant (p &lt; 0.0001) between C group and both F and N groups but insignificant between F and N groups. Nausea, shivering, itching, and bradycardia were significantly lower (p &lt; 0.05) in N group in comparison to F and C. HR had a significant difference between F group and both N and C groups. CONCLUSION: Intrathecal nalbuphine is an effective safer alternative to fentanyl to control visceral pain induced by uterine exteriorization during cesarean delivery.

Comparing Duration of Analgesia after Intrathecal Administration of Opioids in Primary Paturients for Lower Segment Cesarean Section.

Background:A pain free post operative period is a boon to mother for caring the neonate. We compared injection butorphanol and fentanyl as an adjuvant to bupivacaine in primary parturients for LSCS (Lower Segment Caesarean Section) with respect to duration of analgesia.Aims and Objectives:To study the effect of butorphanol vs fentanyl on duration of analgesia when added to bupivacaine for LSCS amongst primi parturients and to observe the block characteristics as secondary outcome.Materials and Methods::Study was carried out in 90 patients divided equally into three groups which included 12mg(2 mL) of 0.5% hyperbaric bupivacaine with 0.5 mL NS, 12mg (2 mL) of 0.5% hyperbaric bupivacaine 25 μg butorphanol made upto 2.5 mL with NS and 12mg(2 mL) of 0.5% hyperbaric bupivacaine with 25μg fentanyl made upto 2.5mL with normal saline. All patients were observed for duration of analgesia. Also Heart Rate (HR), Systolic and Diastolic Blood Pressure (SBP, DBP), two segment regression time of sensory block, motor block were assessed. The results were compiled and statistically analyzed using Chi-square test for nonparametric data and ANOVA for parametric data.Results:Two segment sensory regression is significantly prolonged in group with intrathecal administration of Bupivacaine with Butorphanol (190.33±15.86) than Bupivacaine with Fentanyl (170.67±20.83) and Bupivacaine with Normal saline (150.33±16.91). Duration of effective post operative analgesia was 349.67, 591.87 and 468.00 min in Group I, Group II and Group III respectively. There was no significant difference in onset of sensory and motor blockage in all three groups. HR, SBP and DBP were comparable among the groups.Conclusions:Intrathecal bupivacaine with 25 μg butorphanol mixture was clinically better as it provided longer duration of analgesia along with prolonged sensory block when compared to intrathecal bupivacaine with 25μg fentanyl mixture in primary parturients for LSCS.

Safety and Efficacy of Low-dose Selective Spinal Anesthesia with Bupivacaine and Fentanyl as Compared to Intravenous Sedation and Port-Site Infiltration for Outpatient Laparoscopic Tubal Ligation: A Randomized Controlled Trial.

Background:Selective spinal anesthesia has been safely applied for short-duration outpatient gynecological laparoscopic procedure. However, this anesthesia technique is often inadequate and not tolerated by awake patients due to pneumoperitoneum and visceral manipulation.Aims:We aimed to conduct a study to compare spinal anesthesia with bupivacaine, fentanyl, and i.v. sedation with i.v. sedation and laparoscopic port-site infiltration with local anaesthetic in outpatient laparoscopic tubal ligation procedures.Settings and Design:100 female patients posted for elective surgeries were recruited for a prospective single blind randomised control trial in a tertiary care center in two groups.Materials and Methods:In Group S, patients receive intrathecal 3 mg hyperbaric bupivacaine 0.5% plus 20 microgram fentanyl along with intravenous (i.v.) fentanyl at 1μg.kg-1.h-1 and in Group C i.v. fentanyl at 1μg.kg-1.h-1 along with laparoscopic port site infiltration with 0.5% bupivacaine. Postoperatively, overall patient satisfaction, visual analog score (VAS) score, duration of motor blockade, sensory blockade, and time to attain discharge criteria and any adverse.Statistical Analysis:Continuous variables between the groups were compared by the independent t-test and Wilcoxon rank sum. Chi-square and Fisher exact test used for the categorical value.Results:Overall VAS was significantly lower and patient satisfaction was higher in Group S than Group C. Time to oral intake was significantly prolonged in Group C 126.33 (±29.54) compared to group S 110.81 (±29.54). The requirement of total rescue analgesia (fentanyl) was significantly higher in Group C 2.0 (±0.6) μg.kg-1 compared to group S 0.79 (±0.53) μg.kg-1. Incidence of postoperative nausea vomiting (PONV) was significantly greater in Group C while incidence of pruritus was significantly greater in Group S.Conclusion:Low-dose intrathecal anesthesia with 3 mg bupivacaine and 20 μg fentanyl provided better analgesia, patient satisfaction and with less opioids consumption.