Increase In Duration Of Analgesia Research Articles

Supraclavicular Brachial Plexus Block with or without Dexamethasone

Aim: To assess the effect of supraclavicular brachial plexus block in patients with or without dexamethasone. Study design: Double blind randomized controlled trial Place and duration of study: Department of Anesthesia and Critical Care, The Indus Hospital a free of cost tertiary care hospital in Karachi from 9th May 2019 to 19th February 2020. Methodology: Sixty patients were enrolled with 30 patients in each intervention group. Patients who came for elective or emergency surgery of the upper limb below shoulder were included in the study. Block performed on patients lying supine at 45 degree. The dexamethasone group received 0.25% plain bupivacaine 18 ml with 2ml dexamethasone (0.4mg/ml) and control group received 0.25% plain bupivacaine 18 ml with 2 ml normal saline. Results: The age of the group B patients was higher than the group A patients such as 43.4±15.7 years vs 38.6±14.2 years. The ASA level presented higher scoring than II in patients from Group B with 63.3% those patients who called for pain. In this study the intra operative vital signs showed an insignificant variance in both groups.However, a significant increase in duration of analgesia was observed in group A. Conclusion: Perineural administration of dexamethasone with clinical bupivacaine concentration can prolong the duration of anesthesia. Keywords: Supraclavicular, Brachial plexus block, Dexamethasone

Analysis of Dexmedetomidine added to Ropivacaine in Supraclavicular Brachial Plexus block

Aim: To evaluate the effect of Dexmedetomidine added to Ropivacaine in Supraclavicular Brachial Plexus block. Material and Methods: This study was performed in the Department of Anaesthesia, Mahatma Gandhi Missions Institute of Health Sciences, Navi Mumbai, Maharashtra after approval by the Institute Ethics Committee. After getting written informed consent from patients, this study was carried out as a controlled, randomized (chit method), double blind, prospective study in 60 patients. Sensory and motor blockade of radial, median, musculocutaneous and ulnar nerves were recorded at regular intervals (at each min till complete blockade) after drug injection. Following observations were noted intra and post operatively. The duration of analgesia or first request for analgesic defined as the time to attain a Visual Analogue Score (VAS) of 4 or >4 after Ropivacaine administration. The VAS was recorded post-operatively every 30min till the score of 4 or >4. Results: Duration of sensory block was significantly longer in group RD as compared to group R (p < 0.001). It was found that duration of motor block increased more with Dexmedetomidine addition (407.33±53.09 min) than with Ropivacaine alone (278.66±44.77 min). There was significant increase in duration of analgesia in group RD (685.33±90.02 min) than with group R (344.00±52.06 min). In RD group 2 patients developed haematoma and only 1 patient develop blood in aspiration due to arterial puncture, and in R group 1 patient develop haematoma and 2 patients developed blood in aspiration. Conclusion: We conclude that Dexmedetomidine is a good adjuvant in supraclavicular brachial plexus block for upper limb surgeries.

A comparative evaluation of the analgesic efficacy of low doses of intrathecal neostigmine and bupivacaine with plain bupivacaine in lower limb surgery

Intrathecal neostigmine prolongs the duration of analgesia and also appropriate dose reduces the associated side effects. The present study was conducted to evaluate the analgesic efficacy, identify the optimum dose using 3 different doses of neostigmine in combination with bupivacaine in comparison with bupivacaine alone for the intra &amp; postoperative period. Eighty patients of ASA I &amp; II undergoing lower limb surgery under spinal anaesthesia were enrolled and divided into 4 groups of 20 each. Group I: bupivacaine control group, Group II: Bupivacaine + 12.5 µgm Neostigmine, Group III: Bupivacaine +25 µgm Neostigmine, Group IV: Bupivacaine + 50µgm Neostigmine. Hemodynamic parameters, sensory and motor characteristics and adverse effects if any were noted. Pain was assessed using visual analog scale (VAS) in postoperative period hourly for 12 hours &amp; then at 24hours. Onset, duration and level of sensory block were recorded along with onset and duration of motor block. Largest dose (50mgm) produced an increase in duration of analgesia by 16.60min (an increase of 20.10%) compared to control group. The 25mgm intrathecal neostigmine resulted in an increase of 7.20min (an increase by 8.25%). The dose of 50mgm neostigmine in comparison with 25mgm dose significantly prolonged the duration of two segment regression, effective and complete analgesia, with no increase in the incidence of nausea and vomiting and hence 50mgm appears to be the optimum dose amongst the doses considered in our study for intrathecal administration in lower limb surgery.

Comparative study between bupivacaine-dexmedetomidine combination and bupivacaine (plain) in brachial plexus block using nerve stimulator

Introduction: Brachial plexus block has evolved into a valuable and safe alternative to general anaesthesia for the upper limb surgeries. It is a great tool in the anaesthetic armamentarium for relief of pain preoperatively, perioperatively and post operatively. It is possible and desirable for patient to remain ambulatory. Adjuvants with local anaesthetics in brachial plexus block are being used to achieve quick, dense and prolonged block. Dexmedetomidine added to local anesthetics prolongs the duration of block and postoperative analgesia in brachial plexus block. Methods and Methodology: It is a prospective, randomised, comparative study of 60 patients admitted in a tertiary hospital for upper limb surgery who were posted under regional anaesthesia during the period of October 2012 to December 2014. The patients taken in this study were allocated into two groups randomly. Group B (n=30) 20millilitres (ml) of 0.5%% bupivacaine +1ml saline and group D (n=30) 20ml of 0.5% bupivacaine +1microgram (mcg)/kilogram (kg) dexmedetomidine was given. Results: There were no clinical or statistically significant differences in the demographic profile of patients in either group. Onset of sensory block in radial, median and ulnar nerve distributions were significantly shorter in group B. Motor onset was also significantly shorter in group B. However rescue time was higher in group D. There were no adverse effects noted in both the groups. There was a significant percentage of GA conversion seen in case of group. B. Discussion: Onset of sensory block was faster in Group B than in Group D, onset of motor block was faster in Group B than in Group D, and the difference was statistically significant. There was significant increase in duration of analgesia in Group D (456.12±97.99 min) as compared with Group B (289.67±62.50 min). The difference was statistically significant No side-effects (nausea, vomiting, dry mouth) were reported during the first 24 h in the post-operative period in both the groups. From this study, we would like to suggest that dexmedetomidine can be safely used with local anaesthetic in peripheral nerve blocks; however, further trials to determine the exact dose and effect of neurotoxicity on the human nerve are required.

Effect of Dexamethasone on Characteristics of Supraclavicular Nerve Block with Bupivacaine and Ropivacaine: A Prospective, Double-blind, Randomized Control Trial.

Background:Dexamethasone as an adjuvant to bupivacaine and ropivacaine for supraclavicular brachial plexus (SCBP) block prolongs motor and sensory blockade. However, comparison of effect of dexamethasone (8 mg) when added to these two local anesthetics has not been well studied. This study was conducted to compare analgesic efficacy of dexamethasone as adjuvant to bupivacaine and ropivacaine in SCBP block.Subjects and Methods:Nerve stimulator-guided SCBP block was given to 120 patients, randomly assigned to one of four groups: (n = 30 in each group) Group B, BD, R, and RD received 30 ml (0.5%) bupivacaine + 2 ml saline, 30 ml (0.5%) bupivacaine + dexamethasone 8 mg, 30 ml (0.5%) ropivacaine + 2 ml saline, and 30 ml (0.5%) ropivacaine + dexamethasone 8 mg, respectively. Time for request of the first rescue analgesic, 24-h analgesic consumption, and different block characteristics were assessed. Student's t-test, Chi-square test, ANOVA were used for statistical analysis.Results:Dexamethasone significantly prolonged time for request of the first rescue analgesic of both ropivacaine (1211.83 ± 32.86 vs. 283.17 ± 7.71 min){ p R, RD < 0.001} and bupivacaine (1205.17 ± 34.32 vs. 364.67 ± 16.50 min) {p B, BD < 0.001}. 24-h requirement for rescue analgesics was more in Groups B and R when compared to Groups BD and RD. The increase in duration of analgesia was more when Groups R and RD (928.66 min) were compared than Groups B and BD (840.5 min). Similar results were seen with onset times and duration of sensory and motor block.Conclusion:The addition of dexamethasone to bupivacaine and ropivacaine in SCBP block prolonged time for first rescue analgesia and reduced the requirement of rescue analgesics with faster onset and prolonged duration of sensory and motor block, with the effect being stronger with ropivacaine.

A Comparative Study to Evaluate the Efficacy of Butorphanol as an Adjuvant to Epidural Analgesia for Rib Fractures

Abstract Introduction: Pain management via epidural catheters have emerged as an optimal method of pain control in patients with rib fractures (RF). This study was done to evaluate the efficacy of butorphanol in this subset of patients. Materials and methods: Sixty patients were randomly allocated in two groups R (ropivacaine only) and B (ropivacaine with butorphanol). Group R patients received 0.2% ropivacaine epidurally (10 mL) while group B patients received 0.2% ropivacaine and 1 mg butorphanol epidurally (10 mL). Baseline respiratory rate, oxygen saturation, partial pressure of oxygen (PaO2), visual analog score (VAS), peak inspiratory flow rate (PIFR) were noted in both the groups. Results: There was significant increase in duration of analgesia and nonsignificant reduction in VAS score in group B, and nonsignificant decrease in invasive ventilation cases and significant reduction in length of intensive care unit (ICU) stay in group B. There were no significant adverse effects in both the groups except for nausea in group B. Conclusion: Butorphanol as an adjuvant to epidural analgesia leads to better oxygenation, decrease in length of ICU stay and duration of mechanical ventilation without increase in significant side effects.

A comparative study to evaluate the efficacy of butorphanol as an adjuvant to epidural analgesia for rib fractures

Background: Pain management through epidural catheters has emerged as optimal method of pain control in patients with rib fractures. This study was done to evaluate the efficacy of butorphanol in this subset of patients. Materials and Methods: Sixty patients were randomly allocated in two Groups R and B. Group R patients received 0.2% ropivacaine epidurally (10 mL) while Group B patients who received 0.2% ropivacaine and 1 mg butorphanol epidurally (10 mL). Baseline respiratory rate, oxygen saturation, partial pressure of oxygen, visual analog score (VAS), and peak inspiratory flow rate were noted in both the groups. Results: There was a significant increase in duration of analgesia and nonsignificant reduction in VAS score in Group B and nonsignificant decrease in invasive ventilation cases and significant reduction in length of Intensive Care Unit (ICU) stay in Group B. There were no significant adverse effects in both the groups except for nausea in Group B. Conclusion: Butorphanol as an adjuvant to epidural analgesia leads to better oxygenation, decreased length of ICU stay, and duration of mechanical ventilation without increase in significant side effects.

Intravenous Dexmedetomidine enhances the Duration of Spinal Anesthesia with 0.5% Hyperbaric Bupivacaine in Lower Abdominal Surgeries

ABSTRACT Introduction Spinal block is a preferred technique for most lower abdominal and lower limb surgeries. Lignocaine had been the local anesthetic of choice for decades in such surgeries. With the advent of adjuvants, now it has become possible to enhance the duration of spinal anesthesia. These adjuvants can be given intravenously or intrathecally. Intravenous clonidine and dexmedetomidine have been used in recent studies as adjuvant in spinal anesthesia with promising results. Dexmedetomidine is a more suitable adjuvant compared with clonidine due to its more selective alpha-2A receptor agonist activity. Aims and objectives To evaluate the effect of intravenous dexmedetomidine on spinal anesthesia with 0.5% bupivacaine in lower abdominal surgeries in terms of onset and duration of sensory and motor blockade and sensory regression. Materials and methods Sixty patients of American Society of Anesthesiologists grades I and II, 25 to 60 years of age, posted for elective lower abdominal surgeries under spinal anesthesia were included in the study and randomly allocated into computer-generated two groups. Group IV received intrathecal 0.5% bupivacaine heavy and intravenous infusion of dexmedetomidine 1 μg/kg over 20 minutes followed by 0.5 μg/kg/hour till the end of surgery. Patients in group III (control group) received intrathecal 0.5% bupivacaine heavy and intravenous normal saline as placebo. Results In groups IV and III, mean duration of analgesia was 209 ± 29.93 and 150.20 ± 3.46 minutes respectively. This increase in duration of analgesia in dexmedetomidine group was statistically significant. The mean duration of motor blockade was 189.48 ± 1.34 and 158.18 ± 3.27 minutes respectively. Injection diclofenac sodium 75 mg intramuscularly was used as rescue analgesic. How to cite this article Sharma YK, Agrawal M. Intravenous Dexmedetomidine enhances the Duration of Spinal Anesthesia with 0.5% Hyperbaric Bupivacaine in Lower Abdominal Surgeries. Int J Adv Integ Med Sci 2017;2(3):144-148.

Comparison of different doses of magnesium sulphate and fentanyl as adjuvants to bupivacaine for infraumbilical surgeries under subarachnoid block.

Background and Aims:Spinal anaesthesia is used for many years for surgeries below the level of umbilicus. It has certain disadvantages such as limited duration of blockade and post-operative analgesia. This study was undertaken to evaluate the effects of additives fentanyl and magnesium sulphate along with bupivacaine during spinal anaesthesia for prolongation of analgesia and motor blockade.Methods:This randomised study was conducted in 120 patients of either sex of American Society of Anesthesiologists physical status I and II, posted for infraumbilical surgeries. Patients were randomly allocated to four groups and were given the following drugs intrathecally as per group distribution; group A - bupivacaine 15 mg (0.5% heavy) with fentanyl 25 μg, group B - bupivacaine 15 mg (0.5% heavy) with magnesium 100 mg, group C - bupivacaine 15 mg (0.5% heavy) with magnesium 50 mg and group D - bupivacaine 15 mg (0.5% heavy) with 0.5 ml normal saline. Parameters monitored were duration of analgesia along with haemodynamic parameters and side effects. Data were analysed using the Student's t-test for the continuous variables and two-tailed Fisher exact test or Chi-square test for categorical variables.Results:There was significant increase in duration of analgesia in group A (374.37 min) and B (328.13 min) as compared to group C (274.87 min) and D (246.03 min). In group A, all haemodynamic parameters decreased by more than 20%, compared to baseline parameters, which was clinically and statistically significant as compared to other groups. There was also increase in duration of motor blockade in groups A and B.Conclusion:Addition of magnesium sulphate at 100 mg dose or fentanyl 25 μg as adjuvants to intrathecal bupivacaine significantly prolongs the duration of analgesia, though in the given doses, magnesium provides better haemodynamic stability than fentanyl, with fewer side effects.

Effects of Citicoline Sodium on corneal reflex, anesthesia and analgesia duration after thiopental sodium injection in dogs- A preliminary report

Citicoline is a natural substance with neuroprotective and repairing effects. It can also increase the phosphor metabolites in cerebral cortex. Regarding the various effects of citicoline on central nervous system, this research aims at studying the effects of citicoline on the Thiopental sodium anesthesia. Six dogs were anesthetized by intravenous injection of 20 mg ∕ kg of 2.5% Thiopental sodium. After the appearance of recovery signs, both experimental and control groups received either 250 mg citicoline or two milliliter normal saline intravenously, immediately before the second injection of Thiopental sodium. Length of anesthesia, duration of analgesia and response to corneal reflex were measured, and statistically analyzed. Results showed a significant increase in duration of analgesia and a significant decrease in the length of negative corneal reflex in experimental group. Comparison of duration of anesthesia between the two groups showed no significant difference. These findings showed that using citicoline prior to Thiopental sodium anesthesia can improve brain function by decreasing the duration of lack of response to corneal reflex and also regarding the increasing effect of Citicoline on analgesia duration, the use of citicoline as a pre-anesthetic for Thiopental Sodium can probably be considered in the future studies.

Combined spinal-epidural labor analgesia

Combined spinal-epidural (CSE) labor analgesia is a new neuraxial labor analgesic technique. An intrathecal injection of an opioid alone, or in combination with a local anesthetic, initiates analgesia. An epidural catheter can then be used to maintain pain relief for the duration of labor. The CSE technique combines the advantages of spinal analgesia (low drug doses, rapid onset, immediate sacral block) and epidural analgesia (titratable, able to maintain analgesia indefinitely, ability to convert to epidural anesthesia). Side effects are acceptable with attention to patient selection and technique. The initiation of CSE analgesia with either fentanyl (25 μg) or sufentanil (5.0–7.5 μg) is appropriate for early labor, or in patients for whom an acute decrease in preload is not desirable. Although an equipotent dose of sufentanil has a longer duration of analgesia than fentanyl, both drugs provide excellent analgesia and prolonged duration is of minimal clinical significance when the intrathecal dose is followed by maintenance epidural analgesia. The addition of a local anesthetic to the opioid is required to provide satisfactory analgesia once fetal descent begins. The addition of local anesthetic (usually bupivacaine 1.25–2.5 mg) allows the dose of opioid to be decreased. Markedly lower opioid doses (fentanyl 5 μg or sufentanil 1.0–2.5 μg) can then provide effective analgesia with fewer systemic side effects. Several additives have been shown to prolong the duration of analgesia of opioids and opioids plus bupivacaine, but the short increase in duration of analgesia may not be worth the increased difficulty of combining multiple drugs.

Nonopioid additives to local anaesthetics for caudal blockade in children: a systematic review.

Caudal epidural injection with local anaesthetics is a popular regional technique used in infants and children. A disadvantage of caudal blockade is the relatively short duration of postoperative analgesia. Opioids have traditionally been added to increase the duration of analgesia but have been associated with unacceptable side-effects. A number of nonopioid additives have been suggested to increase the duration of analgesia. A systematic review was conducted to identify randomized control trials comparing the use of local anaesthetic to local anaesthetic with nonopioid additives for caudal blockade in children. The increase in duration of analgesia and side-effects were compared. The addition of clonidine to the local anaesthetic solution produces an increase in the duration of analgesia following caudal blockade in children (pooled weighted mean difference of 145 min with 95% confidence interval of 132-157 min). Side-effects include sedation and the potential for neonatal respiratory depression. Ketamine and midazolam further increase the duration of analgesia, however, the potential for neurotoxicity remains a concern. The evidence examined shows an increased duration of analgesia with clonidine, ketamine and midazolam. However, we are not convinced that the routine use of these adjuvants in the setting of elective outpatient surgery shows improved patient outcome. It is unclear if the potential for neurotoxicity is outweighed by clinical benefits. Further testing, including large clinical trials, is required before recommending routine use of nonopioid additives for caudal blockade in children.

Intraoperative and postoperative analgesic efficacy and adverse effects of intrathecal opioids in patients undergoing cesarean section with spinal anesthesia: a qualitative and quantitative systematic review of randomized controlled trials.

SPINAL anesthesia is commonly used for cesarean section, and it has become a popular practice to add opioids to spinal solutions to enhance and prolong intraoperative and postoperative analgesia. Morphine and fentanyl are the opioids most often used for this purpose, but there is not a general consensus about the benefits of the various regimens, and the incidence of side effects with different opioids and doses is controversial. Recently, a number of systematic reviews have been published in the field of pain and perioperative medicine. The aim of a systematic review is to summarize available information from controlled clinical trials to produce evidence-based estimates of the true clinical effect of an intervention. The purpose of this systematic review was to investigate the effect of intrathecal opioids added to spinal anesthesia on intraoperative and postoperative pain and to evaluate adverse effects in patients scheduled for cesarean section, using evidence from all relevant randomized controlled and blinded trials.

THE DURATION OF ACTION OF BUPIVACAINE, PRILOCAINE AND LIGNOCAINE

SUMMARY The duration of analgesia and of hypoaesthesia produced by a variety of solutions has been examined by skin weal testing; each separate study was carried out in twenty female volunteers under double-blind conditions. First, bupivacaine, lignocaine and prilocaine were compared with and without 1 in 200,000 adrenaline. Bupivacaine was found to give significantly longer analgesia than prilocaine and significantly longer hypoaesthesia than both the other agents. Adrenaline significantly lengthened the action of all three drugs, this prolongation being greatest with lignocaine. The second part of the trial compared the duration of action of hospital-prepared and commercially prepared solutions of the three local analgesics plus adrenaline. The commercial ampoule preparations provided significantly longer action than the corresponding drugs in hospital-prepared multidose vials. The third group of experiments studied the effect of doubling the concentrations of the solutions; there was no great increase in duration of analgesia but the duration of hypoaesthesia was lengthened, significantly so with bupivacaine. Throughout all the above studies the individual results with bupivacaine showed a greater range of variation than those with the other agents. Finally the analgesic effect of saline (with and without adrenaline) was investigated; it was found that both agents generally produced a similar brief period of hypoaesthesia. The findings and their practical implications are discussed.