Intrathecal Infusion Of Bupivacaine Research Articles

Intrathecal infusion of bupivacaine and clonidine provides effective analgesia in a terminally ill child

The intrathecal infusion of drugs to provide analgesia for terminally ill children with refractory pain is a rarely utilized but very effective technique. A number of pharmacological agents, most commonly opioids and local anesthetics, have been administered intrathecally for this purpose. However, tachyphylaxis and neuraxial opioid-related side effects can limit their utility. The alpha-2 agonist clonidine is commonly used to augment local anesthetic techniques for postsurgical pain in children and for the management of refractory cancer pain in adults, but there is only a single report of the use of clonidine intrathecally in a terminally ill child. We present the case of the youngest reported child to have received intrathecal analgesia for terminal care: a 3-year-old boy with advanced pelvic rhabdomyosarcoma, whose refractory pain was managed effectively with an intrathecal infusion of bupivacaine and preservative-free clonidine.

Combination Spinal Analgesic Chemotherapy: A Systematic Review

Combination Spinal Analgesic Chemotherapy: A Systematic Review

Combination spinal analgesic chemotherapy: a systematic review.

Combination spinal analgesic chemotherapy: a systematic review.

Utility of Continuous Intrathecal Infusion of Bupivacaine and Fentanyl for Postoperative Pain Following Orthopedic Joint Replacement after Accidental Dural Puncture

Utility of Continuous Intrathecal Infusion of Bupivacaine and Fentanyl for Postoperative Pain Following Orthopedic Joint Replacement after Accidental Dural Puncture

Intrathecal Infusion of Bupivacaine With or Without Buprenorphine Relieved Intractable Pain in Three Patients With Vertebral Compression Fractures Caused by Osteoporosis

Intrathecal Infusion of Bupivacaine With or Without Buprenorphine Relieved Intractable Pain in Three Patients With Vertebral Compression Fractures Caused by Osteoporosis

Long-Term Intrathecal Infusion of Opioid and/or Bupivacaine in the Prophylaxis and Treatment of Phantom Limb Pain

Introduction and Methods. A prospective, open case study was performed on 37 patients, given intrathecal (IT) bupivacaine alone or bupivacaine/opioid combinations for refractory pain located in the extremities to explore the potential of this therapy for prophylaxis against post-amputation pain (PLP) and/or the treatment of severe, established PLP. Intrathecal infusions were administered before, during, and after amputation, as an attempt to prevent PLP ("prophylaxis group"; n = 21), or to relieve existing severe PLP after previous amputations ("treatment group"; n = 16). Results. All patients but one in the prophylaxis group obtained 60-100% pain relief during intrathecal therapy. Systemic daily doses of opioid decreased approximately threefold from pre-intrathecal therapy, analgesic/sedative consumption was reduced by 50% and nocturnal sleep duration improved from 2-4 h to 6-8 h post intrathecal therapy. During post-amputation IT treatment, transient PLP of less than 1 day duration and/or phantom limb sensation (PLS) occurred in 9 patients in the "prophylaxis group" and in 2 patients in the "treatment group." 4 out of 16 patients (25%) in the prophylactic group and 0 out of 10 (0%) in the treatment group presented neither PLP nor PLS after termination of the IT treatment. Conclusions. Continuous IT infusion of bupivacaine with or without opioid gave satisfactory pain relief during the treatment in 95% of the patients. Continuous IT infusion of bupivacaine, alone or in combination with opioid, relieved severe preexisting PLP during the treatment in 100% of the treated patients, but did not prevent its recurrence after the end of the intrathecal treatment.

Intrathecal infusion of bupivacaine with or without morphine for postoperative analgesia after hip and knee arthroplasty

Postoperative pain after major orthopaedic operations can be controlled by continuous intrathecal administration of opioids or local anaesthetics. Effective intrathecal analgesia can be achieved through synergism of low doses of the two analgesic drugs and, possibly, less drug-related adverse effects. Therefore, we have evaluated the usefulness of a combined low-dose bupivacaine and morphine infusion in patients undergoing hip and knee arthroplasty. Spinal anaesthesia was induced in 55 ASA I-III patients with 0.5% bupivacaine 2 ml via a 28-gauge spinal catheter (L3-4 interspace) and 0.5-ml increments were given if needed. Intrathecal 24-h infusions consisted of bupivacaine 2 mg h-1 alone (n = 18), bupivacaine 1 mg h-1 alone (n = 18) or bupivacaine 1 mg h-1 combined with morphine 8 micrograms h-1 (n = 19). The interview after 3, 6, 12 and 24 h included assessment of pain at rest and on movement (VAS scale), occurrence of sensory and motor block and nausea/vomiting. Bupivacaine 1 mg h-1 combined with an infusion of morphine provided as good postoperative analgesia as bupivacaine 2 mg h-1, but motor block disappeared earlier (P = 0.01). Patients in the bupivacaine 1-mg h-1 group required more supplementary doses of oxycodone i.m. than the other groups (P = 0.04). Time to first oxycodone dose from the start of intrathecal infusion did not differ between groups. The frequency of nausea and vomiting was similar in all groups. In spite of this, antiemetic medication was required more often in the bupivacaine 1-mg h-1 group (possible because of opioid rescue medication). On the ward, one patient in the bupivacaine 2-mg h-1 group experienced a new increase in sensory block with concomitant hypotension. One patient in the same group had minor decubitus on the heel of the operated leg, probably because of prolonged motor block. We conclude that intrathecal infusion of a combination of bupivacaine 1 mg h-1 and morphine 8 micrograms h-1 produced adequate postoperative analgesia. Unfortunately, postoperative nausea and vomiting was a frequent disturbing adverse effect.

Evaluation of the usefulness of intrathecal bupivacaine infusion for analgesia after hip and knee arthroplasty

Spinal anaesthesia in 47 ASA I-III patients was induced with 0.5% bupivacaine 2 ml via a 28-gauge spinal catheter (L3-4 interspace) and 0.5-ml increments were given if needed before or during hip or knee arthroplasty. Intrathecal 24-h infusions consisted of 0.5% bupivacaine 0.4 ml h-1 (2 mg h-1) (n = 12), 0.5% bupivacaine 0.2 ml h-1 (1 mg h-1) (n = 12) or saline (n = 11) (12 exclusions). Patients received oxycodone 0.1-0.14 mg kg-1 i.m. for rescue analgesia. Infusion of bupivacaine 2 mg h-1 provided significantly better postoperative analgesia (19 oxycodone doses per group in 24 h) compared with bupivacaine 1 mg h-1 (36 doses of oxycodone per group) and saline (52 doses per group) (P < 0.05). Five patients in the bupivacaine 2-mg h-1 group and none in the other groups had measurable sensory block 24 h after the infusion was started. Three patients in the bupivacaine 2-mg h-1 group, two with concomitant arterial hypotension, and one patient in the bupivacaine 1-mg h-1 group experienced an increase in block on the ward. The incidence of nausea and vomiting was similar in all groups. Although an effective analgesic, intrathecal infusion of bupivacaine 2 mg h-1 cannot be recommended for routine pain relief because of the risk of increasing spinal block. Technical problems (19%) also reduced the overall efficacy of the continuous intrathecal analgesic regimen.