Local Anesthetic Consumption Research Articles

Addition of Bupivacaine to Sufentanil in Patient-Controlled Epidural Analgesia After Lower Limb Surgery in Young Adults

Background and ObjectivesThe usefulness of adding bupivacaine to an opioid administered by the epidural route is controversial. This study examines both the quality of pain relief and side effects, in particular urinary retention, during patient-controlled epidural analgesia (PCEA) with sufentanil alone or in combination with two different concentrations of bupivacaine.MethodsIn a double-blind randomized study, 60 healthy young adults undergoing open knee or ankle surgery with combined spinal-epidural anesthesia received postoperative analgesia via PCEA with sufentanil alone or with 0.06% or 0.12% bupivacaine. In addition to pain scores at rest and during mobilization, bladder function was evaluated. Strict criteria were respected in scoring the occurrence of problems suggestive of urinary retention. The 24-hour analgesic consumption and the incidence of other side effects were also recorded.ResultsPatients receiving bupivacaine had better pain relief than those receiving only the opioid, but this difference was more pronounced when measuring dynamic pain scores. The consumption of sufentanil was significantly higher in the group receiving the opioid alone than in the group receiving 0.06% bupivacaine. The bupivacaine dose requirements were twice as high with the 0.12% concentration. Bladder problems occurred significantly more frequently in patients treated with the highest bupivacaine concentration. Motor impairment was not a major problem.ConclusionsA 0.06% bupivacaine-sufentanil combination offered the best results in terms of analgesic quality and lower side effects, mainly micturition problems, which may be explained by the higher consumption of local anesthetic at the higher bupivacaine concentration. Analgesic quality could not be improved by increasing the bupivacaine concentration.

CONTINUOUS "3-IN-1" BLOCK (CB) AFTER TOTAL HIP REPLACEMENT (THR)

S315 When using a continuous infusion of 10 ml/h of a local anesthetic solution, CB was effective to relieve pain after THR. [1] After hand surgery, PCA technique via an axillary catheter provided good postoperative analgesia and reduced local anesthetic consumption. [2] The aim of this study was to assess the analgesic efficacy of CB when using Patient Controlled infusion after THR. METHODS: After informed consent, 45 ASA class 1-3 patients scheduled for elective THR under general anesthesia (GA) were included in this study. Before GA, CB was performed following Winnie's landmarks. [3] A 20G catheter was threaded 10-15 cm into the psoas compartment and 40 ml 0.25% bupivacaine with epinephrine 1/200000 were injected. The patients were randomly divided into 3 groups of 15. During the first 48 postoperative hours, CB was maintained by a continuous infusion of 0.125% bupivacaine + sufentanil 0.1 [micro sign]g/ml + clonidine 1 [micro sign]g/ml (BSC) at 10 ml/hour in Group 1, and by PCA boluses of BSC in groups 2 (dose: 10 ml - lockout: 60 min.) and 3 (dose: 5 ml - lockout: 30 min.). VAS at rest (R) and on movement (M) (0: no pain - 10: severe pain) at 24 and 48 hours, satisfaction score (0: unsatisfied - 10: completely satisfied) at 72 hours, supplemental analgesia (paracetamol (Parac) and/or piritramide (synthetic opioid (Pirit)), bupivacaine (Bupi) consumption and side effects were recorded. Statistical analysis was done with ANOVA and LSD test and X2 when appropriate. A p value < 0.05 was considered significant. Results are expressed as mean +/- SD. RESULTS: Population data were comparable in all groups. Studied variables are presented in Table 1.Table 1No difference was noted between the groups in terms of supplemental analgesia and side effects. A significantly higher pain score on movement was noted in group 1 at 48 hours. When compared with group 1, bupivacaine consumption was significantly lower in groups 2 and 3. Satisfaction score was significantly higher in group 3 when compared with both other groups. CONCLUSIONS: When compared with continuous infusion, CB with PCA technique provides better pain relief on movement, reduces the consumption of local anesthetic, and increases the satisfaction score after THR. In our experience, PCA boluses of 5 ml/30 min. is the infusion technique of choice for CB after THR.

Labor pain relief using bupivacaine and sufentanil: Patient controlled epidural analgesia versus intermittent injections

Objectives To determine whether the use of patient-controlled epidural analgesia (PCEA) versus intermittent injections (CIT) resulted in local anesthetic dose reduction. Study Design PCEA and CIT using a mixture of 0.125% bupivacaine with sufentanil 1 or 0.75 μg/ml were compared in 60 and 195 parturients, respectively. Assessments included pain scores, local anesthetic consumption, degree of motor blockade, type of delivery and neonatal outcome. Statistical analysis was done using Student's t test and Chi-squares. Results PCEA and CIT provided effective analgesia during labor and delivery. A higher dose of opioid significantly reduced the use of local anesthetic solution in PCEA-patients. There was no difference in motor blockade, type of delivery and neonatal outcome. Conclusion Patient-controlled epidural analgesia is an effective, safe and acceptable alternative to conventional intermittent epidural injections for pain relief during labor and delivery.