mL Of Bupivacaine Hydrochloride Research Articles

Comparison of the Analgesic Effect of Subcutaneous Bupivacaine Infiltration and Intravenous Diclofenac vs. Intravenous Diclofenac Monotherapy After Inguinal Hernioplasty: A Retrospective Study.

BackgroundPostoperative pain is a significant problem encountered by patients after a surgical intervention, and there is a crucial need for effective postoperative pain control. The studies have shown that multimodal analgesia and wound infiltration are effective ways to reduce this pain and have a substantial role in the reduction of postoperative medications requirement. This study aimed to evaluate the effect of subcutaneous infiltration of bupivacaine hydrochloride and intravenous (IV) diclofenac as postoperative pain relief in adults undergoing inguinal hernia repair.MethodsA single-center retrospective study included 104 patients aged 18-65 undergoing unilateral inguinal herniorrhaphy at the selected hospital. The patients were in two groups of 52 each. Group A received a 75 mg dose of IV diclofenac plus a subcutaneous injection of 10 mL of bupivacaine hydrochloride (HCl) 0.5% while Group B only received the IV diclofenac without the bupivacaine injection. The postoperative pain was assessed at one, two, three, six, and 12 hrs after the operation using the visual analog scale (VAS), which exhibited a range of pain from zero (no pain) to 10 (extreme pain).ResultsOf a total of 104 patients, 92% of patients were male. The patients' mean age was 36 ± 11 years, and the mean body mass index (BMI) was 22 ±3 kg/m2. American Society of Anesthesiologists physical class I was similar in both groups (90.4% versus 84.6%). Patients in Group A had significantly lower VAS pain scores at one, two, three, six, and 12 hrs after the operation and a longer emergence time than Group B (all p-values were < 0.001). Subcutaneous bupivacaine infiltration and IV diclofenac were also found to be an effective analgesic technique in open hernia repair with mesh (p-value < 0.001 for all).ConclusionSubcutaneous injection of bupivacaine combined with IV diclofenac provides superior analgesia to monotherapy intravenous diclofenac after inguinal hernia repair.

Analgesic Effect of Morphine Added to Bupivacaine in Serratus Anterior Plane Block Following Modified Radical Mastectomy. Only a Local Effect? Randomized Clinical Trial.

BackgroundSerratus anterior plane (SAP) block, a novel regional anesthetic procedure, involves the anterolateral chest wall. Opioid receptors have been found on peripheral nerve terminals, so morphine may have a local action.ObjectiveThis work aimed at exploring the analgesic efficacy of morphine added to bupivacaine in SAPB in patients for whom modified radical mastectomy was conducted and whether it is a mere local effect.MethodsForty female patients were planned to have modified radical mastectomy participated in the study. Patients were randomly divided into two groups; Control group (C): received ultrasound-guided serratus anterior plane block with 20 mL of bupivacaine hydrochloride 0.25%; Morphine group (M): received the same in addition to 10 mg morphine sulfate. Intra- and post-operative blood samples were taken for the assessment of morphine serum levels. All patients were assessed for VAS scores during rest and movement (VAS-R and VAS-M). Time to the first request and the total amount of the rescue analgesia were recorded.ResultsIn group M, Morphine was not detected in the plasma of all patients. Both VAS-R and VAS-M were significantly higher in group C than in group M (P<0.001) and (P≤0.003), respectively. Time to the first request of rescue analgesia was 8.5 h in group C compared to 20 h in group M (P=0.005) with a median dose of acetaminophen consumption of 2 g in group C compared to 1 g in group M (P=0.006).ConclusionTen mg of morphine, when added to bupivacaine in SAPB, improved postoperative analgesia in patients to whom modified radical mastectomy was conducted. This effect seems to be attributed merely to local mechanisms.RegistrationThe registration number of this study is NCT02962024 at www.clinicaltrial.gov.

1206 The Effect of Sub-Cutaneous and Intra-Peritoneal Anesthesia on Post Laparoscopic Pain: A Randomized Controlled Trial

Study Objective To evaluate whether sub-cutaneous (SC) trocar site and intra-peritoneal (IP) anesthesia reduce post-operative pain. Design This is a randomized, controlled, double-blinded trial. The patients were randomly assigned to one of 4 groups: Group 1-SC and IP anesthesia; Group 2- SC anesthesia and IP placebo; Group 3- SC placebo and IP anesthesia; Group 4- SC and IP placebo. The patients, surgeons, and pain evaluators were all blinded to the patient's allocation. Setting A single tertiary hospital. Patients or Participants Patients who underwent elective laparoscop and gave their informed consent. Exclusion criteria were: malignancy, active infection, pregnancy, known sensitivity to Bupivacaine-Hydrochloride, chronic pelvic pain, conversion to laparotomy, or additional vaginal procedures. Interventions A total of 9 ml of Bupivacaine-Hydrochloride (Marcaine) 0.5%, or Sodium-Chloride 0.9%, as a placebo, were injected sub-cutaneously to the trocar site, prior to skin incision. In addition, 10 ml of Bupivacaine-Hydrochloride 0.5%, diluted with 40 ml of Sodium-Chloride 0.9%, or 50 ml of Sodium-Chloride 0.9%, as a placebo, were injected intra-peritoneally at the end of the surgery. Measurements and Main Results By using 10 cm Visual-analogue-scale (VAS) we assessed the pain at rest at 3, 8, and 24 hours, and pain during movement at 8 and 24 hours after surgery. One hundred and twenty women were included (30 patients in each). Demographic data, as well as operations' characteristics, were similar between the groups. The level of post-operative pain, either at rest or movement, was not significantly different between the groups, in all points of time. There were also no differences in pain levels when all SC analgesia groups (1&2) were compared to all SC placebo groups (3&4), and when all IP analgesia groups (1&3) were compared to all IP placebo groups (2&4). Conclusion Sub-cutaneous and/ or intra-peritoneal anesthesia were not effective in reducing post-operative pain. To evaluate whether sub-cutaneous (SC) trocar site and intra-peritoneal (IP) anesthesia reduce post-operative pain. This is a randomized, controlled, double-blinded trial. The patients were randomly assigned to one of 4 groups: Group 1-SC and IP anesthesia; Group 2- SC anesthesia and IP placebo; Group 3- SC placebo and IP anesthesia; Group 4- SC and IP placebo. The patients, surgeons, and pain evaluators were all blinded to the patient's allocation. A single tertiary hospital. Patients who underwent elective laparoscop and gave their informed consent. Exclusion criteria were: malignancy, active infection, pregnancy, known sensitivity to Bupivacaine-Hydrochloride, chronic pelvic pain, conversion to laparotomy, or additional vaginal procedures. A total of 9 ml of Bupivacaine-Hydrochloride (Marcaine) 0.5%, or Sodium-Chloride 0.9%, as a placebo, were injected sub-cutaneously to the trocar site, prior to skin incision. In addition, 10 ml of Bupivacaine-Hydrochloride 0.5%, diluted with 40 ml of Sodium-Chloride 0.9%, or 50 ml of Sodium-Chloride 0.9%, as a placebo, were injected intra-peritoneally at the end of the surgery. By using 10 cm Visual-analogue-scale (VAS) we assessed the pain at rest at 3, 8, and 24 hours, and pain during movement at 8 and 24 hours after surgery. One hundred and twenty women were included (30 patients in each). Demographic data, as well as operations' characteristics, were similar between the groups. The level of post-operative pain, either at rest or movement, was not significantly different between the groups, in all points of time. There were also no differences in pain levels when all SC analgesia groups (1&2) were compared to all SC placebo groups (3&4), and when all IP analgesia groups (1&3) were compared to all IP placebo groups (2&4). Sub-cutaneous and/ or intra-peritoneal anesthesia were not effective in reducing post-operative pain.

Effect of adding midazolam to bupivacaine during rectus sheath block: a randomised controlled trial.

Various adjuvants have been tried to improve quality and increase duration of local anaesthetics during various nerve blocks. We aimed to evaluate the effect of adding midazolam to bupivacaine on rectus sheath (RS) block in patients undergoing umbilical or epigastric hernia repair. In all, 60 adult patients were divided into two equal groups, each group included 30 patients. Group I received 20ml of bupivacaine hydrochloride 0.25% + midazolam 50μg/kg in 2ml saline 0.9% (Midazolam group, n=30), whereas Group II received 20ml of bupivacaine hydrochloride 0.25% + 2ml saline (Control group, n=30) for RS block on each side. The primary outcome was post-operative 48h morphine consumption, whereas secondary outcomes included analgesia duration, post-operative pain, as evaluated by visual analogue scale (VAS) for pain scoring at 1, 2, 6, 12, 24 and 48h post-operatively, reported post-operative nausea and or vomiting (PONV), somnolence or any adverse drug reactions. The current study showed that addition of midazolam to bupivacaine for RS blockade provided good analgesia as evidenced by a statistically significant less morphine consumption in the post-operative 48h [11.2 (5.3-18.3) vs. 25.9 (15.2-31.0) mg, P=0.002], longer duration of analgesia, lower VAS during post-operative 48h, lower incidence of PONV, somnolence and pruritus. Midazolam addition to bupivacaine for RS blockade provided adjuvant analgesia as supported by less morphine consumption, longer duration of analgesia, and lower VAS score.

Dexmedetomidine in a surgically inserted catheter for transversus abdominis plane block in donor hepatectomy: A prospective randomized controlled study.

Background:Transversus abdominis plane (TAP) block is a promising technique for analgesia after abdominal surgery. This prospective, randomized controlled trial assessed the effect of adding dexmedetomidine to bupivacaine in TAP block for donor hepatectomy. We hypothesized that this would improve postoperative morphine consumption and reduce analgesia related complication and inflammation.Methods:A total of 50 donor hepatectomy were enrolled in this study. Patients divided into two equal groups according to drugs used for TAP block. Group (B) received 20 ml of bupivacaine hydrochloride 0.25%, Group (BD) received 20 ml of bupivacaine hydrochloride 0.25% and 0.3 μg/kg dexmedetomidine, on both sides at the end of surgery and every 8 h for 48 h at right side only through inserted catheter. Primary outcome objective was morphine consumption at first 72 h. Secondary outcome objectives were morphine requirement, numbers of intake, time to first intake, pain score numerical analog scale (NAS), postoperative analgesia related complications, recovery of intestinal motility, and inflammatory markers.Results:Data were analyzed, rescue morphine analgesia was significantly lower in (BD) group compared with (B) groups as considering total morphine consumption (B 4 ± 1.9, BD 1.5 ± 0.5, P = 0.03), numbers of morphine intake (P = 0.04), morphine requirement (P = 0.03), and first time of analgesia intake (P = 0.04). NAS was significantly lower in group (BD) compared with group (B) group in the first 12 h (NAS 0 - P = 0.001, NAS 1 - P = 0.03). Adding dexmedetomidine improved gut motility, first oral intake without detectable anti-inflammatory effect.Conclusion:Adding dexmedetomidine to bupivacine in a surgically inserted catheter for TAP block in donor hepatectomy reduced morphine consumption without detectable anti-inflammatory effect.

Effect of Adding Dexamethasone to Bupivacaine on Transversus Abdominis Plane Block [Transversus Abdominis Plane Bloga Eklenen Deksametazonun Etkisi

We aimed to evaluate the effect of dexamethasone added TAP block on postoperative analgesia accompanied by ultrasound in the TAH. After obtaining the Ethics Committee and the patient's consent a total of 60 ASA I-II patients undergoing planned total abdominal hysterectomy with general anesthesia were enrolled in the study. After surgical termination, ultrasound guided TAP block was performed by the same anesthesiologist. The patients were randomly divided into two groups using the envelope method. TAP block was obtained with 19 mL of bupivacaine hydrochloride 0.25%+1 mLsaline 0.9% (Group B, n=30) or 19 mL of bupivacaine hydrochloride 0.25%+1 mLdexamethasone (4 mg) (Group BD, n=30). Postoperatif pain scores were evaluated with Visual Analog Scale (VAS) at the recovery room and postoperative 2, 4, 6, 12 and 24 hours. Time to first analgesic requirement, morphine consumption, incidence of nausea and vomiting, and sedation scores were recorded. VAS scores at rest and on movement in recovery room and postoperative 2 h were significantly lower Group BD than Group B (p

Effect of adding dexamethasone to bupivacaine on transversus abdominis plane block for abdominal hysterectomy: A prospective randomized controlled trial

Purpose:Different adjuvants have been used to improve the quality and increase the duration of local anesthetics during various nerve block techniques. The current study was aimed to evaluate the effect of adding dexamethasone to bupivacaine on the quality and duration of transversus abdominis plane (TAP) block.Methods:Sixty adult patients undergoing elective open abdominal hysterectomy were randomly allocated to receive TAP block using 20 mL of bupivacaine hydrochloride 0.25% + 2 mL saline 0.9% (control group, n=30) or 20 mL of bupivacaine hydrochloride 0.25% + 2 mL dexamethasone “8 mg” (dexamethasone group, n=30). The primary outcome was postoperative pain, as evaluated by visual analog scale (VAS) for pain scoring at 1, 2, 4, 12, 24 and 48 h postoperatively, whereas the secondary outcomes were time to first analgesia (TFA), morphine consumption and the occurrence of nausea, vomiting or somnolence.Results:The pain VAS score was significantly lower at the postoperative 2 h (4.9 vs. 28.1, P=0.01), 4 h (12.2 vs. 31.1, P=0.01) and 12 h (15.7 vs. 25.4, P=0.02). Furthermore, TFA was significantly longer in the dexamethasone group (459.8 vs. 325.4 min, P=0.002), with lesser morphine requirements in the postoperative 48 h (4.9 vs. 21.2 mg, P=0.003) and lower incidence of nausea and vomiting (6 vs. 14, P=0.03). No complications attributed to the block were recorded.Conclusion:Addition of dexamethasone to bupivacaine in TAP block prolonged the duration of the block and decreased the incidence of nausea and vomiting.

Evaluation of bupivacaine-induced muscle regeneration in the treatment of ptosis in patients with chronic progressive external ophthalmoplegia and Kearns-Sayre syndrome.

Ptosis is common in patients with mitochondrial disease. Whilst surgical shortening of the levator muscle can mechanically elevate the lid, this procedure does not restore normal movement and leaves patients at risk of corneal exposure due to concomitant ophthalmoparesis. Recent studies have shown that bupivacaine-induced muscle regeneration is capable of reversing the molecular genetic and biochemical defect in patients with mitochondrial myopathies. This study was undertaken to assess the potential of this approach in restoring levator muscle function in patients with mitochondrial disease and ptosis. The levator muscle of one eye in five patients with molecularly genetically confirmed mitochondrial DNA disease and ptosis was directly injected with 3 ml of bupivacaine hydrochloride (0.75%). Levator function was compared before and 3 months after the injection. No objective clinical improvement in levator function was detected following bupivacaine administration. The lack of functional recovery seen in our patients is most likely to result from a failure of bupivacaine to induce sufficient regeneration necessary to improve levator muscle function. This result indicates that consideration now needs to be given to the use of alternative and more potent myotoxic agents capable of inducing a more widespread regenerative response from the endogenous muscle satellite cells which contain low or undetectable amounts of mutant mitochondrial DNA.

Preemptive Pain Control in Patients Having Laparoscopic Hernia Repair

To determine if nonsteroidal anti-inflammatory drugs provide adequate pain control for patients having laparoscopic hernia repair and to compare the effectiveness of ketorolac tromethamine with ibuprofen in reducing postoperative laparoscopic hernia pain. Prospective double-blind randomized study at a 100-bed community hospital. Seventy patients ranging in age from 16 to 83 years scheduled for elective laparoscopic inguinal hernia repair. Patients undergoing laparoscopic hernia repair were enrolled in a double-blind randomized study to compare the 2 treatments. Group 1 received a placebo capsule 1 hour before surgery and ketorolac tromethamine, 60 mg intravenously, at the time of trocar insertion. Group 2 received ibuprofen, 800 mg an hour before surgery, and isotonic sodium chloride solution, 2 mL intravenously, at the time of trocar insertion. In addition, all patients received local infiltration of 30 mL of bupivacaine hydrochloride into their trocar sites. All patients were discharged within 5 hours of the operation and were instructed to take 400 mg of ibuprofen orally every 4 hours for 24 hours whether or not they were experiencing pain. A 24-hour supply of ibuprofen was provided to all study patients. Pain was assessed using the Visual Analog Pain Scale with a maximum pain rating of 100. Assessments were done at the time of and 18 hours after discharge. Postoperative pain 18 and 24 hours after discharge was assessed using a standardized questionnaire in a telephone interview by a registered nurse from the Outpatient Surgical Unit. There was no significant difference in the level of pain experienced by 35 patients who received ketorolac intravenously and 35 who received ibuprofen orally. There was no significant difference between the 2 treatment groups in the amount of pain experienced at discharge and 18 hours after discharge. Pain relief from ibuprofen, 800 mg, administered orally an hour before laparoscopic hernia repair was not statistically different from that obtained with intravenous ketorolac, 60 mg, administered intraoperatively when comparing the hospital discharge pain score and the mean and highest pain scores 18 hours after discharge. Ibuprofen offers equivalent pain control at a lower cost and reduced potential for adverse drug events compared with intravenous ketorolac in patients having laparoscopic hernia repair. No patient required narcotic supplementation, and pain control was judged satisfactory by all the patients.