Ml Of Fentanyl Research Articles

Comparison of Ropivacaine with or without Fentanyl in Spinal Anaesthesia for Lower Limb Surgeries

Introduction: Spinal anaesthesia is a preferred technique used for lower limb orthopaedic surgeries. Ropivacaine with its short duration of motor blockade and provision for early ambulation along with addition of spinal additives has proven beneficial to the patient. This prospective, double-blind, randomized controlled study set out to evaluate the effects of 0.75% isobaric ropivacaine with fentanyl versus 0.75% isobaric ropivacaine during lower limb orthopaedic surgeries performed under spinal anaesthesia. Methods: The study enrolled 74 patients, aged 18-65 years of either sex, ASA PS I and II, planned for lower limb orthopaedic surgeries. Patients were randomly allocated to receive either 2.5 ml of 0.75% isobaric ropivacaine and 0.5ml of normal saline (Group R) or 2.5 ml of 0.75% isobaric ropivacaine and 0.5ml of fentanyl (25mcg) (Group RF). Results: The demographic profile, onset time of sensory block to T10 dermatome, time for complete motor blockade, maximum block height, duration of motor block, and haemodynamic parameters did not significantly differ between the two groups. Group R took 200.27 ± 21.28 minutes for the S2 dermatome segment regression, while Group RF took 284.59 ± 32.88 minutes (p-value<0.001). Group RF experienced analgesia for a longer duration (335.68±22.18 min) than Group R (240.00±28.28 min) (p-value<0.001). Conclusion: Fentanyl greatly extends the duration of S2 segment regression and analgesia when combined with ropivacaine; the effects on haemodynamics and motor blockade is clinically negligible and side effects are minimal.

Effects of Continuous Analgesic Titrated Spinal Anesthesia in Elderly Patients Undergoing Hip Fracture Surgery

Background and Objectives: Anesthetizing elderly patients with hip fractures poses a significant challenge in emergency settings, particularly given the aging population both in Algeria and worldwide. With a high prevalence of comorbidities and polypharmacy, effective anesthetic management becomes paramount. Continuous titrated spinal anesthesia (CTSA) has emerged as a promising technique for addressing these complexities by proposing lower doses of local anesthetic (LA) in this patient population. Methods: This retrospective study involved 40 elderly patients (>65 years) undergoing hip fracture repair. Patients received intermittent dosing of a local anesthetic solution via an intrathecal catheter, utilizing 0.25 ml increments of 0.5% isobaric bupivacaine and 0.25 ml of fentanyl (12.5 μg). Evaluation criteria included hemodynamic stability, incidence of hypotension, extent of sensory and motor blockade, total ephedrine consumption, and patient and surgeon satisfaction. Results: A female predominance was noted, with a mean age of 75 years, and 72% classified as ASA ≥ III. Pertrochanteric fractures accounted for 47% of cases, followed by femoral neck fractures at 53%. Nearly all patients achieved a sensory level ≥ D10, with a failure rate of only 2%. Sedation supplementation was required in 20% of cases, with conversion to general anesthesia in one patient. Complications were minimal, including arterial hypotension (3%), vasoconstrictor use (2%), and bradycardia (0.8%). Overall, both patients and surgeons reported high levels of satisfaction. Conclusions: Our findings demonstrate that CTSA is an effective technique for elderly patients undergoing hip fracture repair, offering the advantages of reduced LA doses, excellent hemodynamic stability, and minimal side effects. Its simplicity and cost-effectiveness further enhance its appeal in clinical practice.

A Novel USG-Guided PEC Block with Ropivacaine and Fentanyl for Postoperative Analgesia in Chest Wall Surgeries: A Randomized Controlled Trial

Background: Perioperative analgesia can be administered through various routes to patients undergoing chest wall surgeries. A recently introduced technique is the ultrasound-guided pectoral nerve block, which aims to alleviate pain effectively. Objectives: The purpose of this study is to investigate and compare the total duration of analgesia and the timing of the first rescue analgesia. Methods: In this prospective, randomized, triple-blind study, 60 adult patients scheduled for elective chest wall surgeries were enrolled. They were randomly divided into two equal groups: Group R received 38 mL of 0.2% ropivacaine and 2 ml of normal saline, and group F received 38 mL of 0.2% ropivacaine and 2 mL of fentanyl (100 mcg). All patients were administered general anesthesia and the PEC1 and PEC2 blocks postoperatively prior to extubation. The primary objective was to assess the total duration of postoperative analgesia, the Numeric Rating Scale (NRS) pain score, and the time to first rescue analgesia in both groups. The secondary outcome was the total consumption of postoperative analgesics. Results: The total duration of analgesia, as well as the consumption of paracetamol and fentanyl postoperatively in group F, were 11.02 ± 2.01 hours, 1.5 ± 0.5 g, and 0 mcg, respectively. In contrast, in group R, these were 8.28 ± 0.51 hours, 2.2 ± 0.8 grams, and 35.1 ± 13.4 mcg, respectively. The NRS scores at rest and during movement in group F were lower compared to group R. Conclusions: Ultrasound-guided PEC1 and PEC2 blocks with fentanyl as an adjuvant to ropivacaine have significantly reduced the requirements for analgesia and pain scores.

COMPARISON OF TWO DIFFERENT DOSES OF HYPERBARIC BUPIVACAINE IN SEGMENTAL SPINAL ANESTHESIA FOR LAPAROSCOPIC CHOLECYSTECTOMY

Objective: Thoracic segmental anesthesia, as opposed to general anesthesia (GA), is increasingly preferred by anesthesiologists for laparoscopic cholecystectomy in both sick and healthy patients because it provides favorable operating conditions, a faster block time, and better hemodynamic stability. This study compared the efficacy of two different dosages of hyperbaric bupivacaine administered during segmental spinal anesthesia. Methods: In the current study, 54 American society of anesthesiologists Grade 1 and two patients undergoing elective laparoscopic cholecystectomy were randomly assigned to either Group A, which used 1.5 mL of hyperbaric bupivacaine mixed with 0.5 mL of fentanyl, or Group B, which used 2 mL of hyperbaric bupivacaine mixed with 0.5 mL of fentanyl. Primary objectives were to determine the onset and duration of the sensory and motor block, as well as height of sensory block. Determining the hemodynamic factors and complications were the secondary objectives. The mean, standard deviation, independent t test, Chi-square test, and p-value were used to calculate the data. p<0.05 was regarded as significant. Only some drugs were routinely given to the patient to manage their anxiety, discomfort, shoulder tip pain, etc., before, during, or after operation. Results: Onset of analgesia occurred in 2.5 min for Group A and 2.2 min for Group B. The sensory and motor blocks in Group B lasted longer than in Group A, but the differences were not statistically significant. No patients in either group reported any neurological complications, and there were no discernible differences between the two groups’ hemodynamic and respiratory dysfunctions. Despite some patients experiencing minor discomfort that was easily controlled by midazolam and ketamine in small doses, none of them required the conversion to GA. In two instances, Mephentermine was required to treat hypotension. In every patient, recovery went without a side effect. Conclusion: According to this preliminary study, laparoscopic surgery on healthy people can be performed with segmental spinal anesthesia using low doses of bupivacaine that is just as effective as high doses and present fewer complications.

Randomized controlled study of intrathecal hyperbaric bupivacaine and hyperbaric bupivacaine with fentanyl in caesarean section, government medical college, Suryapet

Background: Spinal anesthesia with hyperbaric bupivacaine and adjuvants such as Fentanyl is now the preferred technique for spinal anesthesia, and is the gold standard for caesarean section. The common procedure is to add such adjuvants in a two-syringe before intrathecal injection into hyperbaric bupivacaine. Drug mixing may alter anesthetic solution density and baricity and may change the distribution of medication in cerebrospinal fluid (CSF). Objectives: In this study, we aimed to assess the effect of comparing block characteristics, intraoperative hemodynamics, and postoperative pain relief in Caesarean section under the subarachnoid block (SAB), following administration of hyperbaric bupivacaine and Fentanyl as a mixture. Methods: The research population consisted of 100 patients parturient women undergoing elective caesarean section under spinal anesthesia with the age ranges aged 20-52 years. By using computer-generated random numbers to obtain they were allocated to one of the two classes of an evenly sized group (50 each). This is a forward-looking, comparative analysis using an inclusive protocol framework for similarly sized classes. Group A received intrathecally 2ml of 0.5% hyperbaric Bupivacaine (10 mg) and Group B received intrathecally 2ml of 0.5% hyperbaric Bupivacaine (10 mg) + 0.5ml of Fentanyl (25 μg) as a concurrent process.

Sequential Intrathecal Injection of Hyperbaric and Isobaric Bupivacaine in Orthogeriatric Lower Limb Surgery, a Prospective Randomized Study.

The hemodynamic consequences of sympathetic blockade under spinal anesthesia remains a major concern especially in elderly frail patients. The baricity of the injected solution remains the principal factor controlling the diffusion of spinal anesthetics and the resulting sympathetic blockade. In this study, the sequential administration of isobaric and hyperbaric bupivacaine (HB) is evaluated regarding the incidence of hypotension during orthogeriatric surgery. Fifty elderly patients (age ＞ 60), scheduled for lower limb orthopedic surgery were randomly divided into two groups. In group HIB (n = 25), sequential injection of two syringes, 1.5 mL of 0.5% HB with 15 μ of fentanyl was injected, followed immediately by 1.5 mL of 0.5% isobaric bupivacaine, and in group HB (n = 25), 3 mL of 0.5% HB mixed with 15 μ of fentanyl citrate (0.3 mL of fentanyl 50 μg/mL) were used for spinal anesthesia. No statistical difference was found between the two groups regarding patient demographics, comorbidities, or preoperative laboratory data. The absolute incidence of hypotension (16% vs. 44%, P = 0.03) was statistically lower in the HIB group than the HB group. Also, the total number of hypotensive episodes and the need for vasopressor medications were statistically lower in the HIB group than the HB group (P = 0.02 vs. P = 0.01). Our results show a better hemodynamic profile of the sequentially injected mixture with a lower incidence of intraoperative hypotension and subsequent lower vasopressor requirements.

Comparative Study of Epidural Dexmedetomidine, Fentanyl, and Tramadol as Adjuvant to Levobupivacaine for Lower Limb Orthopedic Surgeries.

BackgroundDexmedetomidine, fentanyl, and tramadol as an adjuvant to local anesthetics improve postoperative analgesia when used in epidural anesthesia. We aimed to compare the efficacy of dexmedetomidine, fentanyl, and tramadol as an adjuvant to levobupivacaine in epidural anesthesia.Materials and methodsThis was a double-blinded randomized clinical trial (RCT). One-hundred twenty patients of either sex, aged 18-60 years, American Society of Anesthesiologists (ASA) physical status classification I and II, undergoing elective orthopedic procedures under epidural anesthesia were allocated into four groups of 30 each. The dexmedetomidine group received 15 ml of 0.5% levobupivacaine and 25 μg in 2 ml of dexmedetomidine, the fentanyl group received 15 ml of 0.5% levobupivacaine and 50 μg in 2 ml of fentanyl, the Tramadol group received 15 ml of 0.5% levobupivacaine and 100 mg of tramadol in 2 ml, and the control group received 15 ml of 0.5% levobupivacaine and 2 ml normal saline. Patients were monitored for the total duration of analgesia, time of first analgesic requirement, time to reach the T-10 level of sensory block, two-segment regression time of the sensory block, time to reach the motor block (Bromage 3), time to motor regression (Bromage 2), visual analog scale (VAS) scores at 0, 15 minutes, 30 minutes, and the first, second, sixth, twelfth, and twenty-fourth hours postoperatively, total analgesic consumption in 24 hours, and complications, if any, were recorded.ResultsDuring the inter-group comparison, VAS scores were lower, the duration of analgesia was longer, and the total analgesic consumption was less in the dexmedetomidine group compared to the fentanyl, tramadol, and control groups. The time to onset of sensory block to T-10 and the attainment of motor block up to Bromage 3 was lower in the dexmedetomidine group. Two segment regression and regression of motor block to Bromage score 2 was lowest for the dexmedetomidine group compared to the other groups. A lower incidence of hypotension and bradycardia was noted with dexmedetomidine.ConclusionsDexmedetomidine is the better alternative as an adjuvant to epidural anesthesia, with faster onset, good quality, and prolonged duration with no relevant adverse effects.

Sequential Intrathecal Injection of Hyperbaric and Isobaric Bupivacaine in Orthogeriatric Lower Limb Surgery, a Prospective Randomized Study.

The hemodynamic consequences of sympathetic blockade under spinal anesthesia remains a major concern especially in elderly frail patients. The baricity of the injected solution remains the principal factor controlling the diffusion of spinal anesthetics and the resulting sympathetic blockade. In this study, the sequential administration of isobaric and hyperbaric bupivacaine (HB) is evaluated regarding the incidence of hypotension during orthogeriatric surgery.Fifty elderly patients (age ＞ 60), scheduled for lower limb orthopedic surgery were randomly divided into two groups. In group HIB (n = 25), sequential injection of two syringes, 1.5 mL of 0.5% HB with 15 μ of fentanyl was injected, followed immediately by 1.5 mL of 0.5% isobaric bupivacaine, and in group HB (n = 25), 3 mL of 0.5% HB mixed with 15 μ of fentanyl citrate (0.3 mL of fentanyl 50 μg/mL) were used for spinal anesthesia.No statistical difference was found between the two groups regarding patient demographics, comorbidities, or preoperative laboratory data. The absolute incidence of hypotension (16% vs. 44%, P = 0.03) was statistically lower in the HIB group than the HB group. Also, the total number of hypotensive episodes and the need for vasopressor medications were statistically lower in the HIB group than the HB group (P = 0.02 vs. P = 0.01).Our results show a better hemodynamic profile of the sequentially injected mixture with a lower incidence of intraoperative hypotension and subsequent lower vasopressor requirements.

A prospective randomized study comparing 0.5% isobaric solutions of levobupivacaine and ropivacaine with fentanyl as an adjuvant for subarachnoid block in patients undergoing elective lower limb surgery

In the present study we compared levobupivacaine with ropivacaine in order to determine the suitability of each drug for spinal anaesthesia. Aim: To compare levobupivacaine with ropivacaine with respect to onset, duration and regression of motor and sensory blockade. This prospective randomized double blinded study was conducted in 100 patients who were randomly assigned to one of the 2 study groups of 50 patients each. The first group was given 2.5 ml levobupivacaine with 0.5 ml fentanyl and second group was given 2.5 ml of ropivacaine with 0.5 ml of fentanyl for spinal anaesthesia. Statistical analysis: Observation obtained both the groups were recorded and tabulated. Analysis was carried out using student’s t test, fischers exact test and chi- square test. Results: Levobupivacaine-fentanyl group had delayed onset of motor and sensory blockade. Ropivacaine-fentanyl group had faster onset and regression of motor and sensory blockade. Conclusion: Ropivacaine-fentanyl combination is a better option when compared to levobupivacaine – fentanyl combination for use in short surgical procedures due to its faster onset of action, early regression of blockade as well as higher success rate. Keywords: Fentanyl, Levobupivacaine, Ropivacaine, Spinal anesthesia.

Single-dose intrathecal analgesia: a safe and effective method of labor analgesia for parturients in low resource areas

BackgroundEpidural analgesia is often said the gold standard of the labor analgesia. But in the areas where the availability of epidural catheters, multiparameter monitors, trained staff is scarce, we need to rethink for single-dose intrathecal analgesia as an alternate yet effective method to provide labor analgesia. The combination we chose for single-shot spinal was heavy bupivacaine 2.5 mg + fentanyl 25 μg + morphine 250 μg, so as to provide an optimal time period of analgesia and lesser need for supplemental analgesics.MethodsThe prospective open-label study was conducted on 100 parturients. Group S (N = 50) received intrathecal injection of 0.5 ml of heavy bupivacaine (2.5 mg) and 0.5 ml of fentanyl (25 μg), and 1 ml of preservative free morphine (250 μg/ml) was given (total volume of 2 ml) using 26 G Quincke spinal needle. Group C (N = 50) were managed according to the institutional protocol of programmed labor for normal vaginal delivery. The duration of analgesia, VAS score, safety and side effects, and progress of labor was noted and compared.ResultsThe progress of labor, mode of delivery, and fetal parameters was similar in both the groups. But the parturients in the group S had lower VAS score with a pain-free period of 238.96 ± 21.88 min, without any noted side effects.ConclusionSingle-dose intrathecal analgesia with heavy bupivacaine 2.5 mg + fentanyl 25 μg + morphine 250 μg can be used efficaciously covering the complete duration of labor in both primigravida and multigravida with no increase in instrumental delivery or C-section rate or other side effects.Trial registrationInstitutional Ethics Committee, Indira Gandhi Medical College, Shimla. Number: ECR/533/IST/HP/2014. Registered on 12 August 2017

Comparative study between Fentanyl with (Lidocaine and Bupivicaine) Versus (Lidocaine and Bupivicaine) alone in Supraclavicular Brachial Plexus Block in Upper Limb Surgeries

Abstract Background Post operative pain and stress is a very known complication of many surgical procedures which represents a burden for the patient and associated with many complications including stress, myocardial ischemia, prolonged hospital stay and the need of extensive post operative analgesia. Aim of the Work to study the effect of Fentanyl as an adjuvant to bupivacaine and Lidocaine in supraclavicular brachial plexus block. After taking approval from Local Ethical Committee approval and informed written consent from each patient, this randomized prospective comparative study was conducted on 60 patients who were divided into two groups: Group A (Control group): 20 ml of 0.5% bupivacaine + 6 ml of lidocaine hydrochloride 2% + 1 ml of Normal Saline 0.9%. Group B (Fentanyl group): 20 ml of 0.5% bupivacaine + 6 ml of lidocaine hydrochloride 2% + 1ml of fentanyl 50 ug/ml. Results our study showed that addition of a 50 microgram of fentanyl to bupivacaine and lidocaine in ultrasound-guided supraclavicular nerve block has statistically significant effect on the onset of sensory and motor block and prolonged the duration of the sensory and the motor block. In addition, fentanyl prolonged the duration of analgesia of the plexus block significantly, as proved by the time of request of first analgesia. Moreover, in fentanyl group, postoperative analgesic requirements were greatly lesser than that of bupivacaine and lidocaine groups. Addition of fentanyl also did not affect the hemodynamic to a significant level Conclusion fentanyl with bupivacaine and lidocaine more superior than the use of bupivacaine and lidocaine alone.

Comparison Study of Lignocaine-Bupivacaine with Normal Saline and Lignocaine-Bupivacaine Along with Fentanyl in Supraclavicular Brachial Plexus Block in Mid Arm Surgeries

Background and Objective: brachial plexus block by supraclavicular approach achieve good motor, sensory
 & sympathetic blocked in mid arm surgeries. Several adjuvants have been added to enhance effect of local
 anaesthetic agent in peripheral nerve block. We performed a prospective randomized study to compare
 lignocaine-bupivacaine with normal saline and lignocaine-bupivacaine along with fentanyl for onset, quality
 & duration of block as well as post-operative analgesia.
 Method: Randomized controlled study was carried act among 50 patients of either sex aged 20-50 asa grade
 1 & 2 undergoing mid arm surgeries. patient was randomly divided in two groups. Group 1: 20ml of 0.5%
 bupivacaine + 10ml of 2% lignocaine + 1 ml of normal saline Group 2: 20ml of 0.5% bupivacaine + 10ml
 of 2% lignocaine + 1 ml of fentanyl (50 mcg)
 Time taken for onset of sensory & motor as well as complete duration of block were noted in both groups.
 Any complication during procedure during surgery as well as post operatively were noted & treated.
 Result: Addition of fentanyl (50 mcg) to bupivacaine + lignocaine in peripheral nerve block cause early
 onset for sensory block.
 Mean duration of sensory blockade 440+/-62 in group 1 while 635+/-84 in group 2. mean duration of
 analgesia 400+/-68 in group1 while 685+/-90 in group 2
 It suggests that duration of sensory block and analgesia was prolonged in group 2
 Conclusion: The addition of small-dose fentanyl to lignocaine solution in brachial plexus block can increase
 the success rate and prolong the duration of analgesia, [16]with early onset time of sensory blockade as
 compared with that achieved by the same doses of local anaesthetics used in combination.

Unilateral versus bilateral spinal anaesthesia in geriatric patients undergoing hemiarthroplasty: a comparative study.

Conventional bilateral spinal anaesthesia can produce haemodynamic alterations that can be detrimental to geriatric patients. Unilateral spinal anaesthesia produces predominant blockade on the operated side, thereby reducing the incidence of hypotension. There is a scarcity of comparative studies evaluating the effects of unilateral spinal anaesthesia in the elderly population. Therefore, we conducted this study to compare the effects of unilateral and bilateral spinal anaesthesia in geriatric patients. Aprospective, parallel group, randomized, controlled study was conducted on 72 patients of age 60-85 years, ASA physical status Iand II undergoing hemiarthroplasty under spinal anaesthesia. Patients were randomly allocated to two groups: patients in group U(n = 36) received unilateral spinal anaesthesia, those in group B (n = 36) received bilateral spinal anaesthesia. All patients received 1.5 mL of hyperbaric bupivacaine (0.5%) and 0.5 mL of fentanyl intrathecally in the lateral decubitus position. Patients in group B were turned to the supine position and those in group Umaintained the lateral decubitus position for 15 minutes. Intraoperative and postoperative haemodynamic parameters, Bromage score and sensory block height were compared. Hypotension in group B patient was more pronounced compared to group U. There was no significant difference in the Bromage score and the number of patients reaching T10 sensory block height on the operated side between the two groups. The Bromage score and the number of patients reaching T10 sensory block height on the non-operated side were higher in group B. In geriatric patients unilateral spinal anaesthesia produces predominant motor and sensory block on the operated side with less hypotension.

Intradermal Sterile Water Injection versus Epidural Bupivacaine in Painless First Stage of Labor

Background: Many women have moderate to severe low back pain during labor. It has been shown that injection of sterile water can reduce the pain of 1ststage. This method is very cheap, easy to learn and can be used as alternative method for reducing the labor pain. Objectives: The aim of this study was to compare the effectiveness, women satisfaction safety and safety of intradermal sterile water injection and epidural bupivacaine in decreasing the pain of1st stage of labor. Patients and Methods: After approval of Institutional Ethical Committee and obtaining written informed consent from eligible parturient women, 120 healthy parturient divided into 3 groups. 1st group epidural bupivacaine plus fentanyl, Initiated with 10 ml of bupivacaine 0.125% with 2 micrograms/ ml of fentanyl and maintained with 10 ml/ h of the same mixture. 2nd group intradermal injection of sterile water 0.1 ml, while 3rd group intradermal injection of 0.1 ml normal saline. Results: The study reported good pain relief in epidural and sterile water group compared to normal saline group. Pain relief was comparable in both the epidural and sterile water group. Complications were more demonstrated in epidural compared to the sterile water and the normal saline groups. A good maternal satisfaction in epidural and sterile water group with no satisfaction in the normal saline group. Conclusion: The evidence from this study suggests that sterile water injections are safe and effective method for relieving pain of the 1st stage of labor similar to epidural bupivacaine analgesia.

To compare the efficacy of ropivacaine with fentanyl v/s levobupivacaine with fentanyl in post-operative epidural analgesia in lower limb and lower abdominal surgeries

Aims: To compare the efficacy of ropivacaine V/S levobuivacaine with fenatnyl as adjuvant for post operative analgesia in below umbilicus surgeries under combined spinal and epidural anaesthesia. Settings and Design: A prospective randomized double blind study was planned on 60 ASA grade I and II patients, admitted for elective surgeries. Materials and Methods: Patients were randomly divided into two Groups, Group I (n=30) received ropivacaine 0.1% (10ml of 0.2% ropivacaine) with 2µgm/ml of fentanyl (0.8 ml of fentanyl) & 9.2 ml of normal saline making a total volume of 20 ml, Group II (n=30) received 0.1% levobuivacaine (4 ml of 0.5% levobuivacaine) with 2µgm / ml of fentanyl (0.8 ml of fentanyl) & 15.2 ml of normal saline making a total volume of 20 ml. In both the groups, VAS score at different intervals of time, onset and duration of sensory block, and hemodynamic parameters and complications were assessed. Statistical Analysis Used: Data was expressed as either mean + standard deviation or numbers and percentages and analyses were performed using “Microsoft Excel 2007” for windows. The parameters were analyzed using Student’s Paired and Unpaired t-test. Results: The average duration of sensory block was 276±30.80 and 259±20.95 min for Group I and Group II respectively which were comparable for both Groups (p >0.05). The hemodynamic changes and complications have no significant differences between two groups, (p > 0.05). Conclusions: The combination of ropivacaine and levobupivacine with fentanyl as common adjuvant is equipotent for post-operative epidural anesthesia. Keywords: Ropivacaine, Levobupivacaine, Fentanyl, Epidural.

Incidence of hypotension between Intrathecal Hyperbaric Bupivacaine with and without Fentanyl in Geriatric Patients Undergoing Urological Surgeries

Objective: We aimed to assess the efficacy, the incidence of hypotension and adverse consequences of using intrathecal hyperbaric bupivacaine in comparison to a combination of low dose hyperbaric bupivacaine and fentanyl, in geriatric patients undergoing urological surgeries.Material and Methods: Our study was a prospective, triple-blinded and randomized controlled. One hundred and fortyeight geriatric participants scheduled for urological surgeries were randomly assigned into two groups: Group B (n=74) received intrathecal injection with 0.5% hyperbaric bupivacaine 1.5 milliliters (ml) alone (7.5 milligrams; mg), while Group F (n=74) received 0.5% hyperbaric bupivacaine 1 ml (5 mg) plus 0.5 ml of fentanyl (25 micrograms; mcg) making up to a total volume of 1.5 ml.Results: One hundred and forty-eight patients were included however, six patients were excluded from statistical analysis, due to an inadequate level of anesthesia; hence, 142 patients were analyzed. The incidence of hypotension in group B was: 9.7%, and in group F the percentage was 12.9%, respectively (p-value=0.74). There was no significant difference in regards to the highest sensory level in both groups. The anesthesia level in group B was Thoracic level 11 (T10-T12), and in group F it was 11 (T10-T12) (p-value=0.68), while the analgesia level in group B was Thoracic level 7 (T6-T8) with group F being a Thoracic level 6 (T6-T8) (p-value=0.16). The occurrence of bradycardia, and respiratory depression did not differ between the 2 groups.Conclusion: Intrathecal administration of 5 mg of 0.5% hyperbaric bupivacaine, plus 25 mcg of fentanyl provided an adequate level of sensory blockade, but did not decrease the frequency of hypotension.

The Benefit of Fentanyl in Effective Sedation and Quality of Upper Endoscopy: A Double-Blinded Randomized Trial of Fentanyl Added to Midazolam Versus Midazolam Alone for Sedation.

AimsOur goals were to compare the effect of adding fentanyl to midazolam in a double-blinded, randomized, placebo-controlled trial and determine if fentanyl enhances sedation, increases adverse events or effects time of the procedure or discharge.MethodsPatients 18 to 65 years scheduled for outpatient upper endoscopy were eligible for the study. Patients were randomized to receive either 100 mcg/2 mL of Fentanyl or 2 mL of placebo IV with a double-blinded protocol. All patients received 2 mg of intravenous midazolam initially. Additional midazolam could be given to achieve adequate sedation.ResultsThere were 68 patients randomized to the Fentanyl group and 69 patients to the placebo group. The mean dose of midazolam was 4.0 mg for the Fentanyl group and 5.2 mg for placebo group (P=0.003). Both endoscopist and nurse independently rated sedation to be better in the fentanyl group (P=0001). The patient did not perceive any difference in sedation (P=0.4). Procedure time was significantly shorter in the Fentanyl group (8.5 versus 11.1 minutes, P=0.001), with no difference in the discharge time. There was significantly less retching observed in patients in the fentanyl group (P<0.001). There were no major complications.ConclusionsEndoscopists and nurses found adding fentanyl significantly improved sedation, led to a shorter procedure time, and allowed for less midazolam to be used per case. It did not affect the patient experience of sedation and was safe. Fentanyl use for routine outpatient upper endoscopy should be considered as a safe option to improve procedural sedation.NCT:01514695 (www.clinicaltrials.gov)Accepted as an abstract for the Canadian Digestive Diseases Week meeting in February 2014.

English

English

Severe Uterine Hypertonus during Cesarean Section Relieved by Large Doses of Nitroglycerin

A 36 years old female Gravida 3 Para 1 Aborta 1 presented at 35 +2 weeks of gestation with increased frequency and intensity of her uterine contractions. An epidural catheter was inserted at L3-L4 interspace for labor analgesia. A decision was made for Cesarean delivery due to the transverse presentation of the baby. The epidural catheter was loaded by a bolus of 10 ml lidocaine 2%, 5 ml bupivacaine 0.1% and 1ml of fentanyl 50 mcg/ml. Few minutes later; severe uterine hypertonus was noted impairing the delivery of the baby. Very large doses of nitroglycerin (a total dose of 1.3 mg) were needed for uterine relaxation.

Continuous spinal anesthesia versus single small dose bupivacaine–fentanyl spinal anesthesia in high risk elderly patients: A randomized controlled trial

BackgroundGreater numbers of patients are presenting for surgery with aging-related, pre-existing conditions that place them at greater risk of an adverse outcome. Hemodynamic instability due to high sympathetic block largely limits the use of conventional dose spinal anesthesia in high risk elderly patients. In this study we aim to compare the hemodynamic stability and the incidence of hypotension in continuous spinal anesthesia (CSA) versus single low dose spinal anesthesia (SD) in elderly high risk patients.MethodsThis prospective randomized blinded study was carried on 34 ASA III & IV elderly patients aged >75 years undergoing orthopedic lower limb surgery. The patients were randomly assigned to one of the study groups. Group CSA received intermittent dosing of local anesthetic solution via an intrathecal catheter using 0.5 ml of 0.5% isobaric bupivacaine increments and 0.5 ml of fentanyl (25 μg) while group SD single dose of 1.5 ml of 0.5% isobaric bupivacaine and 0.5 ml of fentanyl (25 μg). The study groups were compared regarding hemodynamic stability, incidence of hypotension and total ephedrine consumption.ResultsIncidence of severe hypotension was significant. 52.9% of patients in SD group experienced an episode of severe hypotension versus none of them in CSA group (p 0.033∗). Total dose of fluids infused was significantly more in the SD group. The use of ephedrine was significantly more in SD group.ConclusionCSA provided fewer episodes of hypotension and no severe hypotension versus SD 7.5 mg bupivacaine. CSA offers the added advantage of the ability to titrate dose of local anesthetic as needed while maintaining hemodynamic stability.