Time Of Analgesic Request Research Articles

The effect of preemptive analgesia with bupivacaine on postoperative pain of inguinal hernia repair under spinal anesthesia: a randomized clinical trial

In the absence of any study on the use of bupivacaine as a long acting local anesthetic for the purpose of inducing preemptive analgesia in patients undergoing inguinal hernia repair under spinal anesthesia, this study was conducted to provide some evidence for possible benefits of such practice. In this randomized clinical trial, local infiltration of bupivacaine in patients undergoing inguinal hernia repair under spinal anesthesia was compared with placebo. The patients were randomly divided to two groups of 30 including the case group who received 10 cc of 0.5 % bupivacaine and the control group who received 10 cc of normal saline in the operation site before surgical incision. At the end of spinal block effect, patients were followed for symptoms of pain intensity according to numerical rating scale method, nausea, vomiting and opioid use for 24 h past the operation. The pain scores, nausea, vomiting and postoperative opioid use were 69.6, 76.5, 83.2 and 80 % respectively lower in first 24 h among the case group (P < 0.001, P = 0.005, P = 0.001 and P < 0.001). The number of patients with at least one analgesic request in first 24 h after operation was 64.2 % lower in case group, while time of first analgesic request was 67 % longer in treatment group (P < 0.001 and P < 0.001). The pre-operative local infiltration of bupivacaine reduces pain, nausea, vomiting and opioid use in the first 24 h after inguinal hernia surgery under spinal anesthesia. Therefore, further evaluation of the efficacy of this technique as a modality of preemptive analgesia is suggested.

Comparison of postoperative analgesic effect of intrathecal magnesium and fentanyl added to bupivacaine in patients undergoing lower limb orthopedic surgery

ObjectiveTo compare the analgesic efficacy and side effects of magnesium and fentanyl as an additive to intrathecal bupivacaine. MethodsNinety adult patients scheduled for femur surgery under spinal anesthesia were randomly allocated to one of the following three groups to receive intrathecally: bupivacaine 15 mg combined with 0.5 mL magnesium 10%; bupivacaine 15 mg combined with 0.5 mL fentanyl; or bupivacaine 15 mg combined with 0.5 mL distilled water (control). The time to first analgesic request, sensory and motor blockade onset time, duration of sensory and motor blockade, analgesic requirement in the first 12 hours after surgery, and the incidences of hypotension, bradycardia, hypoxemia and ephedrine were recorded. ResultsMagnesium caused a significant delay in the onset of both sensory and motor blockade compared with the fentanyl (95% CI 3 to 4; p < 0.001) and control (95% CI 3.5–5; p < 0.001) groups. The duration of spinal analgesia in group F (fentanyl) was significantly greater than in group C (control) (95% CI 365–513; p < 0.001) and group M (magnesium) (95% CI 385–523; p < 0.001). The total amount of methadone consumption over 12 hours was significantly lower in the magnesium and fentanyl groups than in the control group (5 mg vs. 5.666 ± 1.728 mg; p = 0.04). ConclusionAddition of intrathecal magnesium sulfate to spinal anesthesia induced by bupivacaine significantly prolonged the onset of both sensory and motor blockade compared with fentanyl. Although magnesium failed to prolong the time to first analgesic requirement as seen with fentanyl, it reduced the total consumption of opioids in the first 12 hours postoperatively compared with the control group.

Comparison of bupivacaine alone and in combination with sufentanil in patients undergoing arthroscopic knee surgery

One disadvantage of spinal anesthesia using bupivacaine is the relatively short duration of action. Combining it with opioids can increase its analgesic effects. It was aimed to analyze the effectiveness and the side effects of bupivacaine alone and in combination with sufentanil in arthroscopic knee surgery during unilateral spinal anesthesia. This is a prospective, randomized, double-blind trial. Fifty patients undergoing unilateral arthroscopic knee surgery were enrolled in this study. The patients were assigned into two groups to receive either 10 mg of 0.5% hyperbaric bupivacaine (Group I) or 5 mg of 0.5% hyperbaric bupivacaine combined with 2.5 μg sufentanil (Group II) to obtain unilateral spinal anesthesia. The time for sensorial block to reach level T10 was 6.3 ± 1.7 min in Group I and 4.8 ± 1.6 min in Group II (P < 0.05). Complete motor block was obtained at the 10th min in 16 patients in Group I (P < 0.005), and the duration of the motor block was lower in Group II (4.9 ± 2.2 h and 2.0 ± 1.1 h, P < 0.001). Bradycardia was encountered in 8 patients in Group I and in 1 patient in Group II (P < 0.05). No differences were encountered regarding other side effects. During the postoperative 24 h, 5 patients in Group I and 3 patients in Group II required analgesic drugs (n.s.). There was not any significant difference between groups with regard to first analgesic request time (8.3 ± 2.4 and 9.0 ± 2.3 h, n.s.). This study showed that combining lower dose bupivacaine with sufentanil provided faster onset of sensorial block and lower risk of motor block in unilateral spinal anesthesia for arthroscopic knee surgery.

A Comparison of Epidural Anesthesia and Lumbar Plexus-Sciatic Nerve Blocks for Knee Surgery

OBJECTIVES:The efficacy of combined lumbar plexus-sciatic nerve blocks was compared to epidural anesthesia in patients undergoing total knee surgery.PATIENTS AND METHODS:The study included 80 American Society of Anesthesiologists (ASA) Physical Status I–III patients (age range 18 to 65) undergoing knee surgery. The patients were randomly divided into one of two groups. Epidural anesthesia was performed in the epidural anesthesia (EA) group (n=40), and the lumbar plexus and sciatic nerves were blockedin the lumbar plexus-sciatic nerve blocks (LPSB) group (n=40). For each patient, onset of sensory and motor block, degree of motor block, sign of sensory block in the contralateral lower limb for the lumbar plexus-sciatic nerve blocks group, success in providing adequate anesthesia, hemodynamic changes, time of first analgesic request, and patient and surgeon satisfaction with the anesthetic technique were recorded.RESULTS:One patient in the epidural anesthesia group and three patients in the lumbar plexus-sciatic nerve blocks group required general anesthesia due to failed block. There were no significant differences between the two groups regarding the success of providing adequate anesthesia. Eight patients in the lumbar plexus-sciatic nerve blocks group developed contralateral spread. The onset of sensory-motor block and the time of the first analgesic request were significantly later in the lumbar plexus-sciatic nerve blocks group than in the epidural anesthesia group. Although there were no significant differences regarding patient satisfaction with the anesthetic technique between the two groups, surgeon satisfaction was significantly higher in the lumbar plexus-sciatic nerve blocks group than in the epidural anesthesia group.CONCLUSION:The lumbar plexus -sciatic nerve blocks provide effective unilateral anesthesia and may offer a beneficial alternative to epidural anesthesia in patients undergoing total knee surgery.

Influence of Positioning on Plain Levobupivacaine Spinal Anesthesia in Cesarean Section

Background. The behaviour of isobaric levobupivacaine in relation to gravity when used in obstetric spinal anesthesia is unclear. Methods. 46 women with ASA physical status 1 undergoing cesarean section were randomly allocated to 2 groups. Spinal anesthesia with 12.5 mg levobupivacaine was performed in the sitting position in all women. Those in the first group were placed in the supine position immediately after the injection, while those in the second group were asked to remain seated for 2 minutes before assuming the supine position. The sensory block level, the onset of sensory and motor blocks, the regression of the sensory block for 2 dermatomes of the sensory block, the first request for analgesics, and the regression of motor block were recorded. Results. No differences in onset times, sensory level, or Bromage score were observed between the two groups. The time of first analgesic request was earlier in the seated group (supine 131 ± 42 min, seated 106 ± 29 min, P = .02). Conclusion. Isobaric levobupivacaine in women at term produces a subarachnoid block the dermatomal level of which does not depend on gravitational forces.

The effects of adding tramadol to ropivacaine on axillary brachial plexus blockade in uremic patients*

Aim: To evaluate the effect of tramadol added to ropivacaine on quality of anesthesia, onset of sensory and motor blockade, duration of sensory and motor blockade, and first analgesic request time for axillary brachial plexus block in uremic patients. Materials and methods: After institutional approval and informed consent had been obtained, 45 ASA III uremic patients (age range 30-80) scheduled for arteriovenous fistula surgery were included in the study. Patients were randomly allocated into 2 groups. Axillary block was performed with a peripheral nerve stimulator by multiple injection technique. Patients in Group R (n = 23) received 38 mL of ropivacaine (3.75 mg/mL) and 2 mL of normal saline, and patients in group RT (n = 22) received 38 mL of ropivacaine (3.75 mg/mL) and 2 mL of tramadol (50 mg/mL). The onset and duration of sensory and motor block in the distribution of the radial, median, and ulnar nerves; the duration of analgesia; the time to first requirement of analgesic; hemodynamics; and side effects were recorded. Results: Demographic data, onset of sensory and motor block, duration of sensory and motor block, quality of anesthesia, and first analgesic requirement times were similar between the groups. In addition, hemodynamic parameters and side effects did not differ between the groups. Conclusion: The addition of 100 mg of tramadol to 3.75 mg/mL of ropivacaine does not have any beneficial effect on the nerve block characteristics of axillary brachial plexus anesthesia for arteriovenous fistula surgery in uremic patients.

Effects of Intrathecal Midazolam on Postoperative Analgesia When Added to a Bupivacaine-Clonidine Mixture

Previous clinical and experimental studies have shown that a midazolam-clonidine mixture has a synergistic antinociceptive effect. This study evaluated the postoperative analgesic effect of adding midazolam to an intrathecal bupivacaine-clonidine mixture. One hundred ten patients scheduled to undergo elective lower-extremity surgery were enrolled in this double-blind, randomized trial. Spinal anesthesia was administered by using 1 of 2 mixtures. Group B-C received 12.5 mg isobaric 0.5% bupivacaine, 30 mug clonidine, and 0.4 mL 0.9% saline. Group B-C-M received the B-C mixture plus 2 mg of midazolam in a 0.4-mL solution. Motor and sensory block levels were assessed before, during, and after the procedure until regression of the block to S2. Sedation levels were determined before anesthesia, during surgery, and at the end of the procedure. Postoperative analgesia was assessed every 15 minutes by using a visual analog scale. Duration of sensory and motor blocks was determined based on a modified Bromage scale, and time of the first pain relief request was noted. Duration of sensory block, time of first postoperative analgesic request, and amount of postoperative morphine administered were comparable between groups. However, the motor blockade lasted significantly longer in the B-C-M group compared with the B-C group (287 +/- 73 minutes vs 257 +/- 72 minutes, respectively; P < .05). Addition of midazolam to an intrathecal B-C mixture does not potentiate postoperative analgesia but prolongs the motor blockade.

Effect of Administration of Ketorolac and Local Anaesthetic Infiltration for Pain Relief after Laparoscopic-assisted Vaginal Hysterectomy

The efficacy of local anaesthetic infiltration and/or non-steroidal anti-inflammatory drugs for post-operative analgesia following laparoscopic-assisted vaginal hysterectomy (LAVH) was investigated in 83 patients, randomized into four groups in this double-blind, placebo-controlled study: group BK, local infiltration with bupivacaine and pre-incisional intramuscular (IM) ketorolac; group NN, saline local infiltration IM; group BN, local infiltration with bupivacaine and saline IM; group NK, local infiltration with saline and ketorolac IM. Post-operative pain scores were assessed at 1 h, 3 h, 6 h, 12 h and 24 h using a visual analogue scale (VAS). The major pain site, first analgesic request time and incidence of analgesic requests were also recorded. At 1 h, 3 h and 6 h after surgery, group BK patients had significantly lower VAS pain scores than group NN patients. The first analgesic request time was significantly longer in group BK than in groups NN, BN and NK. Pre-incisional treatment with ketorolac IM and local infiltration with bupivacaine reduced post-operative pain after LAVH.

The Effect of Butorphanol on Propofol-N2O-O2 Anesthesia: Propofol Dose Requirements, Hemodynamic Responses, and Postoperative Recovery Profiles

Background : This study was proposed to examine the effects of butorphanol on propofol dose require- ments and hemodynamic responses during propofol-NzO-Oz anesthesia. In addition, the effects of butor- phanol on the recovery time, sedation score and postoperative first analgesic request time were assessed. Methods: Forty patients were allocated to 2 groups. Twenty patients received butorphanol (20 mg/kg, group B) and the others received an equal volume of placebo (group P) 3 minutes before induction with propofol. After induction, anesthesia was maintained with propofol (6 - 10 mg/kg, iv)-NzO (70%)-Oz (30%). Propofol doses for induction and maintenance and hemodynamic responses (blood pressure, heart rate) were checked. After surgery, sedation score, recovery profiles, and postoperative first analgesic request time were assessed. Results : The induction doses of propofol were lower in group B than in group P. Diastolic pressure and heart rate decreased in group B compared to group P after endotracheal intubation and before skin incision. After skin incision, decreased diastolic pressure and heart rate returned to preanesthetic levels in group P, but the decreased level was sustained in group B. There were group differences in sedation score at 5 and 10 minutes after extubation. In group B, recovery was delayed and more time elapsed before the first analgesic request. Conclusions : Butorphanol co-administered with propofol reduces the induction dose of propofol and delays the first analgesic request time, but there are significant fluctuations in blood pressure and heart rate during endotracheal intubation and skin incision.(Korean J Anesthesiol 2000; 38: 258~264)