Versus Bupivacaine Research Articles

A Comparison of Subarachnoid Block Characteristics Following Co-administration of Fentanyl Premixed With Hyperbaric Bupivacaine Versus Antecedent or Succedent to Hyperbaric Bupivacaine: A Randomized Controlled Study.

Background Adjuvants are often used during subarachnoid block to enhance and prolong the analgesia and decrease the adverse effects of high doses of local anesthetic agents. Intrathecal fentanyl premixed with hyperbaric bupivacaine has been used in spinal anesthesia and compared with the sequential use of these drugs in separate syringes. However, given the paucity of literature, we conducted this study where premixed antecedent and succedent administration of intrathecal fentanyl with hyperbaric bupivacaine were compared in terms of flow dynamics, block characteristics, and hemodynamic alterations. Methodology This prospective, randomized, triple-blinded comparative study was conducted among 160 patients who were randomly allocated into four groups. Group A (n = 40) (control) received 3.0 mL (15 mg) of 0.5% hyperbaric bupivacaine and 0.5 mL of normal saline via a 5.0 mL syringe. Group B (n = 40) received 3.0 mL (15 mg) of 0.5% hyperbaric bupivacaine and 0.5 mL (25 µg) of fentanyl premixed via a single 5.0 mL syringe. Group C (n = 40) received 0.5 mL (25 µg) of fentanyl via a 1.0 mL syringe followed by 3.0 mL (15 mg) of 0.5% hyperbaric bupivacaine via a 5.0 mL syringe. Group D (n = 40) received 3.0 mL (15 mg) of 0.5% hyperbaric bupivacaine via a 5.0 mL syringe followed by 0.5 mL (25 µg) of fentanyl via a 1.0 mL syringe. The onset and regression of sensory and motor blockade, hemodynamic parameters, time to first rescue analgesia, and adverse events were observed. Data analysis was done using SPSS version 17.0 (SPSS Statistics Inc., Chicago, IL, USA). Results The mean time taken for the onset of sensory and motor blockade was least in Group D followed by Group C. Duration of sensory and motor blockade was prolonged in Group D. Patients in Group A experienced more hypotension than Groups B, C, and D. Requirement of rescue analgesia was delayed in Groups C and D. Conclusions Administering 25 µg (0.5 mL) of Fentanyl separately after 15 mg (3.0 mL) of 0.5% hyperbaric bupivacaine results in early onset and prolonged duration of sensory and motor blockade, intraoperative hemodynamic stability, the delayed requirement of rescue analgesia postoperatively, and fewer side effects compared to its co-administration as a premixed solution or antecedent to hyperbaric bupivacaine.

Ultrasound Guided Genicular Nerve Block for Knee Arthroscopy. Comparing using Bupivacaine Alone Versus Bupivacaine and Dexmedetomidine for Acute Post Operative Pain Management: A Comparative Controlled Study

Ultrasound Guided Genicular Nerve Block for Knee Arthroscopy. Comparing using Bupivacaine Alone Versus Bupivacaine and Dexmedetomidine for Acute Post Operative Pain Management: A Comparative Controlled Study

Intrathecal Injection of Hyperbaric Bupivacaine Versus a Mixture of Hyperbaric and Isobaric Bupivacaine in Lower Abdominal Surgery: A Randomized Controlled Trial.

Bupivacaine hydrochloride is widely used as the primary drug for spinal anesthesia. This research aimed to evaluate the intrathecal administration of both isobaric and hyperbaric bupivacaine (HB) in lower abdominal surgery. A randomized, controlled, double-blind trial was conducted on 50 patients classified as American Society of Anesthesiologists (ASA) class I to II, scheduled for lower abdominal surgery under spinal anesthesia. The patients were allocated randomly into two groups of similar size. Group A (control group) received 20 mg HB 0.5% intrathecally. Group B (case group) received 10 mg HB 0.5% and 10 mg isobaric bupivacaine (IB) 0.5%. There was a significant decline in heart rate and mean arterial pressure in Group A compared to Group B (P < 0.05). Group A had a significantly greater sensory level at 10 and 20 minutes than Group B (P = 0.008 and 0.006, respectively). Group A had an earlier duration in reaching Bromage 3 and the first need for analgesia, compared to group B (P = 0.001 and 0.003, respectively). In lower abdominal surgery, the intrathecal administration of HB with IB increased hemodynamic stability and duration of both sensory and motor blockade but with slower recovery from anesthesia compared to HB alone.

Comparison of Tramadol Versus Bupivacaine as Local Anesthetic in Pain Control in Inguinal Hernia Surgery

Objective: To compare the outcomes of local infiltration of tramadol versus bupivacaine for postoperative pain control and time to mobilize patients out of bed with less intravenous analgesia consumption in inguinal hernia surgery. Methodology: This randomized controlled trial was conducted at the Department of General Surgery, Pakistan Institute of Medical Sciences (PIMS), Islamabad September 2018 to August 2019. A total of 122 patients who were randomly allocated to either Group A (tramadol) or Group B (bupivacaine). Data on postoperative pain scores (VAS at 3, 6, 12, 24 hours), time to first analgesia, and time to mobilization were collected using a structured proforma and analyzed with SPSS version 26. Results: In the bupivacaine group, mean age was 34 ± 9 years; in the tramadol group, 31 ± 8 years. At 24 hours post-surgery, mean pain score was 5.2 ± 1 in bupivacaine and 2.7 ± 0.5 in tramadol. Tramadol showed significantly lower mean pain at 3rd, 6th, 12th, and 24th hours (p &lt; 0.001). Time to first analgesia was 10 ± 7 hours in bupivacaine and 13.5 ± 5.6 hours in tramadol, indicating a statistically longer duration for tramadol (p &lt; 0.05). Mobilization time was 9 ± 4 hours in bupivacaine and 6 ± 4.5 hours in tramadol, with tramadol showing significantly lower time to mobilize (p &lt; 0.001). Conclusion: Tramadol local infiltration is effective in reducing pain, delaying analgesia need, and promoting earlier mobilization compared to bupivacaine. Consideration of tramadol at wound closure for inguinal hernia repair may enhance outcomes and patient satisfaction

Efficacy of Dexmedetomidine Combined with Bupivacaine in Supraclavicular Block Versus Bupivacaine alone in Upper Limb Surgery

Objective: To compare the efficacy of Dexmedetomidine combined with Bupivacaine in supraclavicular block versus Bupivacaine alone in upper limb surgeries&#x0D; Study Design: Quasi-experimental study&#x0D; Place and Duration Of Study: Anaesthesia Department, Combined Military Hospital Quetta, Pakistan, from Sep to Feb 2022.&#x0D; Methodology: Patients planning to undergo plating of radius fractures were included. The patients were divided into two equal sets (n=20) by purposive sampling and marked as Group-A and Group-B. Patients in both groups received supraclavicular block under ultrasound guidance and general endotracheal anaesthesia followed by that. In the first Group,Bupivacaine plain (0.125%) was used to block the brachial plexus, and in the second Group, Bupivacaine (0.125%) with adjuvant Dexmedetomidine (1ug/kg) was given respectively. The visual analogue scale was used to measure pain perception in both groups. &#x0D; Results: The duration of analgesia in the Dexmedetomidine Group was 10 ±0.925 hours and 5.68 ±0.471hours in Bupivacaine Group, which holds statistical significance (p-value&lt;0.001). The demographics, surgery-related parameters (duration and type of surgery), block related parameters (onset of block and time taken to block) were similar in both study groups.&#x0D; Conclusion: We concluded that Dexmedetomidine prolongs the duration of analgesia significantly when used as an adjuvant Bupivacaine in supraclavicular brachial plexus block.

Dexmedetomidine Added to Bupivacaine Versus Bupivacaine Alone in Ultrasound-Guided Erector Spinae Block in Spine Surgeries for Post Operative Pain Management: A Randomized Controlled Study

Dexmedetomidine Added to Bupivacaine Versus Bupivacaine Alone in Ultrasound-Guided Erector Spinae Block in Spine Surgeries for Post Operative Pain Management: A Randomized Controlled Study

A Comparison between Ultrasound Guided Erector Spinae Block Using Bupivacaine Versus Parasternal Nerve Block in Pediatric Patients Undergoing Cardiac Surgery for Post-Operative Pain Management after Median Sternotomy: A Randomized Controlled Double-Blinded Study

A Comparison between Ultrasound Guided Erector Spinae Block Using Bupivacaine Versus Parasternal Nerve Block in Pediatric Patients Undergoing Cardiac Surgery for Post-Operative Pain Management after Median Sternotomy: A Randomized Controlled Double-Blinded Study

Comparative Outcome of Lidocaine Versus Bupivacaine for Cervical Medial Branch Block in Chronic Cervical Facet Arthropathy: A Randomized Double-Blind Study

This study evaluated the effect of prolonged concordant response and functional clinical improvement between lidocaine and bupivacaine for cervical medial branch block (CMBB) in chronic cervical facet syndrome. Sixty-two patients diagnosed with chronic cervical facet syndrome were randomized into either lidocaine or bupivacaine groups. The therapeutic CMBB was performed under ultrasound guidance. Either 2% lidocaine or 0.5% bupivacaine with a volume of 0.5-1 ml per level, according to the patient's pain symptoms. The patients, pain assessor, and pain specialist were blinded. The primary outcome was the duration of pain reduction by at least 50%. The numerical rating scale (NRS) of 0-10 and the Neck Disability Index (NDI) questionnaire were recorded. There was no significant difference in the duration of 50% and 75% pain reduction and NDI between the lidocaine and bupivacaine groups. Lidocaine provided significant pain reduction up to 16 weeks (P<0.05) and significant improvement in neck functional outcomes up to 8 weeks (P<0.01) compared to the baseline. Whist bupivacaine yielded significant pain alleviation for up to 8 weeks for pain upon neck mobilization (P<0.05) and demonstrated notable improvement in neck function up to 4 weeks (P<0.01) compared to the baseline. CMBB using lidocaine or bupivacaine provided clinical benefits in prolonged analgesic effect and improving neck functions for chronic cervical facet syndrome. Lidocaine illustrated better performance and could be considered a local anesthetic of choice regarding the prolonged concordance response.

A Comparative Study of Intrathecal Plain Bupivacaine Versus Bupivacaine with Midazolam for Subarachnoid Block in Lower Abdominal and Lower Limb Surgeries

A Comparative Study of Intrathecal Plain Bupivacaine Versus Bupivacaine with Midazolam for Subarachnoid Block in Lower Abdominal and Lower Limb Surgeries

Comparative Evaluation of Levobupivacaine with Fentanyl Versus Bupivacaine with Fentanyl for Postoperative Epidural Analgesia in Patients Undergoing Gynae-Oncological Surgeries: A Randomised Clinical Study

Introduction: Epidural analgesia is one of the preferred mode of perioperative management. Neuraxial opioids like fentanyl when used in epidural offer advantage of augmenting local anaesthetic effect and reducing the anaesthetic and analgesic requirement. Aim: To compare the adequacy of analgesia, requirement of rescue analgesics between 0.125% bupivacaine with 2 mcg/cc fentanyl and 0.125% levobupivacaine with 2 mcg/cc fentanyl. Materials And Methods: The randomised clinical study was carried out from September 2016 to May 2017 in 70 patients (35 in each group) of American Society of Anaesthesiologists (ASA) 1 and 2 scheduled for elective gynae-oncological surgeries. The epidural analgesia in group Bupivacaine with Fentanyl (BF) was 0.125% Bupivacaine with 2 mcg/cc Fentanyl and group Levobupivacaine with Fentanyl (LF) was 0.125% Levobupivacaine with 2 mcg/cc fentanyl. All data was statistically analysed and compared using Student t-test, Chisquare/Fisher-Exact test. Results: Total of 70 patients were analysed, 35 each in Group BF (mean age: 50.06±7.19 years) and Group LF (mean age: 46.43±8.41 years). Both the groups were compatible with regard to demographic data and haemodynamic variables. The mean Visual Analogue Scale (VAS) score was higher in group BF compared to group LF at 0,1,4,6,1,2 and 18 hours but the observed difference in both the groups was not statistically significant except at 2nd (p-value: 0.016) and 24th hour (p-value 0.017). Number of rescue analgesics as epidural boluses (p-value=0.001) and paracetamol (p-value=0.044) requirement were more in group BF compared to group LF respectively. Conclusion: On account of adequate postoperative analgesia, haemodynamic stability, levobupivacaine with fentanyl is a better option than bupivacaine with fentanyl for epidural infusion.

Pain Levels Did Not Differ Following Uncomplicated Third Molar Extractions Utilizing Liposomal Bupivacaine Versus Standard Bupivacaine

Operations in the oral cavity are often characterized by an acute period of postoperative pain historically mitigated via opioids and other analgesics. The purpose of the study was to determine if liposomal bupivacaine infiltration (LBI) following uncomplicated extraction of bilateral, mandibular third molars will significantly reduce postoperative pain when compared to standard bupivacaine. The study was designed as a parallel-arm randomized clinical trial. The sample size was calculated for the primary outcome variable: postoperative pain levels measured at 48-hours. Using a power analysis, a sample size of n=13 for each group was required. Patients meeting the inclusion/exclusion criteria requiring exodontia from November 4, 2018, to June 16, 2022, were recruited out of the oral and maxillofacial surgery clinic. The patients were randomized and divided into 2 groups. Group A was administered 0.50% bupivacaine (with 1:200,000 epinephrine) via infiltration while group B underwent LBI. The primary outcome of interest was postoperative pain levels followed by the secondary outcomes of postoperative narcotic analgesic use, return to oral function, and satisfaction. Patient demographics and characteristics were analyzed as potential covariates utilizing the Fisher exact test and t test for continuous outcomes, respectively. Thirty patients were recruited for the study. The average age of patients receiving the third molar operation was 24.1 ± 5.8 years. Of the 30, 62.5% were female, and 37.5% were male. Seventy-five percent of the patients were Caucasian, 20.8% were African American, and 4.2% were Asian. Forty-eight-hour postoperative interviews revealed mean pain levels of 2.5±2.8 in the control group and 2.9±2.3 in the LBI group (P=.730) as measured on a visual analog scale. The 48-hour postoperative interview identified a mean of 1.9±2.1 narcotic pills used in the control group and 2.5±5.0 pills used in the LBI group (P=.693). Mandibular LBIs following bilateral mandibular third molar extractions showed no statistically significant advantage over the standard bupivacaine at either time point analyzed. Furthermore, no statistically significant difference was found regarding narcotic use between the 2 groups.

Mepivacaine Versus Bupivacaine in Adult Surgical Patients: A Meta-analysis, Trial Sequential Analysis of Randomized Controlled Trials

PurposeEvidence supporting the choice between mepivacaine and bupivacaine is inconclusive. This meta-analysis aims to determine whether mepivacaine can reach a similar effect to bupivacaine after surgeries. DesignA meta-analysis, trial sequential analysis of randomized controlled trials (RCTs). MethodsRCTs were identified in PubMed, EMBASE (Ovid), Medline (Ovid), and Cochrane Library using a controlled vocabulary (MeSH) and keywords. There were no date and language restrictions. We strictly included RCTs comparing mepivacaine with bupivacaine. The primary outcome was motor function recovery time. Secondary outcomes included postoperative analgesic requirement, transient neurologic symptoms (TNS), pain score at 24 hours, length of stay (LOS), duration of analgesia, complications, and patient satisfaction. A trial sequential analysis (TSA) was performed for motor function recovery time, postoperative analgesic requirement, and TNS. FindingsSeven RCTs with a total of 672 patients were included. Return of motor function was quicker in patients who received mepivacaine than in those who received bupivacaine (weighted mean differences [WMD] = -2.23 minutes; 95% confidence intervals [CI], -3.58 to -0.88; P = .02; I2 = 97.08%; TSA adjusted CI -17.52 to -10.9). Postoperative analgesic requirement was significantly more with mepivacaine (risk ratio [RR] = 3.23; 95% CI, 1.37-7.62; P = .01; I2 = 55.11%; TSA adjusted CI 5.73-63.27). Duration of analgesia (WMD = -8.83 hours; 95% CI, -11.75 to -7.90; P < .001; I2 = 0%) and LOS (WMD = -3.95 hours; 95% CI, -4.83 to -3.07; P < .001; I2 = 0%) in group mepivacaine was significantly shorter compared with bupivacaine. There were no differences for TNS (RR = 3.90; 95% CI, 0.94-16.22; P = .062; I2 = 72.23%), postoperative pain score (standard mean differences [SMD] = 0; 95% CI, −0.10 to 0.10; P = .972; I2 = 0%), complications (RR = 1; 95% CI, 0.70-1.43; P = .998; I2 = 0%), and satisfaction (RR = 0.97; 95% CI, 0.85-1.11; P = .40; I2 = 45%) between bupivacaine and mepivacaine. ConclusionsMepivacaine appears to yield a faster return of motor function and shorter LOS compared with bupivacaine. and may be more popular in short-stay and outpatient surgery. However, the results of TSA indicate that more high-quality trials are needed to confirm the true effects.

Comparison of Hemodynamic Changes after Use of Intrathecal 0.75% Hyperbaric Bupivacaine Versus 0.5% Hyperbaric Bupivacaine with Dexmeditomidine in Patients Undergoing Cesarean Section

Objective: To compare analysis of hemodynamic changes after use of intrathecal 0.75% and 0.5% hyperbaric bupivacaine with dexmedetomidine in cesarean section patients. Study Design: Comparative analytical study Place and Duration of Study: Divisional Headquarters Teaching Hospital Mirpur from 1st April 2020 to 30th April 2021. Methodology: Seventy women were enrolled as study participants. Full term pregnant women between the age of 20-35 years were enrolled. These women were further grouped into two major groups with both groups having equal number of participant (35 in each group). Group A consisted of those women who were given 12mg of 0.5% hyperbaric bupivacaine with 1µg dexmedetomidine while Group B women were intervened with 12mg 0.75% hyperbaric bupivacaine. The localized anesthesia with 2-3ml xylocaine (2%) was administered within intended space in all patients. A 25-gauge needle was used post confirmation of the free cerebrospinal fluid flow. Patient’s vital signs were continuously monitored. Results: The mean age was 31±4 years in group A while it was 27±4 year in group B. The post-operative parameters presented a decrease in blood pressure among both group women. The pulse rate showed that group A had slight higher reduction in pulse than group B however the difference was not significant (p=0.46).Both groups required ephedrine injections for substantial decrease in blood pressure. Conclusion: Patients administered with 0.75% hyperbaric bupivacaine for lower segment caesarean section showed significant and relevantly more hemodynamic alterations than 0.5% hyperbaric bupivacaine with Dexmedetomidine. Keywords: C-section, Spinal anesthesia, Adjuvants, Hemodynamic changes

Comparing the Anaesthetic Efficacy of 2% Lignocaine in Combination with 0.5% Bupivacaine Versus 0.5% Bupivacaine for Inferior Alveolar Nerve Block in Surgical Removal of Bilateral Impacted Mandibular Third Molar: A Prospective Study

Comparing the Anaesthetic Efficacy of 2% Lignocaine in Combination with 0.5% Bupivacaine Versus 0.5% Bupivacaine for Inferior Alveolar Nerve Block in Surgical Removal of Bilateral Impacted Mandibular Third Molar: A Prospective Study

Mepivacaine Versus Bupivacaine for Spinal Anesthesia: A Systematic Review and Meta-analysis of Random Controlled Trials.

Bupivacaine is a more widely used anesthetic than mepivacaine. However, the long-acting effects of bupivacaine often lead to slow and unpredictable return. As an intermediate-acting local anesthetic, mepivacaine can enable earlier ambulation and thus has other benefits. We performed a systematic review and meta-analysis of available randomized controlled trials (RCTs) comparing the anesthetic effects of mepivacaine and bupivacaine. On August 12, 2021, a search was performed in PubMed, Embase, and the Cochrane Library. Effect estimates with 95% CI were combined using a random effects model. We performed sensitivity analyses to explore sources of heterogeneity and stability of results. Of the 406 papers screened, 14 population-based randomized controlled trials were included, with a total of 1007 patients. Overall, compared to bupivacaine, mepivacaine was associated with higher numbers of motor block 3 (OR, 4.05; 95% CI 1.92-8.57), shorter length of stay (SMD, - 0.77; 95% CI - 1.52 to - 0.03), faster recovery from motor block (SMD, - 1.45; 95% CI - 2.39 to - 0.51), and shorter time to return to voiding (SMD, - 1.24; 95% CI - 1.83 to - 0.64). Mepivacaine was associated with a higher incidence of transient neurologic symptoms (TNS) and transient nerve root irritation (TRI) (OR, 9.18; 95% CI 2.42-34.88). There was no statistical difference between the two anesthetics in terms of pain index on the postoperative day (SMD, 0.20; 95% CI - 0.06 to 0.46) and incidence of urinary retention (OR, 0.98; 95% CI 0.47-2.03). Mepivacaine may have advantages over bupivacaine in terms of achieving motor block 3, shorter length of stay, earlier recovery from motor block, and earlier time to return to voiding, but it may have a higher incidence of TNS or TRI than bupivacaine. Therefore, mepivacaine may be used before bupivacaine in spinal anesthesia.

Effect of Lidocaine 2% Versus Bupivacaine 0.5% and 1 Versus 2 Dual Separate Injections on Onset and Duration of Ultrasound-Guided Wrist Blocks: A Blinded 2 × 2 Factorial Randomized Clinical Trial.

Local anesthetics are often selected or mixed to accomplish faster onset of anesthesia. However, with ultrasound guidance, local anesthetics are delivered with greater precision, which may shorten the onset time with all classes of local anesthetics. In this study, we compared onset time and duration of ultrasound-guided wrist blocks with a fast onset versus a longer lasting local anesthetic administered via single or dual (spatially separate) injections at the level of the midforearm. In this randomized clinical trial, 36 subjects scheduled for carpal tunnel release were randomly assigned to receive ultrasound-guided median and ulnar nerve blocks with lidocaine 2% or bupivacaine 0.5% via single or dual injections (n = 9 in each group). Subjects fulfilled the study requirements. The main outcome variables were onset and duration of sensory blockade, which were tested separately in 2 (drug) × 2 (injection) analysis of variances (ANOVAs) with interaction terms. Sensory block onset time did not differ significantly between subjects given lidocaine 2% (9.2 ± 3.4 minutes) or bupivacaine 0.5% (9.5 ± 3.1 minutes) (P = .76; mean difference, -0.3 ± 1.1 minutes [95% confidence interval {CI}, -2.5 to 1.9]) or between the single- (9.6 ± 2.8 minutes) and dual- (9.1 ± 3.6 minutes) injection groups (P = .69; mean difference, -0.4 ± 1.1 minutes [95% CI, -1.8 to 2.6]). Sensory duration was longer for subjects in the bupivacaine 0.5% group (27.3 ± 11.6 hours) than for subjects in the lidocaine 2% group (8.4 ± 4.1 hours) (P < .001; 95% CI, 12.7-25.1). However, sensory duration in the single- (15.7 ± 12.5 hours) and dual- (19.4 ± 13.1 hours) injection groups did not differ significantly (P = .28; mean difference, -3.7 ± 4.3 hours [95% CI, -12.6 to 5.1]). No significant effect was found for onset time between lidocaine 2% and bupivacaine 0.5% used in ultrasound-guided wrist blocks. Dual injections did not shorten onset time. Since mean nerve block duration was longer with bupivacaine 0.5%, our results suggest that the selection of local anesthetic for the median and ulnar nerves at the level of the midforearm should be based on the desired duration of the block and not on its speed of onset.

Comparative Study Between Bupivacaine 0.5% Versus Bupivacaine 0.5% with Fentanyl in TAP Block for Post-Operative Analgesia After Appendectomy

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. Objective to compare the effectiveness of US guided TAP block using 0.5% bupivacaine versus 0.5% bupivacaine with Fentanyl for postoperative analgesia in patients undergoing appendectomy. Patients and Methods After ethical committee approval and informed consent from the patients, this prospective randomized control study, randomization done by closed envelope method &amp; was performed on total 60 patients who underwent surgical appendectomy in Ain Shams University hospitals for 3 months from January to March 2019. Results In our study, 60 patients were randomly divided into 2 equal groups. Control group received bupivacaine only while the fentanyl group in which 50 ug of fentanyl were added to bupivacaine. All patients received equal volumes. Our study showed that addition of a 50 microgram of fentanyl to bupivacaine in ultrasound-guided TAP block has statistically significant effect on the onset of sensory block and prolonged the duration of the sensory block. In addition, fentanyl prolonged the duration of analgesia 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 groups. Addition of fentanyl also did not affect the hemodynamics to a significant level. This makes fentanyl with bupivacaine more superior than the use of bupivacaine alone. Conclusion Fentanyl as an adjuvant to bupivacaine in Ultra-sound guided TAP block reduced post-operative pain scores, porolonged the duration of analgesia and decreased demand for rescue analgesics.

Clinical and Economic Outcomes Associated With Use of Liposomal Bupivacaine Versus Standard of Care for Management of Postsurgical Pain in Pediatric Patients Undergoing Spine Surgery.

Background: Approximately 60% of hospitalized children undergoing surgery experience at least 1 day of moderate-to-severe pain after surgery. Pain following spine surgery may affect opioid exposure, length of stay (LOS), and costs in hospitalized pediatric patients. This is a retrospective cohort analysis of pediatric patients undergoing inpatient primary spine surgery.Objectives: To examine the association of opioid-related and economic outcomes with postsurgical liposomal bupivacaine (LB) or non-LB analgesia in pediatric patients who received spine surgery.Methods: Premier Healthcare Database records (January 2015–September 2019) for patients aged 1–17 years undergoing inpatient primary spine surgery were retrospectively analyzed. Outcomes included in-hospital postsurgical opioid consumption (morphine milligram equivalents [MMEs]), opioid-related adverse events (ORAEs), LOS (days), and total hospital costs. A generalized linear model adjusting for baseline characteristics was used.Results: Among 10 189 pediatric patients, the LB cohort (n=373) consumed significantly fewer postsurgical opioids than the non-LB cohort (n=9816; adjusted MME ratio, 0.53 [95% confidence interval (CI), 0.45–0.61]; P<0.0001). LOS was significantly shorter in the LB versus non-LB cohort (adjusted rate ratio, 0.86 [95% CI, 0.80–0.94]; P=0.0003). Hospital costs were significantly lower in the LB versus non-LB cohort overall (adjusted rate ratio, 0.92 [95% CI, 0.86–0.99]; P=0.0227) mostly because of decreased LOS and central supply costs. ORAEs were not significantly different between groups (adjusted rate ratio, 0.84 [95% CI, 0.65–1.08]; P=0.1791).Discussion: LB analgesia was associated with shorter LOS and lower hospital costs compared with non-LB analgesia in pediatric patients undergoing spine surgery. The LB cohort had lower adjusted room and board and central supply costs than the non-LB cohort. These data suggest that treatment with LB might reduce hospital LOS and subsequently health-care costs, and additional cost savings outside the hospital room may factor into overall health-care cost savings. LB may reduce pain and the need for supplemental postsurgical opioids, thus reducing pain and opioid-associated expenses while improving patient satisfaction with postsurgical care.Conclusions: Pediatric patients undergoing spine surgery who received LB had significantly reduced in-hospital postsurgical opioid consumption, LOS, and hospital costs compared with those who did not.

Effect of Epidural Bupivacaine Versus Intrathecal Single Dose inAnalgesia during Normal Vaginal Labor of Multiparous Women

AbstractBackground: Epidural analgesic technique is the mostcommonly used and most effective analgesia during labor.Intrathecal labor analgesia is alternatively and effective methodto provide labor analgesia.Aim of Study: To compare the effect of epidural bupi-vacaine versus single-dose intrathecal bupivacaine duringlabor of multiparous women on the duration of labor analgesia,progress of labor, block characteristics and side effects.Material and Methods: In a prospective randomizeddouble-blind study, 80 multiparous women of ASA class Iand II were randomly allocated into two groups of pregnantwomen 40 each. The spinal group received hyperbaric bupi-vacaine 0.5% at a dose of 3.75mg (0.75ml) of hyperbaricbupivacaine with 25ug fentanyl (0.5ml) and diluted withsterilized normal saline to 1.5ml whereas the epidural groupreceived isobaric bupivacaine 8-10ml of 0.125% bupivacainewith fentanyl 50mg. Patients were monitored for hemodynam-ics, sensory and motor block characteristics, side effects,duration of stages of labor and pain intensity was also recorded on a visual analogue scale.Results: Maternal hemodynamics showed a nonsignificantchanges between both groups. Onset of sensory block andduration were significantly delayed in epidural group incomparison to spinal group (8.80±5.27, 163±16.64min) vs (4.6± 1.20, 120.2±3.33min) and visual analogue scale comparable in both groups but scale was lower in the spinal group. Patient's satisfaction was insignificantly more in S group. The duration of the first and second stages of labor in the spinal group was shorter than that in the epidural group and incidence of maternal complications in both groups were insignificant.Conclusion: A safe and effective alternative method toepidural analgesia is a single-dose intrathecal bupivacaine.

A Double-Blind, Randomized Controlled Trial of Pre-incision Wound Infiltration Using Diclofenac Versus Bupivacaine for Post-operative Pain Relief in Open Thyroid and Parathyroid Surgery.

Pre-incision wound infiltration using NSAID is an alternative method to manage post-operative pain in surgery. It is postulated that NSAID delivered peripherally exerts efficient analgesic and anti-inflammatory effect with minimal systemic complication. This study explored the efficacy of using diclofenac for wound infiltration in open thyroidectomy and parathyroidectomy as compared to conventional agent, bupivacaine. The study was designed as a double-blind, randomized controlled trial involving 94 patients who underwent open thyroidectomy or parathyroidectomy in Hospital Pulau Pinang, Malaysia, from November 2015 to November 2016. The study compared the efficacy of pre-incision wound infiltration of diclofenac (n = 47) versus bupivacaine (n = 47) in post-operative pain relief. Wound infiltration is given prior to skin incision. Mean pain score at designated time interval within the 24-h post-operative period, time to first analgesia, total analgesic usage and total analgesic cost were assessed. Ninety-four patients were recruited with no dropouts. Mean age was 49.3 (SD = 14.2) with majority being female (74.5%). Ethnic distribution recorded 42.6% Chinese, 38.3% Malay, followed by 19.1% Indian. Mean duration of surgery was 123.8min (SD = 56.5), and mean length of hospital stay was 4.7days (SD = 1.8). The characteristics of patient in both groups were generally comparable except that there were more cases of total thyroidectomy in the diclofenac group (n = 31) as compared to the bupivacaine group (n = 16). Mean pain score peaked at immediate post-operative period (post-operative 0.5h) with a score of 3.5 out of 10 and the level decreased steadily over the next 20h starting from 4h post-operatively. Pre-incision wound infiltration using diclofenac had better pain control as compared to bupivacaine at all time interval assessed. In the resting state, the mean post-operative pain score difference was statistically significant at 2h [2.1 (SD = 1.5) vs. 2.8 (SD = 1.8), p = 0.04]. During neck movement, the dynamic pain score difference was statistically significant at post-operative 1h [2.7 (SD = 1.9) vs. 3.7 (SD = 2.1), p = 0.02]; 2h [2.7 (SD = 1.6) vs. 3.7 (SD = 2.0), p = 0.01]; 4h [2.2 (SD = 1.5) vs. 2.9 (SD = 1.7), p = 0.04], 6h [1.9 (SD = 1.4) vs. 2.5 (SD = 1.6), p = 0.04] and 12h [1.5 (SD = 1.5) vs. 2.2 (SD = 1.4), p = 0.03]. Mean dose of tramadol used as rescue analgesia in 24h duration was lower in the diclofenac group as compared to bupivacaine group [13.8mg (SD = 24.9) vs. 36.2mg (SD = 45.1), p = 0.01]. The total cost of analgesia used was significantly cheaper in diclofenac group as compared to bupivacaine group [RM 3.47 (SD = 1.51) vs. RM 13.43 (SD = 1.68), p < 0.01] or [USD 0.83 (SD = 0.36) vs. USD 3.21 (SD = 0.40), p < 0.01]. Pre-incision wound infiltration using diclofenac provides better post-operative pain relief compared to bupivacaine for patient who had underwent open thyroidectomy or parathyroidectomy. Diclofenac is cheap and easily available in the limited resource setting. This approach offers a superior alternative for post-operative pain relief as compared to bupivacaine.