Programmed intermittent epidural bolus versus continuous epidural infusion for pain relief during termination of pregnancy: a prospective, double-blind, randomized trial

2016 ◽  
Vol 25 ◽  
pp. 37-44 ◽  
Author(s):  
U. Leone Roberti Maggiore ◽  
R. Silanos ◽  
S. Carlevaro ◽  
A. Gratarola ◽  
P.L. Venturini ◽  
...  
Keyword(s):  
Pain Relief ◽  
Randomized Trial ◽  
Termination Of Pregnancy ◽  
Epidural Infusion ◽  
Double Blind ◽  
Continuous Epidural Infusion

scholarly journals Programmed intermittent epidural bolus in comparison with continuous epidural infusion for uterine contraction pain relief after caesarean section: a randomised, double-blind clinical trial

2021 ◽  
Author(s):  
Xiaofei Mo ◽  
Tianyun Zhao ◽  
Jinghui Chen ◽  
Xiang Li ◽  
Jun Liu ◽  
...  
Keyword(s):  
Pain Relief ◽  
Caesarean Section ◽  
Motor Block ◽  
Uterine Contraction ◽  
Medical Center ◽  
Elective Caesarean Section ◽  
Visual Analog Scale Score ◽  
Epidural Infusion ◽  
Double Blind ◽  
Continuous Epidural Infusion

Objective Programmed intermittent epidural bolus (PIEB) was reported to provide superior maintenance of labour analgesia with better pain relief, and less motor block than continuous epidural infusion (CEI). Whether this is also evident for uterine contraction pain relief after caesarean section remains unknown. Design Randomised, double blind, positive-control trial. Setting Guangzhou Women and Children’s Medical Center, China Population Parturients scheduled for elective caesarean section under combined spinal-epidural anaesthesia were enrolled. Methods At the end of the surgery, after a similar epidural loading dose given, patients received either PIEB (6 mL every hour) or CEI (6 mL/h) of 0.1% ropivacaine. Main outcome measures The primary outcome was the effectiveness of uterine contraction pain relief during breastfeeding assessed with visual analog scale score (VAS-UD) at the postoperative 36 h. Secondary main outcome was lower extremity motor block (defined as Bromage score > 0). Results One hundred and twenty parturients were studied (PIEB, 60; CEI, 60). The VAS-UD at the postoperative 36 h was significantly lower in the PIEB group than in the CEI group [median (IQR), 30 (20 to 40) mm] compared with the CEI group [40 (30 to 50) mm], with an estimated difference of -10 mm (95% CI -15 to -5 mm; P=0.001). Motor block was higher in the CEI group than in the PIEB group during the study period except 2 h (all P<0.05). Conclusions PIEB provides more effective uterine contraction pain relief and less motor block after caesarean section than CEI.

Pharmacokinetics of Bupivacaine during Postoperative Epidural Infusion

2002 ◽  
Vol 96 (5) ◽  
pp. 1062-1069 ◽  
Author(s):  
Bernadette Th. Veering ◽  
Anton G. L. Burm ◽  
Hilde-Marieken Feyen ◽  
Wim Olieman ◽  
John H. M. Souverijn ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Pain Relief ◽  
Protein Binding ◽  
Bolus Dose ◽  
Plasma Concentrations ◽  
Epidural Infusion ◽  
Total Plasma ◽  
Continuous Epidural Infusion ◽  
Acid Glycoprotein ◽  
Constant Rate

Background Changing plasma protein concentrations may affect the protein binding and pharmacokinetics of drugs in the postoperative period. This study examined the effect of postoperative increases (in response to surgery) in plasma alpha1-acid-glycoprotein (AAG) concentrations on the plasma concentrations of the enantiomers of bupivacaine during continuous epidural infusion of racemic bupivacaine for postoperative pain relief. Methods Six patients scheduled for total hip surgery with combined epidural and general anesthesia received a bolus dose of bupivacaine (65 mg) followed by constant-rate (8 ml/h) epidural infusion of 2.5 mg/ml bupivacaine for 48 h. Total and unbound plasma concentrations of the enantiomers of bupivacaine and plasma AAG concentrations during the 48-h epidural infusion were determined. Results Total plasma concentrations of the enantiomers of bupivacaine increased steadily during the infusion (P &lt; 0.0001), whereas unbound concentrations did not change after 12 h (P &gt; 0.1). Total plasma concentrations of S(-)-bupivacaine were higher than those of R(+)-bupivacaine (P &lt; 0.02), whereas unbound concentrations of S(-)-bupivacaine were lower than those of R(+)-bupivacaine (P &lt; 0.002). AAG concentrations initially decreased, but thereafter increased steadily (P &lt; 0.0001). Consequently, free fractions of the enantiomers initially increased and then decreased with time (P = 0.0002). Free fractions of S(-)-bupivacaine were smaller than those of R(+)-bupivacaine (P = 0.0003). Conclusions The study confirmed that the pharmacokinetics of bupivacaine are enantioselective. During postoperative epidural infusion, changing plasma AAG concentrations affect the protein binding of both enantiomers of bupivacaine. Consequently, total plasma concentrations of the enantiomers increase with time, whereas unbound concentrations reach a plateau.

scholarly journals Postoperative Pain Relief by Continuous Epidural Infusion of 0.25% Bupivacaine.

1992 ◽  
Vol 12 (7) ◽  
pp. 770-773
Author(s):  
Yoshihiro HIRABAYASHI ◽  
Hiromasa MITSUHATA ◽  
Kohjiro FURUYA ◽  
Shigeo IKENO ◽  
Noboru TSUKAMOTO ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Pain Relief ◽  
Epidural Infusion ◽  
Postoperative Pain Relief ◽  
Continuous Epidural Infusion

Pharmacokinetics and Analgesic Effect of Ropivacaine during Continuous Epidural Infusion for Postoperative Pain Relief

1996 ◽  
Vol 84 (4) ◽  
pp. 834-842. ◽  
Author(s):  
Carl-Johan Erichsen ◽  
Jan Sjovall ◽  
Henrik Kehlet ◽  
Cecilia Hedlund ◽  
Torbjorn Arvidsson
Keyword(s):  
Postoperative Pain ◽  
Pain Relief ◽  
Visual Analog Scale ◽  
Plasma Concentrations ◽  
Epidural Infusion ◽  
Postoperative Pain Relief ◽  
Total Plasma ◽  
Analog Scale ◽  
Continuous Epidural Infusion ◽  
Unbound Fraction

Background The pharmacokinetics and clinical efficacy of ropivacaine (2.5 mg/ml) during a 24-h continuous epidural infusion for postoperative pain relief in 20 patients scheduled for abdominal hysterectomy were characterized using an open-label, increasing-dose design. Methods Through an epidural catheter inserted at T10-T12, a test dose of 7.5 mg ropivacaine was given 3 min before a bolus dose of 42.5 mg and immediately followed by a 24-h continuous epidural infusion with either 10 or 20 mg/h. Peripheral venous plasma samples were collected up to 48 h after infusion, and urinary excretion was followed up to the end of infusion. Postoperative pain at rest, on coughing, and at mobilization was assessed by means of a visual analog scale 2,4,6,8,12, and 24 h after the end of surgery. Sensory (pinprick) and motor block (modified Bromage scale) were assessed at the same intervals. Results The total plasma concentrations of ropivacaine increased markedly and consistently during the 24-h epidural infusion, in contrast to stable unbound concentrations. Both total and unbound plasma concentrations at the end of infusion were proportional to the total dose, although only the latter was proportional to the infusion rate. The total and unbound plasma clearance was independent of dose. Total mean clearance decreased on average by 21% (P &lt; 0.001) during the last 12 h of epidural infusion, i.e., from 539 +/- 191 ml/min to 418 +/- 138 ml/min, indicating time-dependent kinetics. The unbound clearance also varied between estimates after 8 h of infusion and the end of treatment, i.e., a 5.3% decrease from 10.4 +/- 5.3 l/min to 9.5 +/- 3.9 l/min (P &lt; 0.05). The unbound fraction of ropivacaine in plasma decreased during treatment, and this was related to the increase in alpha1-acid glycoprotein concentration. Pain was generally well controlled, and median visual analog scale scores during mobilization were less than 30 mm in patients receiving ropivacaine at 20 mg/h. Conclusions The pharmacokinetics of ropivacaine were independent of dose, but total clearance decreased with time over 24 h. The consistent increase in total plasma concentration during the postoperative epidural infusion contrasted to much less variation in the unbound plasma concentrations of ropivacaine.

scholarly journals Frovatriptan 2.5 mg plus dexketoprofen (25 mg or 37.5 mg) in menstrually related migraine. Subanalysis from a double-blind, randomized trial

Cephalalgia ◽  
2014 ◽  
Vol 35 (1) ◽  
pp. 45-50 ◽  
Author(s):  
G Allais ◽  
G Bussone ◽  
V Tullo ◽  
P Cortelli ◽  
F Valguarnera ◽  
...  
Keyword(s):  
Pain Relief ◽  
Randomized Trial ◽  
Efficacy And Safety ◽  
Double Blind ◽  
End Points ◽  
Menstrually Related Migraine ◽  
End Point ◽  
Parallel Group Study ◽  
Parallel Group

Purpose The purpose of this article is to investigate the efficacy and safety of frovatriptan plus dexketoprofen 25 or 37.5 mg (FroDex25 or FroDex37.5, respectively) compared to that of frovatriptan 2.5 mg (Frova) in menstrually related migraine (MRM). Aim The aim of this article is to analyze a subgroup of 76 women who treated an MRM attack in this multicenter, randomized, double-blind, parallel-group study. Methods The primary end-point was the proportion of patients who were pain free (PF) at two hours. Secondary end-points included pain-relief (PR) at two hours and 48 hours sustained pain free (SPF). Results PF rates at two hours were 29% under Frova, 48% under FroDex25 and 64% under FroDex37.5 ( p < 0.05). PR at two hours was Frova 52%, FroDex25 81% and FroDex37.5 88%, while 48 hours SPF was 18% under Frova, 30% under FroDex25 and 44% under FroDex37.5. Conclusion Combining frovatriptan+dexketoprofen produced higher PF rates at two hours compared to Frova while maintaining efficacy at 48 hours. Tolerability profiles were comparable.

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