EXTRADURAL ANALGESIA: THE INFLUENCE OF VOLUME AND CONCENTRATION OF BUPIVACAINE ON THE MODE OF DELIVERY, ANALGESIC EFFICACY AND MOTOR BLOCK

BACKGROUND: Combined spinal epidural anaesthesia is the most popular anaesthetic technique for major gynaecological surgeries. Epidural adjuvants enhance the quality and duration of surgical anaesthesia. Adjuvants like opioids or alpha 2 agonists provide a dose sparing effects on local anaesthetics and accelerate the onset of sensory blockade of epidural anaesthesia. Our study was aimed to compare the hemodynamic, sedative and analgesia potentiating effects of Dexmedetomidine and Fentanyl when added to epidural Bupivacaine for gynaecological surgeries. METHODOLOGY: Patients of ASA Grade I and II, aged between 30 and 65 years who were scheduled for major gynaecological surgeries were included in the study. Patients were randomly divided into two groups, Group D (N = 51) and Group F (N = 51). Group D received epidural injection of 0.5 mcg/kg of Dexmedetomidine diluted to 5ml with Normal Saline (NS) and Group F received 0.5mcg/ kg of Fentanyl diluted to 5 ml with NS, in addition to a spinal dose of 3ml of 0.5 % Bupivacaine. When two segment regression of sensory level was noted, epidural block was supplemented with 0.5 mcg /kg of the study drug in combination with 1.5 ml/segment of 0.5% Bupivacaine. Duration of sensory block, motor block, and incidence of bradycardia, hypotension, nausea and pruritus were assessed. RESULTS: The duration of analgesia and motor block were signicantly longer in the Dexmedetomidine group. The incidence of bradycardia was more in the Dexmedetomidine group, but the incidence of hypotension was nearly the same. CONCLUSION: Dexmedetomidine seems to be a better alternative to Fentanyl as an epidural adjuvant due to early onset of sensory anaesthesia and prolonged postoperative analgesia.

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Comparison of Postoperative Analgesic Effect of Dexamethasone and Fentanyl Added to Lidocaine through Axillary Block in Forearm Fracture

Pain Research and Treatment ◽

10.1155/2013/761583 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 7

Author(s):

Siamak Yaghoobi ◽

Mahyar Seddighi ◽

Zohreh Yazdi ◽

Razieh Ghafouri ◽

Marzieh Beigom Khezri

Keyword(s):

Analgesic Effect ◽

Motor Block ◽

Forearm Fracture ◽

Onset Time ◽

Analgesic Efficacy ◽

Controlled Study ◽

Axillary Block ◽

Regional Analgesia ◽

Double Blind ◽

Hemodynamic Variables

Aim. Regional analgesia has been introduced as better analgesic technique compared to using systemic analgesic agents, and it may decrease the adverse effects of them and increase the degree of satisfaction. Several additives have been suggested to enhance analgesic effect of local anesthetic agents such as opioids and steroids. We designed this randomized double-blind controlled study to compare the analgesic efficacy of the dexamethasone and fentanyl added to lidocaine using axillary block in patients undergoing operation of forearm fracture. Materials and Methods. Seventy-eight patients 20–60 years old were recruited in a prospective, double-blinded, randomized way. Axillary block was performed in the three groups by using 40 mL lidocaine and 2 mL distilled water (L group), 40 mL lidocaine and 2 mL dexamethasone (LD group), and 40 mL lidocaine and 2 mL fentanyl (LF group). The onset time of sensory and motor block, duration of sensory and motor block, the total analgesic dose administered during 6 hours after the surgery, and hemodynamic variables were recorded. Results. The duration of sensory and motor block was significantly longer in LD group compared to other groups (P<0.001). Similarly, the total analgesic consumption in LD group was smaller compared to other groups (P<0.001). Comparison of hemodynamic consequences of axillary block and surgery failed to reveal any statistically significant differences between all groups. Conclusion. Addition of dexamethasone to lidocaine significantly prolonged the duration of analgesia compared with fentanyl/lidocaine mixture or lidocaine alone using axillary block in patients undergoing forearm fracture surgery. This trial is registered with IRCT2012120711687N1.

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Comparison of analgesic efficacy of intramuscular tramadol and pethidine in labour

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20204313 ◽

2020 ◽

Vol 9 (10) ◽

pp. 4197

Author(s):

G. Vinaya ◽

S. M. Surekha ◽

Shivaganga Chiniwal

Keyword(s):

Mode Of Delivery ◽

Analgesic Efficacy ◽

Labour Pain ◽

Maternal Weight ◽

Medical Sciences ◽

Hospital Department ◽

Active Labour ◽

Good Pain Relief ◽

To Receive ◽

Weight Proportion

Background: Labour pain is among the most severe pain experienced by women. It is unpleasant and distressing to the parturient. The objective of the study was to evaluate and compare the analgesic efficacy and adverse effects of intramuscular tramadol and pethidine in labour. Methods: The prospective study conducted in SDM College of Medical Sciences and Hospital, Department of OBG, from December 2013 to November 2014. The study was a study of the parturients admitted in the labour theatre. Written and informed consent was taken from all the patients enrolled in the study. One hundred parturient at term in active labour were randomly assigned to one of the two groups to receive intramuscularly either tramadol 100 mg or pethidine 75 mg. Results: Results were comparable in terms of maternal age, maternal weight and neonatal weight. Proportion of cases with satisfactory to good pain relief was 74% in the tramadol group and 78% in the pethidine group. Nausea and/or vomiting (12% versus 8%), fatigue (6% versus 4%) and drowsiness (8% versus 4%) were significantly high in the pethidine group than the tramadol group(p<0.05). The drugs used did not appear to influence the mode of delivery. Proportion of cases with non-reassuring foetal heart rate was high in the pethidine group. Meconium stained liquor was equally seen in both the groups and there were no incidence of neonatal respiratory depression in any of the groups.Conclusion: Tramadol is an equally effective labour analgesic as pethidine with less maternal and perinatal side effects.

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Epidural haloperidol enhances epidural morphine analgesia: Three case reports

Journal of Opioid Management ◽

10.5055/jom.2008.0021 ◽

2018 ◽

Vol 4 (3) ◽

pp. 163 ◽

Cited By ~ 9

Author(s):

George Colclough, MD ◽

John T. McLarney, MD ◽

Paul A. Sloan, MD ◽

K. Todd McCoun, MD ◽

Gregory L. Rose, MD ◽

...

Keyword(s):

Side Effects ◽

Epidural Morphine ◽

Motor Block ◽

Case Reports ◽

Analgesic Efficacy ◽

Opioid Analgesics ◽

Opioid Analgesia ◽

Morphine Analgesia ◽

Pharmacodynamic Interactions ◽

Epidural Opioid

Epidural opioids provide significant postoperative analgesia; however, their use is often limited by side effects such as nausea and pruritus, or they require the addition of epidural local anesthetics with possible side effects of motor block and hypotension. Adjuncts to epidural opioid analgesia would benefit pain management. There is evidence that epidural butyrophenones may enhance opioid analgesics and reduce side effects. The authors present the first reported use of epidural haloperidol to enhance epidural morphine analgesia in three individuals. Pharmacodynamic interactions of haloperidol, which may explain its analgesic efficacy, are summarized.

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Ropivacaine, 0.1%, Plus Sufentanil, 0.5 μg/ml, versus Bupivacaine, 0.1%, Plus Sufentanil, 0.5 μg/ml, Using Patient-controlled Epidural Analgesia for Labor

Anesthesiology ◽

10.1097/00000542-200006000-00015 ◽

2000 ◽

Vol 92 (6) ◽

pp. 1588-1593 ◽

Cited By ~ 51

Author(s):

Catherine Fischer ◽

Pierre Blanié ◽

Envel Jaouën ◽

Christophe Vayssière ◽

Ismaël Kaloul ◽

...

Keyword(s):

Side Effects ◽

Epidural Analgesia ◽

Visual Analog Scale ◽

Motor Block ◽

Mode Of Delivery ◽

Maternal Satisfaction ◽

Analog Scale ◽

Double Blind ◽

Second Stage Of Labor ◽

Second Stage

Background This study compared the administration of 0.1% ropivacaine and 0.5 microg/ml sufentanil with that of 0.1% bupivacaine and 0.5 microg/ml sufentanil via patient-controlled epidural analgesia route during labor. Methods Two hundred healthy pregnant women at term with a single fetus with a vertex fetal presentation were randomized in a double-blind fashion to receive either 0.1% ropivacaine and 0.5 microg/ml sufentanil or 0.1% bupivacaine and 0.5 microg/ml sufentanil using a patient-controlled epidural analgesia pump (5-ml bolus dose, 10-min locked-out period, no basal infusion). Pain score on a visual analog scale, Bromage score (0-3), level of sensory block, patient-controlled epidural analgesia ratio, drug use, supplemental boluses, and side effects were recorded at 30 min and then hourly. Mode of delivery, duration of first and second stages of labor, umbilical cord pH, Apgar scores of the newborn, and a measure of maternal satisfaction were recorded after delivery. Results No differences were seen between the two groups for pain scores on a visual analog scale during labor, volume of anesthetic solution used, mode of delivery, or side effects. Motor block during the first stage of labor was significantly less in the ropivacaine group than in the bupivacaine group (no motor block in 97.8 of patients vs. 88.3%, respectively; P < 0.01). Duration of the second stage of labor was shorter in the ropivacaine group (1.3 +/- 1.0 vs. 1.5 +/- 1.2 h [mean +/- SD]; P < 0.05). Maternal satisfaction was greater in the bupivacaine group (91 +/- 13 mm for contraction, 89 +/- 19 mm for delivery on a visual scale: 0 = not satisfied at all, 100 = fully satisfied) than in the ropivacaine group (84 +/- 21 and 80 +/- 25 mm; P < 0.0001). Patients in the ropivacaine group requested more supplemental boluses to achieve analgesia during the second stage of labor than those in the bupivacaine group (29.7 vs. 19.8%, respectively, requested one or more supplemental boluses; P < 0.05). Conclusions Delivered as patient-controlled epidural analgesia, 0.1% ropivacaine and 0.5 microg/ml sufentanil produce less motor block but are clinically less potent than 0.1% bupivacaine and 0.5 microg/ml sufentanil.

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Intravenous Regional Anaesthesia: Lidocaine versus Combination of Lidocaine and Dexamethasone

JMS SKIMS ◽

10.33883/jms.v15i2.148 ◽

2012 ◽

Vol 15 (2) ◽

pp. 123-127

Author(s):

Anka Amin ◽

Ayaz Farooqi ◽

Waqar Ul Nisa

Keyword(s):

Regional Anaesthesia ◽

Recovery Time ◽

Motor Block ◽

Onset Time ◽

Analgesic Efficacy ◽

Control Group ◽

Study Group ◽

Analgesic Consumption ◽

Number Of Patients ◽

Intravenous Regional Anaesthesia

BACKGROUND: Intravenous regional anaesthesia, though a effective, reliable and safe technique, has its own share of disadvantages. OBJECTIVE: To compare the analgesic efficacy of lidocaine alone versus combination of lidocaine with dexamethasone for intravenous regional anaesthesia. METHODS: A total number of 50 patients of ASA physical status I and II aged 15 to 65 years undergoing ambulatory hand surgery were recruited. 25 patients received 40 ml of 0.5% lidocaine whereas 25 patients received 40 ml of 0.5% lidocaine and 8mg dexamethasone. Onset, duration and recovery times of sensory and motor block, time to request for first analgesic and total analgesic consumption in 24 hours were recorded. RESULTS: The onset and duration of sensory and motor block did not differ significantly amongst the two groups. The recovery time of sensory and motor block was significantly longer in the study group as compared to the control group. The patients in the study group had a significantly longer pain free interval as compared to the control group. The total analgesic consumption in first 24 hours as well as the total number of patients requiring analgesia was significantly lower in the study group as compared to the control group. CONCLUSION: Adding 8 mg dexamethasone to an intravenous regional anaesthesia solution did not shorten sensory and motor block onset time but prolonged sensory and motor block recovery time, besides reducing postoperative analgesic consumption. JMS 2012;15(2):123-27

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Outcome of labor with epidural analgesia in primigravida at term

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20190879 ◽

2019 ◽

Vol 8 (3) ◽

pp. 1055

Author(s):

Reeti Mehra ◽

Namrata Baweja ◽

Sukanya Mitra

Keyword(s):

Epidural Analgesia ◽

Controlled Trial ◽

Mode Of Delivery ◽

Analgesic Efficacy ◽

Second Stage Of Labor ◽

Second Stage ◽

Prospective Randomized Controlled Trial ◽

Vas Scores ◽

Group 2 ◽

Type Of Delivery

Background: There is widespread acceptance of epidural analgesia among many physicians and patients, but disagreement remains regarding the effect of intrapartum epidural analgesia on the subsequent progress of labour and the mode of delivery. This study was designed to look into the effects of labour analgesia on maternal and fetal outcomes and compare the same with that of opioid analgesics.Methods: It was a prospective randomized controlled trial on 100 patients where parturients were randomly allocated to either group 1-( n=50 patients) who received epidural analgesia or group 2 (n=50) who received intramuscular tramadol. The two groups were compared for duration of labour, analgesic efficacy as assessed by using Visual Analogue Scale (VAS) ,type of delivery – normal/instrumental/operative interventions ,1 and 5 min neonatal Apgar score and neonatal breast-feeding behavior between the two groups.Results: Epidural analgesic gave better pain relief than tramadol which was found to be stastically significant (p<0.001) on comparing the VAS scores and also gave statistically significantly higher satisfaction levels. Duration of both first and second stage of labor was comparable between the two groups and instrumental deliveries and caesarean sections were also comparable to that in tramadol group. There was a trend of higher neonatal Apgar scores in the epidural group than in the tramadol group.Conclusions: Use of effective analgesia in labour, does not prolong second stage of labor and may facilitate good labour outcome both for the mother and the fetus and should be offered to patients in tertiary setups and equipped centres when the patients are apprehensive about labor pains.

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Pain management during labor: use of intermittent drug delivery devices for improvement of obstetric and neonatal outcome and reduction of healthcare burden: A large non-inferiority randomized clinical trial

Journal of Anesthesia, Analgesia and Critical Care ◽

10.1186/s44158-021-00003-w ◽

2021 ◽

Vol 1 (1) ◽

Author(s):

Rinaldi Laura ◽

Ghirardini Anna Maria ◽

Troglio Raffaella ◽

Bellini Valentina ◽

Donno Lara ◽

...

Keyword(s):

Vaginal Delivery ◽

Motor Block ◽

Mode Of Delivery ◽

Vaginal Birth ◽

High Rate ◽

Epidural Administration ◽

Intention To Treat ◽

Safe Management ◽

Analgesic Block

Abstract Background Automated continuous epidural administration of local anesthetics provides a more stable analgesic block with decreasing of healthcare staff compared to manual boluses administration (TOP-UP) but is associated to high rate of operative vaginal delivery. We hypothesized that the use of programmed intermittent automated boluses (PIEB) is able to provide a good quality of analgesia and decreasing of anesthesiologic workload without increasing the rate of instrumental vaginal birth in comparison with TOP-UP technique. Laboring nulliparous woman aged between 18 and 46 years were randomized to epidural analgesia with 0.0625% levobupivacaine and sufentanil administered by PIEB or by TOP-UP techniques. Primary outcome was instrumental vaginal delivery rate and secondary outcomes were quality of analgesia, total and time-related drugs doses used, motor block, newborn outcome, and anesthesiologic workload. Results Six hundred twenty-nine were randomized, and 628 were included in the intention-to-treat analysis. The rate of instrumental vaginal delivery was similar in the PIEB and TOP-UP groups (13.2% vs 9.7%, OR 1.4 95% CI 0.8 to 2.5; p 0.21). There was no difference between groups regarding mode of delivery (cesarean section vs vaginal birth), newborn outcome, and motor block. Patients in the PIEB group received more total and time-related drugs doses and a better quality of analgesia. Anesthesiological workload was significantly reduced in the PIEB group. Conclusions Our study demonstrated that epidural anesthesia with programmed intermittent epidural boluses by an automated device provides an effective and safe management of labor analgesia with improvement of pain control and sparing of man workload compared to manual top-up protocols.

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Continuous Versus Patient-Controlled Epidural Analgesia for Labour Analgesia and Their Effects on Maternal Motor Function and Ambulation

PRILOZI ◽

10.2478/prilozi-2014-0010 ◽

2014 ◽

Vol 35 (2) ◽

pp. 75-83

Author(s):

Margarita Lovach-Chepujnoska ◽

Jordan Nojkov ◽

Slagjana Joshevska-Jovanovska ◽

Robert Domazetov

Keyword(s):

Epidural Analgesia ◽

Motor Function ◽

Motor Block ◽

Mode Of Delivery ◽

Lower Limbs ◽

Controlled Study ◽

Visual Analogue Pain Scale ◽

Visual Analogue Pain ◽

Nulliparous Women ◽

Continuous Epidural Analgesia

Abstract Background and objectives: The advantages of patient-controlled epidural analgesia (PCEA) for delivery compared with continuous epidural analgesia (CEA) have been a point of interest in research obstetric anaesthesia for more than two decades. The aim of this single blind randomized controlled study was to evaluate the incidence of motor block and ability to perform partial knee flexion in women who received CEA or PCEA. Method: Fifty-one healthy nulliparous women were included in this study. After an initial dose and established sensory block at Th 10, parturients were randomized into two groups: group CEA (10 ml/h), and group PCEA (bolus − 5 ml, lockout interval − 15 minutes, basal rate − 0 ml) with bupiva-caine 0.08% and fentanyl 2 μg/ml. The motor function of the lower limbs was evaluated by modified Bromage scale at regular hourly intervals until full cervical dilatation. The quality of analgesia was assessed using a visual analogue pain scale (VAPS) and maternal satisfaction. Mode of delivery, the total number of additional rescue boluses, foetal and neonatal outcomes were recorded. Results: Motor block was significantly lower in the third (33.3% vs. 4.35%; p = 0.008), fourth (57.9% vs. 6.3%; p = 0.003) and fifth hour (75.0% vs. 18.2%; p = 0.001) in the PCEA group. Ambu-lation occurred in 18% in the CEA and 46% in the PCEA group (p = 0.036). VAPS was with borderline significance in the second (p = 0.076) and significantly lower in the fourth hour (p = 0.034). Conclusion: Compared with CEA, PCEA provided less motor block and better first-stage analgesia, which leads to the conclusion that patient-controlled analgesia techniques are the preferred model in obstetric anesthesia.

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EVALUATION OF ANALGESIC EFFICACY OF DEXMEDETOMIDINE AS AN ADJUVANT CO-ADMINISTERED WITH 0.75% ROPIVACAINE BY SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK FOR UPPER LIMB SURGERY

10.36106/ijsr/5725228 ◽

2020 ◽

pp. 25-27

Author(s):

Bimal Kumar Hajra ◽

Stuti Chakraborty ◽

Keka Pandey ◽

Debarshi Jana

Keyword(s):

Brachial Plexus ◽

Upper Extremity ◽

Upper Limb ◽

Motor Block ◽

Brachial Plexus Block ◽

Analgesic Efficacy ◽

Cost Effective ◽

Upper Limb Surgery ◽

Supraclavicular Brachial Plexus Block ◽

Plexus Block

INTRODUCTION Brachial plexus block is a regional anesthesia technique that is sometimes employed as an alternative or as an adjunct to general anesthesia for surgery of the upper extremity. This technique involves the injection of local anesthetic agents in close proximity to the brachial plexus, temporarily blocking the sensation and ability to move the upper extremity. OBJECTIVES To compare time of onset and duration of sensory and motor block between two groups. To compare peri-operative and post-operative analgesia between two groups MATERIAL AND METHOD Orthopaedic operation theatre, post-anaesthesia care unit, orthopaedic post- operative ward of Nil Ratan Sircar Medical College and Hospital. All the ASA physical status I and II patients of either sex, age between 18-60 years undergoing upper limb orthopaedic surgery under supraclavicular brachial plexus block. CONCLUSION Addition of Dexmedetomidine to ropivacaine in supraclavicular brachial plexus block significantly prolongs the duration of analgesia and motor block in patients undergoing upper limb surgeries and is a remarkably safe and cost effective method of providing post-operative analgesia.

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