A Comparative Study between Intrathecal Fentanyl and Dexmedetomidine as Adjuvants to Hyperbaric Levobupivacaine 0.5% in Patients Undergoing Infra Umbilical Surgeries

Abstract Background Spinal anesthesia is a common technique for lower abdomen and lower limb surgery, but the use of local anesthetics alone may produce unwanted side effects such as prolonged motor and autonomic block, limited duration of action, besides, excessive local anesthetics can cause cardiac toxicity and central nervous system side effects. For these reasons, local anesthetics combined with other drugs, to utilize their synergistic analgesia and to reduce the dose of local anesthetics, has become a new option for anesthesiologists. Objectives This study is designed to assess and compare the effect of intrathecal Fentanyl and Dexmedetomidine as adjuvants to hyperbaric Levobupivacaine 0.5% regarding the onset, duration of sensory and motor block, duration of post operative analgesia and possible side effects in patients undergoing infra umbilical surgeries. Materials and Methods The study was performed at Ain Shams university hospitals. After obtaining ethical committee approval and informed consent from the patients. The study protocol was obtaining an informed consent; 75 patients admitted for infraumbilical surgeries in Ain Shams University hospitals operation theatre, were blindly randomized into three groups, using their medical record number (MRN) and subjected to a comparative study. A for Fentanyl group, group B for Dexmedetomidine group and group C for Levobupivacaine control group in the duration of 6 months from March to August 2019. Results The study showed that the quality of intraoperative analgesia was significantly better with dexmedetomidine than fentanyl group, and the requirement for opioids was significantly lower with dexmedetomidine than fentanyl group. The degree of motor block and postoperative analgesia was significantly denser with dexmedetomidine than fentanyl group. Conclusion From the current study we can conclude that using intrathecal 5 µg dexmedetomidine seems to be a suitable alternative to 25 µg fentanyl as adjuvants to 0.5% hyperbaric levobupivacaine in spinal anaesthesia. Its associated with prolonged motor and sensory block and provides good quality of intraoperative analgesia and extended duration of post operative analgesia as compared to fentanyl.

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Epidural butorphanol for post operative analgesia in lower limb surgeries: A comparative study with epidural tramadol

Journal of Chitwan Medical College ◽

10.3126/jcmc.v6i3.16696 ◽

2017 ◽

Vol 6 (3) ◽

pp. 26-32

Author(s):

G P Deo ◽

S K Shrestha ◽

I N Shrestha

Keyword(s):

Patient Satisfaction ◽

Side Effects ◽

Lower Limb ◽

Analgesic Efficacy ◽

Epidural Injection ◽

Double Blind ◽

Duration Of Action ◽

Number Of Patients ◽

Group B

To compare the efficacy of epidural butorphanol and tramadol for post operative analgesia in lower limb surgeries. Randomized, controlled, double blind, prospective study conducted at Department of Anaesthesia and Critical Care, Chitwan Medical College from September 1st 2015 to August 31st 2016. 60 patients of ASA Grade I and II of either sex, aged between 18-65 years willing for epidural analgesia for post operative analgesia were included in the study. They were divided into two groups: Group B- Butorphanol group and Group T- Tramadol group. Subjects of Group B received 2mg of Butorphanol and 0.25% Bupivacaine making a total volume of 10 ml and that of Group T received 100mg of Tramadol and 0.25% Bupivacaine also making a total volume of 10 ml. Analgesic efficacy was assessed by Visual Analogue Scale (VAS). The onset and duration of analgesia along with side effects were also assessed. The quality of analgesia was studied using time to independent mobilization and overall patient satisfaction. Total number of patients was 60, of ASA Grade I and II, aged between 18-65 years. The mean age of patients in Group B was 42.6±11.7 years and 46.1±11.2 years in Group T. Time of onset of analgesia after epidural injection was 7.4±0.9 minutes in Group B and 12.7±1.5 minutes in Group T and the difference was found to be statistically significant. Duration of analgesia was 317.1±99.1 minutes and 438.8±136.6 minutes in Butorphanol and Tramadol groups respectively which was also statistically significant. Sedation was significantly higher in butorphanol group whereas nausea and vomiting was higher in tramadol group. Quality of analgesia in terms of patient satisfaction was better with epidural butorphanol. Both epidural tramadol and butorphanol were effective in relieving post operative pain however butorphanol had lesser side effects and greater patient satisfaction compared to tramadol but the duration of action was relatively short.

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

QJM ◽

10.1093/qjmed/hcaa039.018 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

S A Elsebaay ◽

H A Elgendy ◽

M M Afifi

Keyword(s):

Comparative Study ◽

Brachial Plexus ◽

Motor Block ◽

Brachial Plexus Block ◽

Lidocaine Hydrochloride ◽

Control Group ◽

Supraclavicular Brachial Plexus Block ◽

Group B ◽

Plexus Block ◽

Fentanyl Group

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.

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A Qualitative Research Study to Understand Post-Transfusion Well-Being in Patients with Myelodysplastic Syndromes

Blood ◽

10.1182/blood.v126.23.4446.4446 ◽

2015 ◽

Vol 126 (23) ◽

pp. 4446-4446 ◽

Cited By ~ 1

Author(s):

Naushin S. Sholapur ◽

Shannon Lane ◽

Christopher M Hillis ◽

Mark A. Crowther ◽

Brian Leber ◽

...

Keyword(s):

Informed Consent ◽

Side Effects ◽

Qualitative Study ◽

Board Of Directors ◽

Well Being ◽

Advisory Committees ◽

Coding Scheme ◽

Participant Experience ◽

Rbc Transfusion

Abstract INTRODUCTION Patients with myelodysplastic syndrome (MDS) frequently receive red blood cell (RBC) transfusions to alleviate symptoms of fatigue and improve well-being, yet their experiences of transfusion have not been previously characterized. The aim of this qualitative study was to explore the changes in well-being that patients with MDS experience with RBC transfusion and hence, to inform the selection of Quality of Life (QoL) tools for future studies in this transfused patient population. METHODS: An applied qualitative approach was used for the study. Adult patients with MDS receiving chronic RBC transfusions at two hematology/oncology outpatient clinics between August 1, 2013 and March 31, 2014 were invited to participate in a 10-20 minute semi-structured interview. Patients were excluded if they could not provide informed consent. Interviews elicited information pertaining to: side effects and benefits of transfusion therapy; the patient's experience of anemia and fatigue prior to, during, and after transfusion; and the impact of transfusion on their QoL. Interviews were recorded, transcribed, and analyzed using QSR's NVivo 10 software. Standard techniques of qualitative content analysis were used. Two researchers independently reviewed all transcripts to identify and develop codes to categorize information from the interviews. The coding scheme was applied to the interview information, compared for agreement with discrepancies resolved and refined using consensus. The final version of the coding scheme was applied to all transcripts by one researcher. Informational content of the data within each code were reviewed and interpreted to form summative statements. Statements were grouped, organized and summarized under 3 major themes: participant experience of fatigue, impact of RBC transfusion, and side effects of transfusion. The study was approved by the local research ethics board and informed consent was obtained from all participants. RESULTS: 12/16 (75%) of patients approached consented to participant in the study (median age: 77; IQR, 72, 80 years; 2 female). Participant experience of fatigue: All participants reported experiencing fatigue, which significantly impacted their activities of daily living. Severity of fatigue prior to transfusion varied between participants, and for two participants' levels of fatigue also varied between transfusions. Impact of RBC transfusion: Time to recovery from fatigue varied between participants, ranging an improvement noted during the transfusion to 24 hours post-transfusion. Although transfusion did not alleviate symptoms of fatigue completely, participants reported improved appetite and decreased lethargy. One participant reported having a better frame of mind post-transfusion. Effect of transfusion on symptom relief varied between participants, ranging from several days to three weeks. Side effects of transfusion: Four participants reported side effects accompanying some transfusions, which included: confusion described as "heaviness in the head", headache, rise in temperature, itchiness/rash, epistaxis, and/or lightheadedness. Side effects were short-lived and not severe. In addition to the patient derived findings reported above, we identified 4 challenges to performing this qualitative study in the MDS population: MDS affects an aging population with several comorbidities, which may further compromise well-being; patients live sedentary lifestyles, which may impede their ability to assess subtle changes in well-being; caregiver presence during the interview can impact the patient perspective; and, the timing of interviews can affect the quality of data depending on the participant's level of fatigue. CONCLUSION: Results of this study reveal that the experiences of patients who receive RBC transfusion are diverse and are not consistent between consecutive transfusion episodes. Considering the findings, an appropriate QoL tool for use in this population should be short and quick to complete, disease specific, have an emphasis on fatigue and should have a short recall period to capture transient changes in well-being. Disclosures Leber: Celgene Canada: Honoraria, Membership on an entity's Board of Directors or advisory committees; Novartis Canada: Honoraria, Membership on an entity's Board of Directors or advisory committees.

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DEXMEDETOMIDINE VERSUS FENTANYL IN LOWER LIMB ORTHOPEDIC SURGERIES: A COMPARATIVE EVALUATION

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v5i9.2194 ◽

2021 ◽

Vol 5 (9) ◽

Author(s):

Sukumar Misra

Keyword(s):

Side Effects ◽

Epidural Analgesia ◽

Lower Limb ◽

Local Anesthetics ◽

Comparative Evaluation ◽

Motor Block ◽

Sensory Block ◽

Comparative Assessment ◽

Epidural Fentanyl ◽

Viable Option

Abstract: opioids and local anesthetics have been the traditional choice in epidural analgesia. However opioids suffer from the issue of side effects and res piratory depression. The use of newer agent like dexmedetomidine is a viable option. The present study was formulated to provide a comparative assessment of whether fentanyl or dexmedetomidine is a better adjuvant for lower limb surgeries in which epidural route is used. The study included a pool of 30 subjects who were divided in two equal groups and administered fentanyl or dexmedetomidine. The results displayed a shorter duration of sensory block and motor block in dexmedetomidine group as compared to fentanyl. The overall efficacy of dexmedetomidine was better in the present study. Keywords: analgesia, dexmedetomidine, epidural, fentanyl

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Anesthetic effects of varying doses of Fentanyl combined with spinal Bupivacaine in caesarean delivery

Medical Journal of Shree Birendra Hospital ◽

10.3126/mjsbh.v17i2.18614 ◽

2018 ◽

Vol 17 (2) ◽

pp. 3

Author(s):

Puja Thapa ◽

Amir Babu Shrestha ◽

Mallika Rayamajhi

Keyword(s):

Side Effects ◽

Adverse Effects ◽

Caesarean Delivery ◽

Motor Block ◽

Optimal Dose ◽

Sensory Level ◽

Hyperbaric Bupivacaine ◽

Spinal Opioids ◽

Effective Analgesia

IntroductionSpinal opioids have gained popularity in recent years as they augment the analgesia produced by local anesthetics. Fentanyl is one of the opioids used for such purpose however the optimal dose has not been described adequately in the literature available so far in our setup. The aim of this study is to find out the effect of adding various doses of Fentanyl to low dose hyperbaric Bupivacaine intrathecally.Materials and methodsSeventy-five parturients scheduled for caesarean delivery were randomly allocated into three groups (Bupivacaine-Fentanyl) BF10, BF20 and BF30 who received intrathecal 0.5% hyperbaric Bupivacaine 1.6 ml with Fentanyl 10µg, 20 µg and 30 µg respectively. Total volume was made to 2.2ml by adding normal saline. The outcomes measured were peak sensory level, degree of motor block, quality of intraoperative anesthesia, duration of effective analgesia, neonatal APGAR score and side effects were noted if any.ResultsPeak sensory level and degree of motor block was similar in all the groups. Peak sensory level (Thoracic Dermatome) was 4.52± 0.82, 4.32± 0.62 and 4.32± 0.74 (p=0.540) in BF10, BF20 and BF30 respectively. Degree of motor block was not significantly different (p=1.000). Quality of intraoperative anesthesia improved from BF10 to BF20 (P=0.040) but did not improve significantly from BF20 and BF30 (P=0.189). Duration of effective analgesia prolonged as the dose of Fentanyl increased which was in minutes 173.64±41, 216.80±32 and 273.16±35 (p=0.000) in BF10,BF20 and BF30 respectively. Neonatal APGAR scores were similar in all groups and very little adverse effects in higher doses. ConclusionThe combination of 1.6 ml of 0.5% hyperbaric Bupivacaine and 20 µg of Fentanyl intrathecally provides excellent surgical anesthesia, prolonged postoperative effective analgesia with very few side effects. Increasing the dose of Fentanyl beyond it could prolong the postoperative pain relief but at the cost of increased adverse effects.

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Effects of Combination of Intrathecal Fentanyl Clonidine with Bupivacaine in Patients for Operative Knee Arthroscopic Procedure

Research & Innovation in Anesthesia ◽

10.5005/jp-journals-10049-0013 ◽

2016 ◽

Vol 1 (2) ◽

pp. 52-57

Author(s):

Meenoti Pramod Potdar ◽

Laxmi Laxman Kamat ◽

Manjeet Prakash Save ◽

Tanya R Jha

Keyword(s):

Side Effects ◽

P Value ◽

Hyperbaric Bupivacaine ◽

Fentanyl Citrate ◽

Analgesic Requirement ◽

Duration Of Action ◽

Additional Advantage ◽

Arthroscopic Procedure ◽

Intrathecal Clonidine

ABSTRACT Introduction The addition of neuraxial fentanyl or clonidine potentiates the effect of local anesthetic and increases the duration of action and quality of intraoperative and postoperative analgesia. We decided to conduct this study to analyze the synergistic effect of clonidine and fentanyl with bupivacaine on the duration of analgesia surgies. The primary aim is to determine the duration of analgesia for a combination of intrathecal clonidine and fentanyl with bupivacaine in knee arthroscopic surgeries. Materials and methods We included 100 patients undergoing operative arthroscopio procedure and randomly allocated the patients into four different groups of 25 each. Group S: 15 mg 0.5% hyperbaric bupivacaine with 1.0 mL normal saline (NS). Group F: 15 mg 0.5% HB with 25 μcg fentanyl citrate and 0.5 mL NS. Group C: 15 mg 0.5% HB with 75 μcg clonidine and 0.5 mL NS. Group FC: 15 mg 0.5% HB with 25 μcg fentanyl citrate and 75 μcg clonidine. All the patients received the spinal dosage of 4 mL. Results The duration of spinal analgesia was greatest in group FC (458.4 ± 179.96 minutes, p-value 0.001). The rescue analgesic requirement in 24 hours was significantly less in group FC, and the incidence of side effects was comparable. Conclusion The combination of clonidine and fentanyl with bupivacaine intrathecally does augment its sensory, motor, and analgesic action further, and hence it has an additional advantage with similar side effects. How to cite this article Potdar MP, Kamat LL, Save MP, Jha TR. Effects of Combination of Intrathecal Fentanyl Clonidine with Bupivacaine in Patients for Operative Knee Arthroscopic Procedure. Res Inno in Anesth 2016;1(2):52-57.

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Comparison of efficacy between intrathecal nalbuphine and fentanyl as adjuvant to hyperbaric bupivacaine for perianal surgery

Bangladesh Medical Journal Khulna ◽

10.3329/bmjk.v53i1-2.54886 ◽

2021 ◽

Vol 53 (1-2) ◽

pp. 27-30

Author(s):

Moslema Parvin ◽

Anjuman Ara ◽

Kazi Nurjahan ◽

Lipika Roy ◽

Lailatunnessa

Keyword(s):

Side Effects ◽

Motor Block ◽

Hyperbaric Bupivacaine ◽

Duration Of Action ◽

Female Ratio ◽

Medical College ◽

Group I ◽

Duration Of Surgery ◽

Group Ii ◽

American Society

Background: Intrathecal opioids enhance the duration of action of local anasthetic drugs. Both nalpuphine and fentanyl enhance the action of hyperbaric bupivacaine when introduced intrathecally as adjuvant with bupivacaine. Objective: Our study was aimed to compare the clinical efficiency of nalbuphine and fentanyl as adjuvant to hyperbaric bupivacaine for anal and perianal surgery. Methods: In this prospective randomized clinical trial patients were included from January 2007 to June 2008 at Khulna Medical College & some private clinics in Khulna. Patients were ASA (American Society of Anaesthesiology) status I & II of both gender aged 18-70 years and was randomized into two groups. Each group received either nalbuphine, (Group I) or fentanyl (Group-II) with bupivacaine. After intrathecal use every patient was examined for sensory and motor block, drug related side effects like hypotension pruritus, nausea, vomiting respiratory depression for three hours and were recorded. Results: Among two hundred study patients mean age was 49.5 and 5.2 in respective group I & II. Male female ratio was 16:14 in group I, whereas in group II it was 65:35. Mean duration of surgery was 46 and 43 minutes respectively in group I & II. Onset and cephalic extension of block was almost same in both groups. Time to recovery of sensory and motor block were significantly prolonged in Group 1. Duration of analgesia was also extended in group I. No significant drug related side effects were observed in either group. Conclusion: Nalbuphine as adjuvant to bupivacaine was clinically more efficient than fentanyl for post--operative analgesia and duration of sensory and motor block in SAB (Sub Aracnoid Block) for anal and perianal surgery. Bang Med J Khulna 2020: 53 : 27-30

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Epidural and Intrathecal Opioids

Anaesthesia and Intensive Care ◽

10.1177/0310057x8701500108 ◽

1987 ◽

Vol 15 (1) ◽

pp. 60-67 ◽

Cited By ~ 20

Author(s):

M. Morgan

Keyword(s):

Side Effects ◽

Respiratory Depression ◽

Intrathecal Administration ◽

Duration Of Action ◽

Routes Of Administration ◽

Small Doses ◽

Small Incidence ◽

Speed Of Onset ◽

Central Depressant

Small doses of epidural and intrathecal opioids produce effective and prolonged analgesia postoperatively, although the quality of analgesia does not differ from when conventional routes are used. The different opioids differ only in the speed of onset and duration of action, and in the incidence of side-effects. ‘Minor’ complications such as nausea, vomiting, pruritis and retention of urine are relatively common. There is a small incidence of respiratory depression which is delayed for several hours after drug administration and which may be prolonged. It is commoner after morphine and after intrathecal administration, and is also associated with advanced age, concomitant use of other central depressant drugs, respiratory disease and large doses. Because of the potentially lethal nature of this complication, it is recommended that the epidural and intrathecal routes of administration are used only when patients can be closely and constantly observed postoperatively.

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Anesthetic effects of varying doses of Fentanyl combined with spinal Bupivacaine in caesarean delivery

Medical Journal of Shree Birendra Hospital ◽

10.3126/mjsbh.v17i1.18614 ◽

2018 ◽

Vol 17 (1) ◽

pp. 3-10

Author(s):

Puja Thapa ◽

Amir Babu Shrestha ◽

Mallika Rayamajhi

Keyword(s):

Side Effects ◽

Adverse Effects ◽

Caesarean Delivery ◽

Motor Block ◽

Optimal Dose ◽

Sensory Level ◽

Hyperbaric Bupivacaine ◽

Spinal Opioids ◽

Effective Analgesia

Introduction: Spinal opioids have gained popularity in recent years as they augment the analgesia produced by local anesthetics. Fentanyl is one of the opioids used for such purpose however the optimal dose has not been described adequately in the literature available so far in our setup. The aim of this study is to find out the effect of adding various doses of Fentanyl to low dose hyperbaric Bupivacaine intrathecally.Materials and methods:Seventy-five parturients scheduled for caesarean delivery were randomly allocated into three groups (Bupivacaine-Fentanyl) BF10, BF20 and BF30 who received intrathecal 0.5% hyperbaric Bupivacaine 1.6 ml with Fentanyl 10µg, 20 µg and 30 µg respectively. Total volume was made to 2.2ml by adding normal saline. The outcomes measured were peak sensory level, degree of motor block, quality of intraoperative anesthesia, duration of effective analgesia, neonatal APGAR score and side effects were noted if any.Results: Peak sensory level and degree of motor block was similar in all the groups. Peak sensory level (Thoracic Dermatome) was 4.52± 0.82, 4.32± 0.62 and 4.32± 0.74 (p=0.540) in BF10, BF20 and BF30 respectively. Degree of motor block was not significantly different (p=1.000). Quality of intraoperative anesthesia improved from BF10 to BF20 (P=0.040) but did not improve significantly from BF20 and BF30 (P=0.189). Duration of effective analgesia prolonged as the dose of Fentanyl increased which was in minutes 173.64±41, 216.80±32 and 273.16±35 (p=0.000) in BF10,BF20 and BF30 respectively. Neonatal APGAR scores were similar in all groups and very little adverse effects in higher doses.Conclusion: The combination of 1.6 ml of 0.5% hyperbaric Bupivacaine and 20 µg of Fentanyl intrathecally provides excellent surgical anesthesia, prolonged postoperative effective analgesia with very few side effects. Increasing the dose of Fentanyl beyond it could prolong the postoperative pain relief but at the cost of increased adverse effects.

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DEXAMETHASONE AND POSTOPERATIVE ANALGESIA

Regional Anesthesia and Acute Pain Management ◽

10.18821/1993-6508-2018-12-3-148-154 ◽

2018 ◽

Vol 12 (3) ◽

pp. 148-154

Author(s):

Alexei M. Ovechkin ◽

M. E Politov

Keyword(s):

Laparoscopic Surgery ◽

Side Effects ◽

Peripheral Nerve ◽

Motor Block ◽

Standard Dose ◽

Single Administration ◽

Duration Of Action ◽

Promising Area ◽

Clinically Significant ◽

Area Of Application

The review contains the analysis of analgesic and opioid-saving action of dexamethasone in its systemic administration. These effects are most evident in the preventive administration of the drug 1.5-2 hours before surgery. The most promising area of application of dexamethasone as a component of anesthetic support is laparoscopic surgery. In the orthopedic clinic, the use of dexamethasone can increase the duration of action of peripheral nerve blockades and plexuses (both sensory and motor block), while perineural administration (addition to the local anesthetics) has no advantages over intravenous injection. Single administration of a standard dose of dexamethasone (8 mg) is not accompanied by the occurrence of clinically significant side effects.

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