Acomparative Study between Epidural Analgesia of Levobupivacaine with Fentanyl versus Dexmedetomidine for knee replacement surgeries

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Naglaa Mohammed Ali ◽  
Ehab Hamed Abd El Mohsen ◽  
Rania Maher Hussien ◽  
Omar Abd El Gawad Kamel Massoud
Keyword(s):  
Postoperative Pain ◽  
Epidural Analgesia ◽  
Knee Replacement ◽  
Sedation Score ◽  
Gamma Aminobutyric Acid ◽  
University Hospitals ◽  
Research Committee ◽  
Duration Of Action ◽  
Dose Dependent Decrease ◽  
Double Blinded

Abstract Background The use of epidural analgesia for the management of postoperative pain has evolved as a critical component of multimodal approach to achieve the goal of adequate analgesia with improved outcome. Epidural analgesia offers superior postoperative pain relief compared with systemic opioids. In addition to improved patient outcome. Objective To compare the effect of dexmedetomidine and fentanyl as an adjuvant to epidural levobupivacaine in knee replacement surgeries regarding duration of action and the analgesic potency of both drugs. Patients and Methods This prospective double blinded randomized clinical trial study was conducted in Maadi Military and Ain Shams University Hospitals after approval of the anesthesia department and the local ethics and research committee over 6 months and after obtaining a written informed consent. Sixty patients underwent knee replacement surgeries were included in the study their ages range between 21 and 60 years old and classified as ASA I and II. The patients were randomly divided using computer generated randomization into two groups 30 patients in each (n = 30). Results As regards sedation score intraoperative and postoperative, in the present study, we found that Ramsay sedation score was significantly higher in group ‘BD’ when compared to group ‘BF’ intraoperative and postoperative. This finding may be attributed to the sedative properties of dexmedetomidine that is far superior to fentanyl acting by dose-dependent decrease in activity of noradrenergic neurons in the brain stem via post-synaptic receptor-mediated inhibition. This increases gamma-aminobutyric acid (GABA) neurone activity, which mediates central sedative effects. Conclusion Epidural levobupivacaine with dexmedetomidine provided better sedation, adequate surgical anesthesia with prolonged postoperative analgesia for lower limb surgeries. Both adjuvants reduced the epidural dose of levobupivacaine and potentiated its efficacy.

scholarly journals Patient-Controlled Epidural Levobupivacaine with or without Fentanyl for Post-Cesarean Section Pain Relief

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Shin-Yan Chen ◽  
Feng-Lin Liu ◽  
Yih-Giun Cherng ◽  
Shou-Zen Fan ◽  
Barbara L. Leighton ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Epidural Analgesia ◽  
University Hospital ◽  
Control Regimen ◽  
Background Infusion ◽  
Continuous Background ◽  
American Society ◽  
Group B ◽  
Double Blinded ◽  
American Society Of Anesthesiologists

Purpose.The purpose of this study was to compare the analgesic properties of levobupivacaine with or without fentanyl for patient-controlled epidural analgesia after Cesarean section in a randomized, double-blinded study.Methods.We enrolled American Society of Anesthesiologists class I/II, full-term pregnant women at National Taiwan University Hospital who received patient-controlled epidural analgesia after Cesarean section between 2009 and 2010. Eighty women were randomly assigned into two groups. In group A, the 40 subjects received drug solutions made of 0.6 mg/ml levobupivacaine plus 2 mcg/ml fentanyl, and in group B the 40 subjects received 1 mg/ml levobupivacaine. Maintenance was self-administered boluses and a continuous background infusion.Results.There were no significant differences in the resting and dynamic pain scales and total volume of drug used between the two groups. Patient satisfaction was good in both groups.Conclusion.Our study showed that pure epidural levobupivacaine can provide comparative analgesic properties to the levobupivacaine-fentanyl combination after Cesarean section. Pure levobupivacaine may serve as an alternative pain control regimen to avoid opioid-related adverse events in parturients.

Continuous Femoral Nerve Blockade versus Continuous Epidural Analgesia for Postoperative Pain Relief in Knee Surgeries

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Hala Gomaa Salama ◽  
Ahmed Ali El- Shebiny ◽  
Abd Al Aziz Abdullah Abd Al Aziz ◽  
Mariam Mahmoud Ahmed Ali Shehata
Keyword(s):  
Postoperative Pain ◽  
Epidural Analgesia ◽  
Nerve Block ◽  
Femoral Nerve Block ◽  
Weight Bearing ◽  
Femoral Nerve ◽  
Disease Process ◽  
Continuous Epidural Analgesia ◽  
Significant Difference ◽  
Continuous Femoral Nerve Block

Abstract Background The progression of osteoarthritis is characteristically slow, occurring over several years or decades. Over this period, the patient can become less and less active and thus more susceptible to morbidities related to decreasing physical activity (including potential weight gain). Early in the disease process, the joints may appear normal. However, the patient’s gait may be antalgic if weight-bearing joints are involved. Objective Compare the benefits of continuous femoral nerve block (CFNB) with those of continuous epidural analgesia CEPA for postoperative pain management after Knee surgeries. Methods This study is a randomized controlled clinical trial was conducted in Ain Shams University Hospitals after obtaining approval from the Research Ethical Committee of Ain Shams University during a period of three months. Patients undergoing primary unilateral TKA for osteoarthritis, were recruited at least one day prior to the scheduled surgery, male and female patients. Results There was significant difference in terms of pain scoring between continuous femoral nerve block (CFNB) and continuous epidural analgesia (CEA) in the first 6 hours, 12 hours, 24 hours, 48 hours, 72 hours but non significant difference in incidence of side effects Conclusion Our study showed that CEA had optimal analgesia and pain control than CFNB in management of post operative pain after total knee replacement.

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