Addition of Epinephrine to Intrathecal Bupivacaine and Sufentanil for Ambulatory Labor Analgesia

1997 ◽  
Vol 86 (3) ◽  
pp. 525-531 ◽  
Author(s):  
David C. Campbell ◽  
Robert Banner ◽  
Lesley-Ann Crone ◽  
Wendy Gore-Hickman ◽  
Ray W. Yip
Keyword(s):  
Labor Analgesia ◽  
Saline Control ◽  
Control Group ◽  
Double Blind Study ◽  
Saline Control Group ◽  
Double Blind ◽  
Prolonged Labor ◽  
Intrathecal Analgesia ◽  
Limited Duration ◽  
Effective Analgesia

Background The intrathecal combination of sufentanil and bupivacaine provides rapid, effective analgesia for labor with a limited duration. Many anesthesiologists have concerns that the use of intrathecal local anesthetics precludes maternal ambulation. This prospective, randomized, double-blind study was designed to determine whether the addition of epinephrine to the combination of sufentanil and bupivacaine would prolong intrathecal analgesia for labor. Patients' ability to ambulate was also assessed. Methods Thirty-nine patients received either an intrathecal control dose of 10 micrograms sufentanil plus 2.5 mg bupivacaine plus 0.2 ml normal saline (control group); or 10 micrograms sufentanil plus 2.5 mg bupivacaine plus 0.2 ml (0.2 mg) of epinephrine (EPI group). Results Seven patients (3 control, 4 EPI) delivered vaginally and two (1 control, 1 EPI) required cesarean delivery before requesting epidural analgesia. The duration (mean +/- SD) of intrathecal labor analgesia was prolonged significantly by the addition of epinephrine: control (n = 15): 145 +/- 23 min; EPI (n = 15): 188 +/- 25 min (P < 0.0001). Maternal ambulation was demonstrated in 100% (19 of 19) of the control group and in 80% (16 of 20) of the EPI group (P = NS). Conclusions The addition of 0.2 mg epinephrine to the intrathecal combination of sufentanil and bupivacaine significantly prolonged labor analgesia without causing adverse effects to the mother or fetus. The intrathecal combination of sufentanil and bupivacaine, with or without epinephrine, provided rapid, profound labor analgesia and allowed most patients to ambulate.

A Comparison of Median Effective Doses of Intrathecal Levobupivacaine and Ropivacaine for Labor Analgesia

2005 ◽  
Vol 102 (3) ◽  
pp. 651-656 ◽  
Author(s):  
Alex T. Sia ◽  
Raymond W. Goy ◽  
Yvonne Lim ◽  
Cecilia E. Ocampo
Keyword(s):  
Confidence Interval ◽  
Probit Analysis ◽  
Labor Analgesia ◽  
Double Blind Study ◽  
Double Blind ◽  
Significant Difference ◽  
Effective Doses ◽  
To Receive ◽  
Higher Doses ◽  
Effective Analgesia

Background The study was designed to determine and compare the median effective doses (MEDs) of intrathecal ropivacaine with levobupivacaine for labor analgesia. Methods In this double-blind study, 100 parturients in early labor were randomized to receive either intrathecal ropivacaine or levobupivacaine. For each drug, the patients were assigned to receive one of the five doses studied, namely 1, 1.5, 2, 2.5, or 3 mg. Effective analgesia was defined as a pain score (0-100 visual analog scale) of less than 10 within 15 min of injection, lasting for 45 min or more after the induction of analgesia. MEDs were derived from probit analysis. The duration of analgesia rendered by the two drugs at 2.5 and 3 mg was also compared. Results The MED for levobupivacaine was 1.07 mg (95% confidence interval, 0.88-1.25 mg), and the MED for ropivacaine was 1.40 mg (95% confidence interval, 1.20-1.61 mg). Levobupivacaine was found to be 1.31 (95% confidence interval, 1.04-2.01) times more potent than ropivacaine. At doses of 2.5 mg or greater, there was no significant difference in duration of analgesia between levobupivacaine (median, 63.5 min; range, 46-123 min) and ropivacaine (median, 59.0 min; range, 47-93 min; P = 0.18). We detected no difference in the incidence of hypotension, nausea and vomiting, motor block, or abnormal fetal heart tracing between the two drugs. Conclusions The MED of intrathecal ropivacaine for labor analgesia was significantly greater than levobupivacaine experimentally, but this significance was reduced when the comparison was based on molar potency. There was no difference in the duration of analgesia or adverse effects between the two drugs at higher doses (2.5 mg or greater).

Succinylcholine Dosage and Apnea-induced Hemoglobin Desaturation in Patients

2005 ◽  
Vol 102 (1) ◽  
pp. 35-40 ◽  
Author(s):  
Mohamed Naguib ◽  
Abdulhamid H. Samarkandi ◽  
Khaled Abdullah ◽  
Waleed Riad ◽  
Saleh W. Alharby
Keyword(s):  
Oxygen Saturation ◽  
Upper Airway ◽  
Study Drug ◽  
Face Mask ◽  
Saline Control ◽  
Control Group ◽  
Double Blind Study ◽  
Double Blind ◽  
The Face ◽  
End Tidal

Background The authors examined the notion that a reduction in succinylcholine dose from 1 mg/kg to approximately 0.6 mg/kg would allow a faster recovery of spontaneous ventilation and reduction in the incidence of hemoglobin desaturation during the period of apnea in simulated complete upper airway obstruction situations. Methods This prospective, randomized, double-blind study involved 60 patients. After preoxygenation to an end-tidal oxygen concentration >90%, patients were anesthetized with 2 microg/kg fentanyl and 2 mg/kg propofol. After loss of consciousness, patients were randomly allocated to receive 0.56 or 1.0 mg/kg succinylcholine or saline (control group). Oxygen saturation was monitored continuously at the index finger. When the patient became apneic, the face mask was removed and the patient's airway was left unsupported. If the oxygen saturation decreased to 90%, the face mask was reapplied, and ventilation was assisted until the patient was awake. Time from injection of the study drug to the first visible spontaneous diaphragmatic movements was noted. Results Oxygen saturation decreased <90% in 45%, 65%, and 85% of patients in the control, 0.56 mg/kg, and 1.0 mg/kg succinylcholine groups, respectively (P = 0.03). Corresponding times (mean +/- SD) to spontaneous of diaphragmatic movements were 2.7 +/- 1.2, 4.8 +/- 2.5, and 4.7 +/- 1.3 min, respectively. These times were longer (P < 0.001) after either dose of succinylcholine compared with controls. Conclusions Reduction in succinylcholine dose from 1.0 mg/kg to 0.56 mg/kg decreased the incidence of hemoglobin saturation <90% from 85% to 65% but did not shorten the time to spontaneous diaphragmatic movements. A significant fraction of patients would be at risk if there were failure to intubate and ventilate whether succinylcholine is administered or not and regardless of the dose of succinylcholine administered.

scholarly journals Role of Dexamethasone on Reducing Post Tonsillectomy Morbidities

2009 ◽  
Vol 20 (1) ◽  
pp. 13-17 ◽  
Author(s):  
Rubina Yasmin ◽  
Zamir Hossain Khan ◽  
SM Shafiqul Alam
Keyword(s):  
Surgical Techniques ◽  
Oral Intake ◽  
Saline Control ◽  
Control Group ◽  
Double Blind Study ◽  
Double Blind ◽  
Post Operative Pain ◽  
Poor Oral Intake ◽  
Induction Of Anaesthesia

Pain, nausea, vomiting, oedema and poor oral intake are the most common morbidities after general anesthesia and surgery like tonsillectomy. This study was done to evaluate the effectiveness of intravenous dexamethasone (0.15mg/kg) at induction of anaesthesia on post tonsillectomy morbidities. In this prospective randomized double blind study, sixty children of age between 8-12 years, ASA I & II undergoing tonsillectomy under general anaesthesia were randomly assigned into two equal groups of 30 each. They received dexamethasone IV or saline (control) following induction of anaesthesia. Both anesthetic and surgical techniques were standardized. Post operative pain was assessed by visual analogue scale (VAS). Inj. Tramadol 1mg/kg in first 6 hrs and oral paracetamol 10mg/kg in next 24 hrs were administered as rescue analgesic. Incidence of nausea, vomiting, time and quantity of first oral intake were also noted. Patients receiving dexamethasone experienced significantly less pain, nausea and vomiting than control group throughout 24 hrs. Lesser patients required rescue analgesics (23.33% vs. 46.67%) in first 6 hrs. So, it is found that, single intravenous dose of dexamethasone (0.15mg/kg) provided significant analgesia, reduced nausea, vomiting and improved quality of oral intake in paediatric patients who underwent tonsillectomy.   Journal of BSA, Vol. 20, No. 1, January 2007 p.13-17

scholarly journals Spinal and intravenous midazolan anesthetic effects on fentanyl/ ligdocaine regional anesthesia following back minor orthopedic surgery

2010 ◽  
Vol 9 (1) ◽  
pp. 30-34
Author(s):  
Gabriela Rocha Lauretti ◽  
Anita L. Mattos
Keyword(s):  
Orthopedic Surgery ◽  
Concentration Level ◽  
Statistical Significance ◽  
Intrathecal Injection ◽  
Control Group ◽  
Sensory Level ◽  
Double Blind Study ◽  
Double Blind ◽  
Effective Analgesia ◽  
Group 1

OBJECTIVES: the present study was designed to evaluate the usefulness of intravenous and intrathecal midazolan as an adjunct to intrathecal ligdocaine, with or without intrathecal fentanyl. METHODS: double-blind study, institutional approval and informed consent; 40 patients scheduled for minor lumbar orthopedic surgery were randomly assigned to one of five groups (n=8). Patients were premedicated with a 4 mL final intravenous volume (saline or midazolan). Spinal anaesthesia was administered to a 3 mL final volume - 75 mg of lidocaina plus either 33 mg fentanyl or 500 mg midazolan diluted in saline (0,9%) - with the patient in sitting position. The latency time for onset of the block (LT), time to progress to T10 sensory level (TT10), duration of the block (Bl), duration of effective analgesia (An), the subjective degree of intraoperative sedation, level of alertness, concentration level and degree of anxiety were specifically measured. P<0.05 was considered significant. RESULTS: the addition of midazolan to the intrathecal injection in the absence of fentanyl was the only procedure which caused a statistically significant reduction in LT (p<0.002) and TT10 (p<0.001). Intrathecal midazolan increased the blockade time both with (p<0.05) and without (p<0.02) intrathecal fentanyl, but, when given intravenously, this effect failed to reach statistical significance (p>0,05). Both intrathecal fentanyl and midazolan increased the duration of analgesia (p<0.01). With respect to the subjective measures, group 1 served as the control group, demonstrating an alert, fully awake patient who was able to concentrate but showed some anxiety. CONCLUSIONS: while all additional treatments resulted in a relaxed patient, only those given intrathecal midazolan remained fully awake, alert and able to concentrate. Intrathecal fentanyl with saline premedication or intravenous midazolan premedication resulted in decreased alertness and inability to concentrate, as well as sleepiness, which was more extreme in the case of those patients given intravenous midazolan.

scholarly journals Evaluation of Prophylactic Effect of Intramuscular Diclofenac Sodium for Prevention of Succinylcholine-Induced Myalgia

KYAMC Journal ◽  
2019 ◽  
Vol 10 (1) ◽  
pp. 35-38
Author(s):  
Muhammad Sazzad Hossain ◽  
Md Afzalur Rahman ◽  
Syed Ariful Islam ◽  
Md Waliullah
Keyword(s):  
Intramuscular Injection ◽  
Elective Surgery ◽  
Demographic Data ◽  
Diclofenac Sodium ◽  
Saline Control ◽  
Control Group ◽  
Double Blind Study ◽  
Double Blind ◽  
Duration Of Action ◽  
Group I

Background: Succinylcholine a depolarizing muscle relaxant with rapid onset, predictable course and short duration of action is associated with myalgia. Objectives: To assess the efficacy of intramuscular injection of diclofenac sodium in preventing succinylcholine-induced myalgia. Materials and Methods: Eighty healthy adults scheduled for elective surgery under general anesthesia were enrolledin a double-blind study and randomly allocated into two groups of forty patients. Patients in Group I (diclofenacgroup) were pretreated with inj. diclofenac 75 mg deep intramuscularly into gluteal region one hour prior to induction of anesthesia, while patients in Group II (saline group) received an equivalent volume of saline inj. in same site. Anesthesia was induced in both groups with fentanyl 1.5 mcg/kg, propofol 2.0 mg/kg and succinylcholine1.5 mg/kg. Postoperative myalgia was assessed 24 hours after induction and graded as nil, mild, moderate, or severe. Results:The demographic data for both groups were comparable (p > 0.05). Postoperative myalgia was recorded at 24 hours after induction in diclofenac group with twelve (30%) patients and 24 (60%) patients in normal saline (control) group respectively (p < 0.05). Conclusion: Prophylactic use of intramuscular injection of diclofenac is effective in the prevention of postoperative myalgia KYAMC Journal Vol. 10, No.-1, April 2019, Page 35-38

Optimal Dose of Succinylcholine Revisited

2003 ◽  
Vol 99 (5) ◽  
pp. 1045-1049 ◽  
Author(s):  
Mohamed Naguib ◽  
Abdulhamid Samarkandi ◽  
Waleed Riad ◽  
Saleh W. Alharby
Keyword(s):  
Rapid Sequence Induction ◽  
Optimal Dose ◽  
Spontaneous Respiration ◽  
Saline Control ◽  
Control Group ◽  
Double Blind Study ◽  
Double Blind ◽  
Intubating Conditions ◽  
Rapid Sequence ◽  
Sequence Induction

Background The authors reappraised the conventional wisdom that the intubating dose of succinylcholine must be 1.0 mg/kg and attempted to define the lower range of succinylcholine doses that provide acceptable intubation conditions in 95% of patients within 60 s. Methods This prospective, randomized, double-blind study involved 200 patients. Anesthesia was induced with 2 mug/kg fentanyl and 2 mg/kg propofol. After loss of consciousness, patients were randomly allocated to receive 0.3, 0.5, or 1.0 mg/kg succinylcholine or saline (control group). Tracheal intubation was performed 60 s later. A blinded investigator performed all laryngoscopies and also graded intubating conditions. Results Intubating conditions were acceptable (excellent plus good grade combined) in 30%, 92%, 94%, and 98% of patients after 0.0, 0.3, 0.5, and 1.0 mg/kg succinylcholine, respectively. The incidence of acceptable intubating conditions was significantly greater (P &lt; 0.05) in patients receiving succinylcholine compared with those in the control group but was not different among the different succinylcholine dose groups. The calculated doses of succinylcholine (and their 95% confidence intervals) that were required to achieve acceptable intubating conditions in 90% and 95% of patients at 60 s were 0.24 (0.19-0.31) mg/kg and 0.56 (0.43-0.73) mg/kg, respectively. Conclusions The use of 1.0 mg/kg of succinylcholine may be excessive if the goal is to achieve acceptable intubating conditions within 60 s. Comparable intubating conditions were achieved after 0.3, 0.5, or 1.0 mg/kg succinylcholine. In a rapid-sequence induction, 95% of patients with normal airway anatomy anesthetized with 2 mug/kg fentanyl and 2 mg/kg propofol should have acceptable intubating conditions at 60 s after 0.56 mg/kg succinylcholine. Reducing the dose of succinylcholine should allow a more rapid return of spontaneous respiration and airway reflexes.

Comparative Evaluation of 0.1% Octenidine Mouthwash with 0.2% Chlorhexidine Mouthwash in Prevention of Plaque and Gingivitis – A Clinicomicrobiological Study

2021 ◽  
Vol 13 (3) ◽  
pp. 202-210
Author(s):  
Sowmya Sadanandan ◽  
Suhas S ◽  
Sanjay Venugopal ◽  
Kavitha Karur
Keyword(s):  
Antibacterial Properties ◽  
Chlorhexidine Gluconate ◽  
Control Group ◽  
Double Blind Study ◽  
Gingival Inflammation ◽  
Patient Acceptability ◽  
Double Blind ◽  
Microbiological Parameters ◽  
Group B ◽  
The Impact

Background: Our study aimed to assess the efficacy of 0.1% Octenidine mouthwash as an anti-plaque agent and to assess its effect on gingival inflammation and staining of teeth when compared to 0.2% chlorhexidine gluconate by evaluating the impact on plaque and gingival inflammation as well as on microbial load. Materials and Methods: A three week double blind study was conducted on 69 subjects, aged 20-50 years, with moderate to severe gingivitis. The study population was divided into three groups with 23 subjects in each group: Group A - control subjects received only scaling, Group B received 0.2% chlorhexidine gluconate in addition to scaling and Group C received 0.1% Octenidine mouthwash along with scaling. Clinical and microbiological parameters were recorded at baseline, on 14th day and on 21st day. Subjective and objective criteria were assessed on the 14th day and 21st day. Results: There was a statistically significant reduction in all the tested parameters within all the three groups and between the groups from baseline to 21st day. The highest mean reduction in all the parameters was seen in subjects using 0.1% Octenidine. On comparison with the control group, subjects using the mouthwashes (Group B and Group C) had better improvement in clinical and microbiological parameters from baseline to 21st day. On comparison with chlorhexidine, Octenidine mouthwash significantly reduced plaque (p<0.05) and showed better patient acceptability. However, it was comparable to chlorhexidine in other two tested parameters. Conclusion: Owing to Octenidine’s pronounced and comparable antibacterial properties, it can be a promising candidate for the use in antiseptic mouthwashes.

The Effectiveness of Group Acceptance and Commitment Therapy and Cognitive Therapy on Alexithymia and Marital Boredom, Case study: Women Affected by Marital Infidelity in Mashhad, Iran

2022 ◽  
Author(s):  
Maryam Sadeghi ◽  
Naeimeh Moheb ◽  
Marziyeh Alivandi Vafa
Keyword(s):  
Cognitive Therapy ◽  
Analysis Of Covariance ◽  
Control Group ◽  
Double Blind Study ◽  
University Counseling Center ◽  
Double Blind ◽  
University Counseling ◽  
Acceptance And Commitment ◽  
Marital Infidelity ◽  
The Mean

Introduction: The aim of current paper was to compare the effectiveness of acceptance and commitment group therapy (ACT) and group cognitive therapy (GCT) on Alexithymia and marital boredom (MB) among women affected by marital infidelity in Mashhad. Method: This clinical trial was a double- blind study with a pretest-posttest design in which two intervention groups and one control group were investigated. The study performed on women who realized their spouse infidelity and referred to Azad University Counseling Center in Mashhad in 2018. The sample consisted of 30 women who were selected by purposive sampling and were randomly assigned to two intervention groups and a control group (n=10 per group). The intervention groups were put under ACT training (twelve 90-minute sessions) and GCT training (twelve 90-minute sessions), but the control group did not receive any intervention. Data was obtained by the Toronto Alexithymia Scale-20 and Pines Marital Boredom Scale and was analyzed by multivariate analysis of covariance with SPSS (version 22) software. Results: The results showed a significant reduction in the mean score of MB in the ACT group, also there was a significant reduction in the mean score of Alexithymia in the GCT group (P <0.05). So comparing both therapies, ACT was more influential on reducing marital boredom whereas GCT was more effective on reducing alexithymia. Conclusion: Although both intervention methods were effective on Alexithymia and Marital Boredom in women affected by marital infidelity, it was demonstrated that ACT and GCT have more effect on Marital Boredom and Alexithymia, respectively.

scholarly journals Comparison of three different concentrations of epidural ropivacaine (0.05%, 0.1% & 0.2%) for labor analgesia: A prospective randomized and double blind study

2018 ◽  
Vol 5 (3) ◽  
pp. 403-406
Author(s):  
Kunal Singh ◽  
Hariom Khandelwal ◽  
Shikha Agarwal ◽  
Ashutosh Singh ◽  
Prithwis Bhattacharya
Keyword(s):  
Labor Analgesia ◽  
Blind Study ◽  
Double Blind Study ◽  
Double Blind
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