A Double-blind Comparison of 0.125% Ropivacaine with Sufentanil and 0.125% Bupivacaine with Sufentanil for Epidural Labor Analgesia 

1999 ◽  
Vol 90 (3) ◽  
pp. 772-778 ◽  
Author(s):  
Philippe Gautier ◽  
Marc De Kock ◽  
Albert Van Steenberge ◽  
Dominique Miclot ◽  
Luc Fanard ◽  
...  
Keyword(s):  
Motor Impairment ◽  
Epidural Injection ◽  
Motor Blockade ◽  
Double Blind ◽  
Patient Satisfaction Scores ◽  
Severe Motor ◽  
American Society ◽  
Blind Comparison ◽  
American Society Of Anesthesiologists ◽  
To Receive

Background This study intends to evaluate the benefits of the administration of intermittent bolus doses of ropivacaine (0.125%) compared with bupivacaine (0.125%) after addition of sufentanil for analgesia during labor. Methods One hundred thirty American Society of Anesthesiologists physical status 1 or 2 parturients were studied. The 90 initial patients were assigned randomly to receive 10 ml bupivacaine, 0.125%, plus 7.5 microg sufentanil (initial bupivacaine 0.125% group) or ropivacaine, 0.125%, plus 7.5 microg sufentanil (ropivacaine 0.125% group). Forty additional patients were recruited and received 0.125% bupivacaine plus 7.5 microg sufentanil (additional bupivacaine 0.125% group) or 0.100% bupivacaine plus 7.5 microg sufentanil (additional bupivacaine 0.100% group). The duration of analgesia, visual analogue scores for pain, motor blockade (using a six-point modified Bromage scale), patient satisfaction scores, nausea, pruritus, heart rate, and blood pressure were recorded. Results Bupivacaine 0.125% and ropivacaine 0.125% coadministered with sufentanil provided rapid and complete analgesia. Onset of analgesia occurred after +/-15 min and lasted +/-90 min. After the third epidural injection, patients in the ropivacaine group experienced significantly less severe motor blockade than patients in the initial bupivacaine 0.125% group. At this point, 93% of the patients in the ropivacaine group were free from motor impairment versus 66% in the bupivacaine group (P<0.05). Comparable levels of motor blockade were obtained in both additional groups. Patients' evaluation of their analgesia was worst in the bupivacaine 0.100% group. Conclusions Ropivacaine 0.125% with sufentanil affords reliable analgesia with minimal motor blockade.

Dilution of Spinal Lidocaine Does Not Alter the Incidence of Transient Neurologic Symptoms 

1999 ◽  
Vol 90 (2) ◽  
pp. 445-450 ◽  
Author(s):  
Julia E. Pollock ◽  
Spencer S. Liu ◽  
Joseph M. Neal ◽  
Carol A. Stephenson
Keyword(s):  
Postoperative Complications ◽  
Knee Arthroscopy ◽  
Physical Status ◽  
Double Blind ◽  
Neurologic Symptoms ◽  
The Third ◽  
Ambulatory Patients ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
To Receive

Background Although it has been suggested that the dilution of 5% hyperbaric lidocaine before injection for spinal anesthesia may decrease the incidence of transient neurologic symptoms, previous studies have not noted a decreased incidence between 5% and 2% lidocaine. The aim of the current study was to determine whether the incidence of transient neurologic symptoms could be altered by further diluting spinal lidocaine from 2.0% to 0.5%. Methods One hundred nine patients with American Society of Anesthesiologists physical status 1 or 2 undergoing outpatient knee arthroscopy were randomized in a double-blind fashion to receive 50 mg hyperbaric spinal lidocaine as a 2.0%, 1.0%, or 0.5% concentration. On the third postoperative day, patients were contacted by a blinded investigator and questioned regarding the incidence of postoperative complications, including transient neurologic symptoms, defined as pain or dysthesia in one or both buttocks or legs occurring within 24 h of surgery. Results The incidence of transient neurologic symptoms did not differ among patients receiving 2.0% (incidence of 15.8%), 1.0% (incidence of 22.2%), and 0.5% (incidence of 17.1%) lidocaine (P = 0.756). Conclusions For ambulatory patients undergoing arthroscopy, the incidence of transient neurologic symptoms is not reduced by decreasing spinal lidocaine concentrations from 2.0% to 1.0% or 0.5%. The incidences of transient neurologic symptoms with the 0.5%, 1.0%, and 2.0% solutions are similar to previously reported incidences for 5.0% lidocaine, suggesting that dilution of lidocaine from 5.0% to 0.5% does not change the incidence of these symptoms.

Epidural dexamethasone for postoperative analgesia in patients of carcinoma rectum undergoing lower anterior resection (LAR)

JMS SKIMS ◽  
2019 ◽  
Vol 22 (1) ◽  
Author(s):  
Sheikh Irshad Ahmad ◽  
Gowhar Hameed ◽  
Tanveera Gani ◽  
Tantry Tariq Gani ◽  
Wasim Mohammad Bhat ◽  
...  
Keyword(s):  
Postoperative Analgesia ◽  
Anterior Resection ◽  
Double Blind Study ◽  
Double Blind ◽  
Rescue Analgesia ◽  
Carcinoma Rectum ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
To Receive ◽  
Lower Anterior Resection

Background and Aims: This prospective, randomized, double blind study was undertaken to establish the effect of addition of dexamethasone as an adjunct to epidural ropivacaine in patients of carcinoma rectum undergoing lower anteriorresection. Materials and Methods: Sixty ASA (American Society of Anesthesiologists) class I and II patients undergoing lower anterior resection were enrolled to receive either 6mg or 8mg or 10mg of dexamethasone along with epidural ropivacaine to a total of 10ml test solution in each group for epidural analgesia. Hemodynamic parameters, postoperative analgesia, total requirement of rescue analgesia and adverse events were monitored. Results: Analgesia in the postoperative period was better in Group receiving 10mg of dexamethasone associated with less postoperative rescue analgesic consumption Conclusion: Hence, addition of dexamethasone 10mg to epidural ropivacaine can be advantageous with respect to better postoperative analgesia.

scholarly journals Prophylactic ondansetron eight milligrams versus four milligrams against post spinal anaesthesia shivering

2021 ◽  
Vol 8 (5) ◽  
pp. 1545
Author(s):  
Ajay Kumar ◽  
Anuj Singh ◽  
Shamabhu P. Sharma ◽  
Amitava Dutta ◽  
Amit Kumar Sharma
Keyword(s):  
Spinal Anesthesia ◽  
Spinal Anaesthesia ◽  
Double Blind Study ◽  
Double Blind ◽  
Prophylactic Administration ◽  
American Society ◽  
Group B ◽  
Control And Management ◽  
American Society Of Anesthesiologists ◽  
To Receive

Background: Shivering is one of the commonly encountered adverse affect after spinal anaesthesia. Shivering can be very discomforting to the patient and hampers operative maneuvering. Pharmacological therapies have been studied for control and management of shivering. One such drug is ondansetron, a 5-HT3 antagonist. Aim of current study is to evaluate the efficacy of prophylactic administration of ondansetron 8 mg vs. 4 mg for prevention of shivering.Methods: A prospective, randomized, and double blind study was conducted on 100 patients, from either gender, aged 20-60 years, of the American society of anesthesiologists grade I or II, scheduled for various surgeries under spinal anesthesia. The patients were randomly divided into two groups of 50 each to receive either ondansetron 8 mg (group E) or ondansetron 4 mg, (group F) as slow intravenous infusion prior to spinal anesthesia. The primary end point were intraoperative shivering and secondary outcomes included hypotension, adverse reaction, cardiac dysrhythmia’s.Results: A total of 10 patients in group E (20%) and 20 (40%) patients in group F experienced shivering (p=0.029). Incidence of nausea was similar in both groups, total of 8 (16%) patients in group E and 5 (10%) in group B had hypotension (p=0.27). 1 (2%) patient in group E experienced bradycardia.Conclusions: Prophylactic administration of ondansetron 8 mg has better efficacy in prevention of spinal anaesthesia induced shivering with minimal side effects as compared to 4 mg dosage.

scholarly journals Comparison of Effectiveness of Ropivacaine (0.5 %) with Fentanyl, and Bupivacaine (0.5 %) with Fentanyl, in Spinal Anaesthesia in Lower Limb and Lower Abdominal Surgeries

2020 ◽  
Vol 7 (48) ◽  
pp. 2836-2840
Author(s):  
Abhilasha Singh ◽  
Shivpriya P.N ◽  
Sanjeev Sharma ◽  
Alka Gupta
Keyword(s):  
Spinal Anaesthesia ◽  
Lower Limb ◽  
Motor Blockade ◽  
Lower Abdomen ◽  
Sensory Blockade ◽  
American Society ◽  
Comparison Of Effectiveness ◽  
American Society Of Anesthesiologists ◽  
To Receive ◽  
Fentanyl Group

BACKGROUND We wanted to compare the efficacy of motor and sensory blockade in lower limb and lower abdomen surgeries achieved by ropivacaine-fentanyl and bupivacainefentanyl combinations administered intrathecally. METHODS A prospective, randomized [block randomization], interventional, comparative study was conducted on 116 American Society of Anesthesiologists physical status I – II patients. They were randomly divided into two groups of 58 patients each, to receive either 3 mL of 15 mg of 0.5 % ropivacaine with 25 mcg fentanyl [group RF] or 3 mL of 15 mg of 0.5 % bupivacaine with 25 mcg fentanyl [group BF] intrathecally. Pinprick test and Bromage scale was used to assess sensory and motor blockade, respectively. RESULTS Time taken for motor regression in group RF is lesser than that taken in group BF. CONCLUSIONS Ropivacaine along with fentanyl is more advantageous in spinal anaesthesia for infraumbilical surgeries due to brief duration of motor blockade. KEYWORDS Bupivacaine, Fentanyl, Ropivacaine, Spinal Anaesthesia

scholarly journals Reliable and rapid smooth extubation after Ketofol for induction of general anesthesia in Laparoscopic Drilling of polycystic ovary: A randomized controlled trial

2020 ◽  
Author(s):  
Atef Mohamed Sayed Mahmoud ◽  
Joseph Makram Botros ◽  
Safaa Gaber Ragab
Keyword(s):  
General Anesthesia ◽  
Polycystic Ovary ◽  
Controlled Trial ◽  
Controlled Study ◽  
Double Blind ◽  
Randomized Controlled ◽  
Airway Response ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Better Than

Abstract Background the outcome of ketofol on the hemodynamics and the airway response during induction of general anesthesia has been studied before. Its effect on smoothness of extubation has not been studied before. So, we aimed to assess the effect of ketofol on the smoothness of extubation and compare it with propofol only for induction of general anesthesia. Methods This double-blind, randomized, and controlled study was conducted on one hundred and six American Society of Anesthesiologists Physical status ''ASA PS'' class I and II female patients aged 18–40 years old and scheduled for laparoscopic drilling for polycystic ovary disease under general anesthesia. The patients were assigned into one of two groups (53) patients each; group KP = ketofol and group P = propofol. Results There was good sedation score during suction and extubation in the ketofol group. Airway response and smoothness of extubation were better in the ketofol group better than the propofol group. Conclusion Ketofol as an induction anesthetic agent was effective in attenuating the airway response during extubation more than profofol only. Trial registration: This trial was retrospectively registered at the Clinical Trial.gov with the Identification Number: NCT04365686.

scholarly journals Comparison of Effect of Intrathecal Fentanyl-bupivacaine and Tramadol-bupivacaine Combination on Postoperative Analgesia in Lower Abdominal Surgeries

2016 ◽  
Vol 1 (2) ◽  
pp. 35-40 ◽  
Author(s):  
Naina P Dalvi ◽  
Narendra Patil
Keyword(s):  
Blood Pressure ◽  
Postoperative Analgesia ◽  
Total Duration ◽  
Double Blind Study ◽  
Motor Blockade ◽  
Hyperbaric Bupivacaine ◽  
Double Blind ◽  
Sensory Blockade ◽  
Prolonged Duration ◽  
American Society

ABSTRACT Introduction This single-center, prospective, randomized, double-blind study compares the effect of intrathecal fentanylbupivacaine and tramadol-bupivacaine on the onset and duration of sensory and motor blockade, as well as postoperative analgesia in lower abdominal surgeries. Materials and methods Patients of either sex, aged 18 to 60 years, American Society of Anesthesiologists (ASA) grade I/II undergoing lower abdominal surgeries like appendicectomy, inguinal hernia repair surgery, and hydrocele surgery were administered either 2.5 mL of 0.5% bupivacaine + 0.5 mL (25 μg) of fentanyl citrate (group F) or 2.5 mL of 0.5% bupivacaine + 0.5 mL (25 mg) of tramadol (group T) intrathecally. Monitoring of the vital parameters, onset and duration of sensory and motor block, duration of postoperative analgesia, visual analog scale (VAS) score, sedation score, and any adverse drug reactions was done at predetermined intervals. Results Sixty patients were randomized to the group F (n = 30) and group T (n = 30). The duration of sensory blockade was significantly prolonged in group F (314.66 ± 49.25 minutes) as compared to group T (261.66 ± 27.92 minutes). Similarly, duration of motor blockade was longer in group F (263.66 ± 40.97 minutes) compared to group T (214.66 ± 26.61 minutes). The total duration of analgesia was significantly prolonged (p < 0.001) in group F (412 ± 97.888 minutes) compared to group T (301 ± 38.75 minutes). Hemodynamic parameters, such as pulse, systolic blood pressure, diastolic blood pressure and oxygen saturation were comparable in both the groups. Visual analog scores were significantly lower in the group F patients as compared to the group T patients. The group F patients had got significantly higher sedation scores as compared to Group T patients. Discussion Fentanyl 25 μg, when added to 2.5 mL of 0.5% hyperbaric bupivacaine, confers prolonged duration of sensory and motor blockade than 25 mg tramadol added to 2.5 mL of 0.5% hyperbaric bupivacaine. The bupivacaine-fentanyl combination prolonged duration of sensory and motor blockade, improved analgesia, as manifested by lower pain scores, and prolonged duration of postoperative analgesia. How to cite this article Dalvi NP, Patil N. Comparison of Effect of Intrathecal Fentanyl-bupivacaine and Tramadol-bupivacaine Combination on Postoperative Analgesia in Lower Abdominal Surgeries. Res Inno in Anesth 2016;1(2):35-40.

Epidural Neostigmine versus Fentanyl to Decrease Bupivacaine Use in Patient-controlled Epidural Analgesia during Labor

2017 ◽  
Vol 127 (1) ◽  
pp. 50-57 ◽  
Author(s):  
Jessica L. Booth ◽  
Vernon H. Ross ◽  
Kenneth E. Nelson ◽  
Lynnette Harris ◽  
James C. Eisenach ◽  
...  
Keyword(s):  
Epidural Analgesia ◽  
Local Anesthetic ◽  
Primary Outcome ◽  
A Priori ◽  
Regulatory Compliance ◽  
Epidural Bupivacaine ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Labor Epidural ◽  
To Receive

Abstract Background The addition of opioids to epidural local anesthetic reduces local anesthetic consumption by 20% but at the expense of side effects and time spent for regulatory compliance paperwork. Epidural neostigmine also reduces local anesthetic use. The authors hypothesized that epidural bupivacaine with neostigmine would decrease total hourly bupivacaine use compared with epidural bupivacaine with fentanyl for patient-controlled epidural analgesia. Methods A total of 215 American Society of Anesthesiologists physical status II, laboring parturients requesting labor epidural analgesia consented to the study and were randomized to receive 0.125% bupivacaine with the addition of either fentanyl (2 μg/ml) or neostigmine (2, 4, or 8 μg/ml). The primary outcome was total hourly local anesthetic consumption, defined as total patient-controlled epidural analgesia use and top-ups (expressed as milliliters of 0.125% bupivacaine) divided by the infusion duration. A priori analysis determined a group size of 35 was needed to have 80% power at α = 0.05 to detect a 20% difference in the primary outcome. Results Of 215 subjects consented, 151 patients were evaluable. Demographics, maternal and fetal outcomes, and labor characteristics were similar among groups. Total hourly local anesthetic consumption did not differ among groups (P = 0.55). The total median hourly bupivacaine consumption in the fentanyl group was 16.0 ml/h compared with 15.3, 14.6, and 16.2 ml/h in the 2, 4, and 8 μg/ml neostigmine groups, respectively (P = 0.55). Conclusions The data do not support any difference in bupivacaine requirements for labor patient-controlled epidural analgesia whether patients receive epidural bupivacaine with 2 to 8 μg/ml neostigmine or epidural bupivacaine with 2 μg/ml fentanyl.

A Multiple-Dose, Double-Blind Comparison of Intramuscularly and Orally Administered Ketorolac Tromethamine and Ketogan® in Patients with Pain following Orthopaedic Surgery

1994 ◽  
Vol 22 (4) ◽  
pp. 202-217 ◽  
Author(s):  
P H Gebuhr ◽  
M Soelberg ◽  
W Strauss
Keyword(s):  
Orthopaedic Surgery ◽  
Multiple Dose ◽  
Fixed Time ◽  
Double Blind Study ◽  
Standard Regimen ◽  
Double Blind ◽  
Intramuscular Dose ◽  
Blind Comparison ◽  
Oral Doses ◽  
To Receive

In this multiple-dose, double-blind study 100 patients with moderate, severe or very severe pain following orthopaedic surgery were randomly assigned to receive ketorolac, a nonsteroidal anti-inflammatory drug with potent analgesic properties (10 mg), or the standard regimen of Ketogan® (a combination product containing the narcotic analgesic, ketobemidone, plus a spasmolytic agent) by intramuscular injection every 1 – 6 h as needed for pain. When patients were able to tolerate an oral diet and were expected to respond to oral analgesic medication, based on overall pain sensitivity, they were switched to oral doses of the same medication every 4 – 6 h as needed. A maximum of four daily doses of medication was allowed for up to 10 days. The severity of pain was scored on a five-point scale and was recorded before the first intramuscular dose, at fixed time points therafter for up to 6 h and at the end of each day. Both treatments were effective immediately after the first dose and during the subsequent multiple-dose phase. There were no statistically significant differences between ketorolac and Ketogan®. The results show that 10-mg doses of ketorolac in intramuscular injections followed by 10-mg doses of oral ketorolac are as effective as Ketogan® for the treatment of pain following orthopaedic surgery. Ketorolac appears to be better tolerated than Ketogan® since significantly fewer patients reported adverse events ( P = 0.004) when taking ketorolac.

A randomized double-blind comparison of ondansetron and metoclopramide in the prophylaxis of emesis induced by cyclophosphamide, fluorouracil, and doxorubicin or epirubicin chemotherapy.

1990 ◽  
Vol 8 (6) ◽  
pp. 1063-1069 ◽  
Author(s):  
J Bonneterre ◽  
B Chevallier ◽  
R Metz ◽  
P Fargeot ◽  
E Pujade-Lauraine ◽  
...  
Keyword(s):  
Group Analysis ◽  
Loading Dose ◽  
Breast Cancer Patients ◽  
Double Blind ◽  
Parallel Group ◽  
Blind Comparison ◽  
Prophylaxis Of Emesis ◽  
To Receive ◽  
Blind Crossover Study ◽  
Double Blind Crossover Study

Seventy-five breast cancer patients scheduled to receive a first course (in a new cycle) of cyclophosphamide, fluorouracil, and doxorubicin (FAC) or epirubicin (FEC) participated in a double-blind crossover study to compare the antiemetic efficacy and safety of ondansetron (GR38032), a 5-hydroxytryptamine3 (5-HT3) receptor antagonist, and metoclopramide. Ondansetron was given as an 8 mg loading dose (4 mg intravenously [IV] plus 4 mg orally) before chemotherapy followed by 8 mg every 8 hours orally for 3 to 5 days. Metoclopramide was given as an 80 mg loading dose (60 mg IV plus 20 mg orally) before chemotherapy followed by 20 mg every 8 hours orally for 3 to 5 days. A "period" interaction in the analysis of emetic response in the first 24 hours necessitated a parallel group analysis of first treatments only, 68 patients being assessable for this parameter. In the first 24 hours, complete or major control (zero to two emetic episodes) of emesis was achieved in 30 of 35 (86%) patients receiving ondansetron and in 14 of 33 (42%) patients receiving metoclopramide (P less than .001). Ondansetron was also more effective in reducing acute nausea. On days 2 to 3, the complete or major responses were significantly better with ondansetron (81% v 65%; P = .033), but there was no statistical difference in the control of nausea. There was a significant patient preference for ondansetron (63% v 26%; P = .001). Extrapyramidal reactions were observed in two metoclopramide treatments; both treatments were otherwise well tolerated. These results are consistent with serotonin (5-HT), being a significant neurotransmitter of cyclophosphamide/doxorubicin- or epirubicin/fluorouracil-induced emesis.

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