Minimum Local Analgesic Dose of Intrathecal Bupivacaine in Labor and the Effect of Intrathecal Fentanyl

2001 ◽  
Vol 94 (4) ◽  
pp. 593-598 ◽  
Author(s):  
Gary M. Stocks ◽  
Stephen P. Hallworth ◽  
Roshan Fernando ◽  
Adrian J. England ◽  
Malachy O. Columb ◽  
...  
Keyword(s):  
Spinal Analgesia ◽  
Double Blind ◽  
Duration Of Action ◽  
Pain Scores ◽  
Analgesic Dose ◽  
Sequential Allocation ◽  
Sparing Effect ◽  
Spinal Epidural ◽  
To Receive ◽  
Dose Dependent Increase

Background Combining bupivacaine with fentanyl for intrathecal analgesia in labor is well recognized, but dosages commonly used are arbitrarily chosen and may be excessive. This study aimed to determine the median effective dose (ED50) of intrathecal bupivacaine, defined as the minimum local analgesic dose (MLAD), and then use this to assess the effect of different doses of fentanyl. Methods In this double-blind, randomized, prospective study, 124 parturients receiving combined spinal epidural analgesia at 2-6-cm cervical dilatation were allocated to one of four groups to receive bupivacaine alone or with 5, 15, or 25 microg fentanyl, using the technique of up-down sequential allocation. Analgesic effectiveness was assessed using 100-mm visual analog pain scores, with less than or equal to 10 mm within 15 min defined as effective. MLAD was calculated using the formula of Dixon and Massey. Pruritus and duration of spinal analgesia were also recorded. Results Minimum local analgesic dose of intrathecal bupivacaine was 1.99 mg (95% confidence interval, 1.71, 2.27). There were similar significant reductions in MLAD (P < 0.001) for all bupivacaine-fentanyl groups compared with bupivacaine control. There was a dose-dependent increase in both pruritus and duration of spinal analgesia with increasing fentanyl (P < 0.0001). Conclusion Under the conditions of this study, the addition of intrathecal fentanyl 5 microg offers a similar significant bupivacaine dose-sparing effect as 15 and 25 microg. Analgesia in the first stage of labor can be achieved using lower doses of fentanyl, resulting in less pruritus but with a shortening of duration of action.

Minimum Local Analgesic Doses of Ropivacaine, Levobupivacaine, and Bupivacaine for Intrathecal Labor Analgesia

2005 ◽  
Vol 102 (3) ◽  
pp. 646-650 ◽  
Author(s):  
Michela Camorcia ◽  
Giorgio Capogna ◽  
Malachy O. Columb
Keyword(s):  
Local Anesthetic ◽  
Labor Analgesia ◽  
Allocation Model ◽  
Analgesic Dose ◽  
Sequential Allocation ◽  
Visual Analog Pain Score ◽  
Spinal Epidural ◽  
To Receive ◽  
Local Anesthetic Drug ◽  
Analgesic Potency

Background Doses for intrathecal opioid-local anesthetic mixtures have been arbitrarily chosen. The aim of this study was to compare the analgesic efficacies of intrathecal ropivacaine, levobupivacaine, and bupivacaine for labor analgesia and to determine the analgesic potency ratios for these three drugs. For this purpose, the authors used the up-down sequential allocation model, which estimates the minimum local analgesic dose for intrathecal local anesthetic. Methods Ninety-seven nulliparous term parturients in spontaneous labor, requesting combined spinal-epidural analgesia, were randomly allocated to one of three groups to receive 0.25% spinal ropivacaine, levobupivacaine, or bupivacaine. The initial dose of the local anesthetic drug was chosen to be 2.5 mg, and the testing interval was set at 0.25 mg. The subsequent doses were determined by the response of the previous parturient. Efficacy was accepted if the visual analog pain score decreased to 10 mm or less on a 100-mm scale within 30 min. The minimum local analgesic dose was calculated using the method of Dixon and Massey. Results The intrathecal minimum local analgesic dose was 3.64 mg (95% confidence interval, 3.33-3.96 mg) for ropivacaine, 2.94 (2.73-3.16) mg for levobupivacaine, and 2.37 (2.17-2.58) mg for bupivacaine. The relative analgesic potency ratios were 0.65 (0.56-0.76) for ropivacaine:bupivacaine, 0.80 (0.70-0.92) for ropivacaine:levobupivacaine, and 0.81 (0.69-0.94) for levobupivacaine:bupivacaine. There were significant trends (P </= 0.021) for greater motor block with bupivacaine and levobupivacaine. Conclusions This study suggests a potency hierarchy of spinal bupivacaine > levobupivacaine > ropivacaine.

Minimum Local Analgesic Dose

2005 ◽  
Vol 103 (6) ◽  
pp. 1233-1237 ◽  
Author(s):  
Raffaella Parpaglioni ◽  
Maria Grazia Frigo ◽  
Anna Lemma ◽  
Massimo Sebastiani ◽  
Giulia Barbati ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Randomized Study ◽  
Double Blind ◽  
Effective Response ◽  
Nulliparous Women ◽  
Analgesic Dose ◽  
Sequential Allocation ◽  
Group 10 ◽  
Group 5 ◽  
Spinal Epidural

Background This double-blind, randomized study was aimed at detecting the effect of three different volumes of intrathecal levobupivacaine on the minimum local analgesic dose in early labor. Methods Ninety-three nulliparous women requesting combined spinal-epidural analgesia, at more than 37 weeks gestation, with spontaneous onset of labor, cervical dilatation from 2 to 5 cm, were enrolled. Parturients received 10 ml (group 10), 5 ml (group 5), or 2.5 ml (group 2.5) of the spinal solution containing plain levobupivacaine diluted with 0.9% wt/vol saline to achieve the desired dose and volume at room temperature. A lumbar epidural catheter was then placed. The initial dose for each group was 2.0 mg, and the following doses were determined by the response of the previous patient using up-down sequential allocation. The authors required the test solution to achieve a visual analog pain score of 10 mm or less to be considered effective. The up-down sequences were analyzed using the Dixon and Massey formula and regression logistic model. Results The minimum local analgesic dose of spinal levobupivacaine in spontaneously laboring women was 1.35 mg (95% confidence interval, 1.25-1.45 mg) in group 10, 1.63 mg (95% confidence interval, 1.51-1.76 mg) in group 5, and 1.97 mg (95% confidence interval, 1.89-2.05 mg) in group 2.5. A unit change in volume increased the odds of an effective response multiplicatively by a factor of 1.8. Conclusions Analgesia can be achieved using lower doses and higher volumes even in subarachnoid space. The important role of the volume should be considered not only in epidural but also in spinal analgesia.

Minimum Analgesic Dose of Epidural Sufentanil for First-stage Labor Analgesia

2001 ◽  
Vol 94 (5) ◽  
pp. 740-744 ◽  
Author(s):  
Giorgio Capogna ◽  
Raffaella Parpaglioni ◽  
Gordon Lyons ◽  
Malachy Columb ◽  
Danilo Celleno
Keyword(s):  
Pain Relief ◽  
Probit Regression ◽  
Analgesic Requirement ◽  
Double Blind ◽  
Induced Labor ◽  
Pain Scores ◽  
Nulliparous Women ◽  
Analgesic Dose ◽  
Sequential Allocation ◽  
First Stage Of Labor

Background The aim of this prospective, double-blind, sequential allocation study was to compare the effects of spontaneous and prostaglandin-induced labor on the minimum analgesic dose of epidural sufentanil in the first stage of labor. Methods Seventy healthy, nulliparous women, at more than 37 weeks' gestation with cervical dilatation from 2 to 4 cm, requesting epidural pain relief in labor were enrolled. The subjects were assigned to two different groups according to whether labor was spontaneous or induced with dinoprostone 0.5 mg. Parturients received 10 ml of the study solution through a lumbar epidural catheter. The initial dose was sufentanil 25 microg, and subsequent doses were determined by the response of the previous patient in the same group using up-down sequential allocation. The analgesic effectiveness was assessed using 100-mm visual analog pain scores. The up-down sequences were analyzed using the method of independent paired reversals and probit regression. Results The minimum analgesic dose of sufentanil in spontaneous labor was 22.2 microg (95% CI: 19.6, 22.8) and 27.3 microg (95% CI: 23.8, 30.9) in induced labor. The minimum analgesic dose of sufentanil in induced labor was significantly greater (P = 0.0014) than that in spontaneous labor (95% CI difference: 2.9, 9.3) by a factor of 1.3 (95% CI: 1.1, 1.5). Conclusion Prostaglandin induction of labor produces a significantly greater analgesic requirement than does spontaneous labor.

Morphine-Sparing Effect of Ketoprofen after Abdominal Surgery

2000 ◽  
Vol 28 (1) ◽  
pp. 22-26 ◽  
Author(s):  
A. S. Rao ◽  
M. Cardosa ◽  
K. Inbasegaran
Keyword(s):  
Abdominal Surgery ◽  
Morphine Consumption ◽  
Controlled Clinical Trial ◽  
Patient Controlled Analgesia ◽  
Double Blind ◽  
Double Blind Placebo ◽  
Pain Scores ◽  
Oliguric Renal Failure ◽  
Sparing Effect ◽  
Excessive Sedation

In a double-blind, placebo-controlled clinical trial (power of 80% to detect a 30% reduction in morphine consumption, P<0.05), we have determined that the administration of two doses of intravenous ketoprofen 100 mg, one at the end of surgery and the second 12 hours postoperatively, was associated with a significant reduction in morphine consumption at eight (P=0.028), 12 (P=0.013) and 24 hours (P=0.013) but not four hours (P=0.065) postoperatively, as compared to placebo, when assessed by patient-controlled analgesia. There was no difference between the groups in pain scores or in the incidence of nausea and vomiting. One patient in the placebo group suffered from excessive sedation while one patient from the ketoprofen group suffered from transient oliguric renal failure. There were no other adverse effects. The results of this study show that ketoprofen does provide a morphine-sparing effect in the management of postoperative pain after abdominal surgery.

Trigger Finger Corticosteroid Injection With and Without Local Anesthetic: A Randomized, Double-Blind Controlled Trial

Hand ◽  
2019 ◽  
pp. 155894471988466
Author(s):  
J. Randall Patrinely ◽  
Shepard P. Johnson ◽  
Brian C. Drolet
Keyword(s):  
Local Anesthetic ◽  
Corticosteroid Injection ◽  
Controlled Trial ◽  
Treatment Method ◽  
Trigger Finger ◽  
Injection Pain ◽  
Double Blind ◽  
Pain Scores ◽  
Injection Methods ◽  
To Receive

Background: The first-line treatment for trigger finger is a corticosteroid injection. Although the injectable solution is often prepared with a local anesthetic, we hypothesize that patients receiving an injection with anesthetic will experience more pain at the time of injection. Methods: C Patients with trigger finger were prospectively randomized into 2 cohorts to receive triamcinolone (1 mL, 40 mg) plus 1% lidocaine with epinephrine (1 mL) or triamcinolone (1 mL, 40 mg) plus normal saline (1 mL, placebo). Both patient and surgeon were blinded to the treatment arm. The primary outcome was pain measured using a (VAS) immediately following the injection. Results: Seventy-three patients with a total of 110 trigger fingers were enrolled (57 lidocaine with epinephrine and 53 placebo). Immediate postinjection pain scores were significantly higher for injections containing lidocaine with epinephrine compared with placebo (VAS 3.5 vs 2.0). Conclusions: In the treatment of trigger finger, corticosteroid injections are effective and have relatively little associated pain. This study shows there is more injection-associated pain when lidocaine with epinephrine is included with the corticosteroid. Therefore, surgeons looking to decrease injection pain should exclude the anesthetic, but they should discuss the trade-off of foregoing short-term anesthesia with patients. Using only a single drug (ie, corticosteroid alone) is not only less painful but is also more simple, efficient, and safe; this has therefore become our preferred treatment method.

scholarly journals Efficacy of Addition of Fentanyl to Epidural Bupivacaine on Postoperative Analgesia after Thoracotomy for Lung Resection in Infants

2008 ◽  
Vol 109 (5) ◽  
pp. 890-894 ◽  
Author(s):  
Arjunan Ganesh ◽  
N Scott Adzick ◽  
Travis Foster ◽  
Giovanni Cucchiaro
Keyword(s):  
Side Effects ◽  
Lung Resection ◽  
Epidural Fentanyl ◽  
Double Blind Study ◽  
Double Blind ◽  
Rescue Dose ◽  
Pain Scores ◽  
Epidural Bupivacaine ◽  
Group B ◽  
To Receive

Background The authors evaluated the efficacy of adding fentanyl to epidural bupivacaine in infants up to 6 months of age after a thoracotomy in a prospective, randomized, double-blind study. The primary outcome was the total amount of rescue doses of intravenous nalbuphine in the first 24 h after surgery. Secondary outcomes included (1) time to first rescue dose of nalbuphine, (2) pain scores, and (3) behavior scores. Methods Thirty-two infants were randomly assigned to receive an epidural infusion containing 0.1% bupivacaine (group B; n = 16) or 0.1% bupivacaine and 2 microg/ml fentanyl (group BF; n = 16). Patients were evaluated up to 24 h after surgery for pain; amount of analgesic rescues and time to first rescue; pain scores; behavior scores (five-item behavior score); and complications, including respiratory depression, oxygen requirement, vomiting, and urinary retention. Results The two groups had similar demographics. Nalbuphine consumption (P = 0.001) and pain scores (P &lt; 0.001) in the first 24 h were significantly decreased in group BF compared with group B. The time to first analgesic rescue was significantly longer in group BF (P = 0.005). The five-item behavior score was significantly better in group BF than in group B (P = 0.01). The incidence of side effects, the time to first successful feeding, and the time to discharge were similar in both groups. Conclusions Addition of 2 microg/ml epidural fentanyl to 0.1% bupivacaine results in improved postthoracotomy analgesia without any increase in side effects, compared with 0.1% bupivacaine, in infants up to 6 months of age.

scholarly journals Intramuscular Ketorolac for Postoperative Analgesia following Laparoscopic Sterilisation

1994 ◽  
Vol 22 (1) ◽  
pp. 22-24 ◽  
Author(s):  
M. H. Shapiro ◽  
B. L. Duffy
Keyword(s):  
Side Effects ◽  
Intramuscular Injection ◽  
Double Blind Study ◽  
Day Case ◽  
Double Blind ◽  
Apparent Lack ◽  
Pain Scores ◽  
Significant Difference ◽  
To Receive ◽  
Intramuscular Ketorolac

The analgesic effect of intramuscular ketorolac was assessed by double blind study in forty women presenting for day-case laparoscopic sterilisation. The patients were randomly allocated to receive either ketorolac 30 mg or saline by intramuscular injection immediately following induction of general anaesthesia. There was no statistically significant difference between the groups in pain scores, opioid requirements or incidence of nausea and vomiting in the postoperative period. In view of the potential side-effects of ketorolac, and the apparent lack of efficacy when used prophylactically, the routine use of the drug in this group of patients cannot be recommended.

Post-tonsillectomy pain management in children: Can we do better?

2007 ◽  
Vol 137 (4) ◽  
pp. 545-551 ◽  
Author(s):  
Jolene D. Bean-Lijewski ◽  
Shane H. Kruitbosch ◽  
Lewis Hutchinson ◽  
Barry Browne
Keyword(s):  
Side Effects ◽  
Day Surgery ◽  
Healthy Children ◽  
Review Of The Literature ◽  
Time Intervals ◽  
Double Blind ◽  
Pain Scores ◽  
Study Results ◽  
Cox 2 ◽  
To Receive

Objective The search for an effective post-tonsillectomy analgesic has been disappointing. This study tests the hypothesis that rofecoxib improves pain scores in children for 72 hours post-tonsillectomy when compared to hydrocodone with acetaminophen elixir. Study Design Prospective, randomized, double-blind, active comparison of postoperatively administered rofecoxib or hydrocodone with acetaminophen in 60 healthy children scheduled for elective tonsillectomy. Subjects and Methods Sixty ASA I and II children scheduled for elective tonsillectomy were enrolled to receive either rofecoxib or hydrocodone with acetaminophen, commencing at discharge from day surgery. Active and passive pain scores and side effects were assessed for 3 days. Results and Conclusion Rofecoxib significantly reduced active pain scores at all time intervals after 6 hours following surgery when compared to hydrocodone with acetaminophen without detectable differences in adverse effects. This difference was not apparent in passive pain scores. A review of analgesic strategies is presented. Study results and review of the literature support the development of pediatric formulations of NSAIDs with greater COX-2 selectivity to improve postsurgical pain relief for children.

Effect of Celecoxib and Dexamethasone on Postoperative Pain after Lumbar Disc Surgery

Neurosurgery ◽  
2003 ◽  
Vol 53 (2) ◽  
pp. 331-337 ◽  
Author(s):  
Matthias Karst ◽  
Tanja Kegel ◽  
Anne Lukas ◽  
Wolf Lüdemann ◽  
Samii Hussein ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Lumbar Disc ◽  
Lumbar Disc Surgery ◽  
Double Blind Study ◽  
Double Blind ◽  
Wound Area ◽  
Pain Scores ◽  
Disc Surgery ◽  
Pain At Rest ◽  
To Receive

Abstract OBJECTIVE This study was designed to assess the efficacy of perioperative administration of celecoxib (Celebrex; Pharmacia GmbH, Erlangen, Germany) in reducing pain and opioid requirements after single-level lumbar microdiscectomy. METHODS We studied 34 patients (mean age, 44.26 yr; standard deviation [SD], 13.09 yr) allocated randomly to receive celecoxib 200 mg twice a day for 72 hours starting on the evening before surgery or placebo capsules in a double-blind study. Fourteen patients received 20 to 80 mg dexamethasone intravenously during surgery (mean, 40 mg; SD, 19.22 mg) because of visible signs of compression of the affected nerve root. After lumbar disc surgery, patients were monitored for visual analog scores for pain at rest and on movement, patient-controlled analgesia (PCA) piritramide requirements, and von Frey thresholds in the wound area. RESULTS Pain scores decreased and wound von Frey thresholds increased continuously until discharge, with no intergroup differences. Mean 24-hour PCA piritramide requirements were 22.63 mg (SD, 23.72 mg) and 26.14 mg (SD, 22.57 mg) in the celecoxib and placebo groups, respectively (P = not significant). However, patients with intraoperative dexamethasone (n = 14) required only 10.29 mg (SD, 8.55 mg) 24-hour PCA piritramide, in contrast to the 34.25 mg (SD, 24.69 mg) needed in those who did not receive intraoperative dexamethasone (P = 0.001). In addition, 24 hours after the operation, pain scores on movement were significantly lower in the dexamethasone subgroup (P = 0.003). CONCLUSION Celecoxib has no effect on postoperative pain scores and PCA piritramide requirements. The intraoperative use of 20 to 80 mg dexamethasone is able to significantly decrease postoperative piritramide consumption and pain scores on the first day after surgery.

A Randomized Sequential Allocation Study to Determine the Minimum Effective Analgesic Concentration of Levobupivacaine and Ropivacaine in Patients Receiving Epidural Analgesia for Labor

2003 ◽  
Vol 99 (6) ◽  
pp. 1383-1386 ◽  
Author(s):  
Dan Benhamou ◽  
Caroline Ghosh ◽  
Frédéric J. Mercier
Keyword(s):  
Adverse Events ◽  
Epidural Analgesia ◽  
Vital Signs ◽  
Sensory Block ◽  
Labor Pain ◽  
Double Blind Study ◽  
Double Blind ◽  
Treatment Groups ◽  
Pain Scores ◽  
Sequential Allocation

Background This study was designed to determine and compare the minimum local analgesic concentrations of levobupivacaine and ropivacaine when used in epidural obstetric analgesia. Methods In a double-blind study, healthy women requiring epidural analgesia for labor pain were randomized to receive either ropivacaine or levobupivacaine. Drugs were administered as a 20-ml epidural bolus. The concentration of each started at 0.11% and increased or decreased at intervals of 0.01%, depending on the response of the previous patient, using the technique of up-down sequential allocation. Minimum local analgesic concentrations were calculated using the formula of Dixon and Massey. Efficacy was assessed using visual analog pain scores and motor and sensory block assessments, and safety was assessed by recording maternal and fetal/neonate vital signs and adverse events. Results Forty-seven patients received levobupivacaine, and 47 received ropivacaine. Minimum local analgesic concentrations for levobupivacaine (0.077%; 95% CI, 0.058-0.096%) were lower than those for ropivacaine (0.092%; 95% CI, 0.082-0.102%). The 0.015% difference was not statistically significant. There was no notable difference between treatment groups in the proportion of patients reporting drug-related adverse events. Conclusions Levobupivacaine was 19% more potent than ropivacaine and provided similar safety results.

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