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 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 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.

Intrathecal Clonidine Combined with Sufentanil for Labor Analgesia 

1998 ◽  
Vol 88 (3) ◽  
pp. 651-656 ◽  
Author(s):  
Philippe E. Gautier ◽  
Marc De Kock ◽  
Fanard Luc ◽  
Albert Van Steenberge ◽  
Jean-Luc Hody
Keyword(s):  
Rapid Onset ◽  
Maternal Serum ◽  
Labor Analgesia ◽  
Motor Blockade ◽  
Blood Concentrations ◽  
Analgesic Effects ◽  
Intrathecal Clonidine ◽  
Spinal Epidural ◽  
To Receive ◽  
First Stage Of Labor

Background Intrathecal sufentanil provides rapid-onset and complete analgesia for the first stage of labor. The dose required to produce this effect can be associated with maternal respiratory depression, hypotension, nausea, or pruritus. Because clonidine potentiates the analgesic effects of opioids without increasing their side effects, the authors wanted to determine the efficacy of low doses of intrathecal clonidine (15 and 30 microg) combined with sufentanil. Methods Ninety-eight parturient requesting labor analgesia were studied. In a combined spinal-epidural technique, patients were randomly assigned to receive one of the following intrathecal solutions: either 15 microg clonidine (n = 10); 30 microg clonidine (n = 10); 2.5 microg sufentanil (n = 13); 5 microg sufentanil (n = 13); 2.5 microg sufentanil and 15 microg clonidine (n = 13); 2.5 microg sufentanil and 30 microg clonidine (n = 13); 5 microg sufentanil and 15 microg clonidine (n = 13); or 5 microg sufentanil and 30 microg clonidine (n = 13). Visual analog scores for pain, blood pressure, heart rate, sensory levels, incidence of nausea and pruritus, and motor blockade, and maternal and cord blood concentrations of clonidine were recorded. Results Patients receiving 30 microg intrathecal clonidine with 2.5 or 5 microg intrathecal sufentanil had significantly longer-lasting analgesia (145 +/- 36 and 145 +/- 43 min vs. 104 +/- 35 for those receiving 5 microg intrathecal sufentanil alone). Clonidine levels were undetectable in maternal serum. Conclusions Thirty micrograms of intrathecal clonidine combined with 2.5 or 5 microg intrathecal sufentanil significantly increased the duration of analgesia during the first stage of labor without adverse maternal or fetal effects.

Treatment of Incomplete Analgesia after Placement of an Epidural Catheter and Administration of Local Anesthetic for Women in Labor 

1998 ◽  
Vol 88 (6) ◽  
pp. 1502-1506 ◽  
Author(s):  
Yaakov Beilin ◽  
Jeffrey Zahn ◽  
Howard H. Bernstein ◽  
Barbara Zucker-Pinchoff ◽  
Wendy J. Zenzen ◽  
...  
Keyword(s):  
Success Rate ◽  
Epidural Catheter ◽  
Epidural Space ◽  
Local Anesthetic ◽  
Labor Analgesia ◽  
Repeated Dosing ◽  
To Receive

Background Approximately 15% of women still have pain after placement of an epidural catheter and administration of local anesthetic for labor analgesia. Two techniques frequently used to treat this pain were compared: (1) withdrawal of the catheter 1 cm and repeated dosing with additional local anesthetic, and (2) repeated dosing with additional local anesthetic without any catheter manipulation. Methods Fifteen minutes after placement of a multiple-orifice epidural catheter 5 cm into the epidural space and administration of 13 ml 0.25% bupivacaine to the parturient in labor, the adequacy of analgesia was assessed. All women who had incomplete analgesia were randomized (first intervention) to receive an additional 5 ml 0.25% bupivacaine (local-anestheticonly group) or to receive 5 ml 0.25% bupivacaine after first withdrawing the epidural catheter 1 cm (catheter-manipulation group). If after 15 min the woman still had pain, then (second intervention) the catheter was withdrawn 1 cm and an additional 5 ml 0.25% bupivacaine was administered to the local-anesthetic-only group, whereas 5 ml 0.25% bupivacaine was given to the catheter-manipulation group without further catheter manipulation. The success rate of the second intervention was assessed 15 min later. Results Seventy-eight women were enrolled in the study, 39 to each group. In the local-anesthetic-only group, 29 (74%) women were successfully treated with the first intervention and the remaining 10 (100%) were successfully treated with the second intervention. In the catheter-manipulation group, 30 (77%) were successfully treated with the first intervention and 7 (100%; 2 patients were not studied because of investigator error) were successfully treated with the second intervention (P=NS). Conclusions Administration of additional local anesthetic without first withdrawing the epidural catheter will effectively treat most women for whom analgesia is incomplete after the placement of an epidural catheter during labor.

Low-dose Clonidine and Neostigmine Prolong the Duration of Intrathecal Bupivacaine–Fentanyl for Labor Analgesia

2000 ◽  
Vol 92 (2) ◽  
pp. 361-361 ◽  
Author(s):  
Medge D. Owen ◽  
Özer Özsaraç ◽  
Şükran Şahin ◽  
Nesimi Uçkunkaya ◽  
Nuray Kaplan ◽  
...  
Keyword(s):  
Side Effects ◽  
Low Dose ◽  
Fetal Heart ◽  
Vital Signs ◽  
Labor Analgesia ◽  
Pain Scores ◽  
Active Labor ◽  
Effective Pain Relief ◽  
Spinal Epidural ◽  
To Receive

Background Intrathecal (IT) opioid and local anesthetic combinations are popular for labor analgesia because of rapid, effective pain relief, but the duration of analgesia is limited. This study was undertaken to determine whether the addition of clonidine and neostigmine to IT bupivacaine-fentanyl would increase the duration of analgesia without increasing side effects for patients in labor. Methods Forty-five healthy parturients in active labor were randomized to receive a 2-ml IT dose of one of the following dextrose-containing solutions using the combined spinal-epidural technique: (1) bupivacaine 2.5 mg and fentanyl 25 microg (BF); (2) BF plus clonidine 30 microg (BFC); or (3) BFC plus neostigmine 10 microg (BFCN). Pain, sensory levels, motor block, side effects, maternal vital signs, and fetal heart rate were systematically assessed. Results Patients administered BFCN had significantly longer analgesia (165+/-32 min) than those who received BF (90+/-21 min; P<0.001) or BFC (123+/-21 min; P<0.001). Pain scores, block characteristics, maternal vital signs, Apgar scores, maternal satisfaction, and side effects were similar among groups except for nausea, which was significantly greater in the BFCN group (P<0.05 as compared with BFC). Conclusions The addition of clonidine and neostigmine significantly increased the duration of analgesia from IT bupivacaine-fentanyl during labor, but neostigmine caused more nausea. Although serious side effects were not observed in this study, safety must be further addressed before the routine use of multiple IT drugs is advocated.

scholarly journals Genetic Algorithm for the Retailers’ Shelf Space Allocation Profit Maximization Problem

2021 ◽  
Vol 11 (14) ◽  
pp. 6401
Author(s):  
Kateryna Czerniachowska ◽  
Karina Sachpazidu-Wójcicka ◽  
Piotr Sulikowski ◽  
Marcin Hernes ◽  
Artur Rot
Keyword(s):  
Genetic Algorithm ◽  
Profit Maximization ◽  
Allocation Rule ◽  
Maximization Problem ◽  
Shelf Space ◽  
Allocation Model ◽  
Space Allocation ◽  
Shelf Space Allocation ◽  
To Receive

This paper discusses the problem of retailers’ profit maximization regarding displaying products on the planogram shelves, which may have different dimensions in each store but allocate the same product sets. We develop a mathematical model and a genetic algorithm for solving the shelf space allocation problem with the criteria of retailers’ profit maximization. The implemented program executes in a reasonable time. The quality of the genetic algorithm has been evaluated using the CPLEX solver. We determine four groups of constraints for the products that should be allocated on a shelf: shelf constraints, shelf type constraints, product constraints, and virtual segment constraints. The validity of the developed genetic algorithm has been checked on 25 retailing test cases. Computational results prove that the proposed approach allows for obtaining efficient results in short running time, and the developed complex shelf space allocation model, which considers multiple attributes of a shelf, segment, and product, as well as product capping and nesting allocation rule, is of high practical relevance. The proposed approach allows retailers to receive higher store profits with regard to the actual merchandising rules.

scholarly journals Intrathecal dexmedetomidine improves epidural labor analgesia effects: a randomized controlled trial

2021 ◽  
Vol 49 (4) ◽  
pp. 030006052199953
Author(s):  
Gehui Li ◽  
Hao Wang ◽  
Xiaofei Qi ◽  
Xiaolei Huang ◽  
Yuantao Li
Keyword(s):  
Local Anesthetic ◽  
Controlled Trial ◽  
Intrathecal Injection ◽  
Onset Time ◽  
Labor Analgesia ◽  
Controlled Clinical Trial ◽  
Time Duration ◽  
Clinical Registry ◽  
Randomized Controlled ◽  
Group D

Objective α2‑agonists and opioids have been used as intrathecal adjuvants to local anesthetics for several years, but the effect of intrathecal dexmedetomidine (Dex) or sufentanil combined with epidural ropivacaine in labor analgesia is not fully understood. Methods A total of 108 parturient women receiving combined spinal-epidural labor analgesia were randomly divided into three groups. Group C received l mL saline (0.9%) intrathecally, Group D received 5 µg Dex intrathecally, and Group S received 5 µg sufentanil intrathecally. All parturient women then received 0.1% epidural ropivacaine and 0.2 µg/mL sufentanil for patient-controlled epidural analgesia with standard settings. The visual analog scale score, onset time, duration of intrathecal injection, local anesthetic requirements, and side effects were recorded. Results The labor analgesia effects in Groups D and S were better than those in Group C. Groups D and S displayed significantly shorter onset times, longer durations of intrathecal injection, and reduced local anesthetic requirements compared with Group C. The incidence of shivering and pruritus in Group D was lower than that in Group S. Conclusion Intrathecal administration of 5 µg Dex could improve epidural labor analgesia effects. This randomized controlled clinical trial was registered with the Chinese Clinical Registry Center (ChiCTR-1800014943, http://www.chictr.org.cn/ ).

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