A Comparative Study of Sequential Epidural Bolus Technique and Continuous Epidural Infusion

2005 ◽  
Vol 103 (1) ◽  
pp. 126-129 ◽  
Author(s):  
Kenichi Ueda ◽  
Wasa Ueda ◽  
Masanobu Manabe
Keyword(s):  
Continuous Infusion ◽  
Visual Analog Scale ◽  
Local Anesthetic ◽  
Rescue Medication ◽  
The Body ◽  
Epidural Infusion ◽  
Analog Scale ◽  
Continuous Epidural Infusion ◽  
Spinal Segments ◽  
Hourly Dose

Background In this randomized, double-blind study, the authors compared the effectiveness of a sequential epidural bolus (SEB) technique versus a standard continuous epidural infusion (CEI) technique of local anesthetic delivery. Both techniques used the same hourly dose of local anesthetic. Methods Sixteen gynecologic patients undergoing abdominal surgery received postoperative epidural analgesia using 0.75% ropivacaine at a dose of 22.5 mg (3 ml) per hour. Patients were randomly assigned to one of two groups. In the SEB group (n = 8), patients received one third of the hourly dose every 20 min as a bolus. In the CEI group (n = 8), the hourly dose was administered as a continuous infusion. Analgesia was assessed by rest pain scored by a visual analog scale and pinprick to determine the number of separately blocked spinal segments on each side of the body. Doses of rescue medication for pain were also recorded. Results The median number of blocked spinal segments was 19.5 (range, 18-24) in the SEB group and 11.5 (range, 10-18) in the CEI group (P < 0.001). The median difference in the number of blocked segments between the right and left sides was 0 (range, 0-1) in the SEB group and 2 (range, 0-6) in the CEI group (P < 0.04). No patients in the SEB group but one patient in the CEI group required rescue medication for pain. The visual analog scale pain score was 0 in both groups except for one patient in the CEI group during the study period. Conclusion The SEB technique with ropivacaine provides superior epidural block compared with an identical hourly dose administered as a continuous infusion.

Pharmacokinetics and Analgesic Effect of Ropivacaine during Continuous Epidural Infusion for Postoperative Pain Relief

1996 ◽  
Vol 84 (4) ◽  
pp. 834-842. ◽  
Author(s):  
Carl-Johan Erichsen ◽  
Jan Sjovall ◽  
Henrik Kehlet ◽  
Cecilia Hedlund ◽  
Torbjorn Arvidsson
Keyword(s):  
Postoperative Pain ◽  
Pain Relief ◽  
Visual Analog Scale ◽  
Plasma Concentrations ◽  
Epidural Infusion ◽  
Postoperative Pain Relief ◽  
Total Plasma ◽  
Analog Scale ◽  
Continuous Epidural Infusion ◽  
Unbound Fraction

Background The pharmacokinetics and clinical efficacy of ropivacaine (2.5 mg/ml) during a 24-h continuous epidural infusion for postoperative pain relief in 20 patients scheduled for abdominal hysterectomy were characterized using an open-label, increasing-dose design. Methods Through an epidural catheter inserted at T10-T12, a test dose of 7.5 mg ropivacaine was given 3 min before a bolus dose of 42.5 mg and immediately followed by a 24-h continuous epidural infusion with either 10 or 20 mg/h. Peripheral venous plasma samples were collected up to 48 h after infusion, and urinary excretion was followed up to the end of infusion. Postoperative pain at rest, on coughing, and at mobilization was assessed by means of a visual analog scale 2,4,6,8,12, and 24 h after the end of surgery. Sensory (pinprick) and motor block (modified Bromage scale) were assessed at the same intervals. Results The total plasma concentrations of ropivacaine increased markedly and consistently during the 24-h epidural infusion, in contrast to stable unbound concentrations. Both total and unbound plasma concentrations at the end of infusion were proportional to the total dose, although only the latter was proportional to the infusion rate. The total and unbound plasma clearance was independent of dose. Total mean clearance decreased on average by 21% (P < 0.001) during the last 12 h of epidural infusion, i.e., from 539 +/- 191 ml/min to 418 +/- 138 ml/min, indicating time-dependent kinetics. The unbound clearance also varied between estimates after 8 h of infusion and the end of treatment, i.e., a 5.3% decrease from 10.4 +/- 5.3 l/min to 9.5 +/- 3.9 l/min (P < 0.05). The unbound fraction of ropivacaine in plasma decreased during treatment, and this was related to the increase in alpha1-acid glycoprotein concentration. Pain was generally well controlled, and median visual analog scale scores during mobilization were less than 30 mm in patients receiving ropivacaine at 20 mg/h. Conclusions The pharmacokinetics of ropivacaine were independent of dose, but total clearance decreased with time over 24 h. The consistent increase in total plasma concentration during the postoperative epidural infusion contrasted to much less variation in the unbound plasma concentrations of ropivacaine.

Epidural Administration of Neostigmine and Clonidine to Induce Labor Analgesia

2005 ◽  
Vol 102 (6) ◽  
pp. 1205-1210 ◽  
Author(s):  
Fabienne Roelants ◽  
Patricia M. Lavand'homme ◽  
Valérie Mercier-Fuzier
Keyword(s):  
Adverse Effects ◽  
Pain Score ◽  
Visual Analog Scale ◽  
Local Anesthetic ◽  
Demographic Data ◽  
Visual Analog Scale Score ◽  
Labor Analgesia ◽  
Epidural Administration ◽  
Analog Scale ◽  
Continuous Epidural Infusion

Background Epidural clonidine produces analgesia without motor impairment, and is associated with a local anesthetic-sparing effect during labor. The authors have recently demonstrated that epidural neostigmine initiates selective labor analgesia devoid of adverse effects. Both drugs possess common analgesic mechanisms mediated through spinal acetylcholine release. This study evaluates their epidural combination in parturients. Methods At the beginning of labor, parturients were randomly allocated to one of five groups to receive one of the following after a test dose: 150 microg epidural clonidine, 750 microg neostigmine, or 75 microg clonidine combined with 250, 500, or 750 microg neostigmine. A pain score (visual analog scale, 0-100) was recorded before administration and at regular intervals until request for a supplemental injection. Subsequent analgesia was provided by continuous epidural infusion of ropivacaine. Results Parturients did not differ regarding demographic data and initial pain score. Clonidine 150 microg , neostigmine 750 microg , and 75 microg clonidine plus 250 microg neostigmine produced ineffective and short-lasting effects. Clonidine 75 microg plus 500 microg neostigmine and 75 microg clonidine plus 750 microg neostigmine presented comparable durations of 90 +/- 32 and 108 +/- 38 min (mean +/- SD), respectively, and final analgesic efficacies, with 72.2% and 84%, respectively, of the parturients reporting a visual analog scale score of less than 30 out of 100 after 30 min. Ropivacaine use was significantly reduced in all clonidine groups (average, 9.5 mg/h) in comparison with neostigmine alone (17 +/- 3 mg/h). No adverse effects were observed for 75 mug clonidine combined with any dose of neostigmine while maternal sedation (20%) and hypotension (33%) occurred with 150 microg clonidine alone. Conclusions Epidural clonidine, 75 microg , with 750 microg neostigmine is an effective combination to initiate selective labor analgesia without adverse effects. Clonidine use further reduces local anesthetic consumption throughout the course of labor.

scholarly journals Programmed Intermittent Epidural Bolus versus Continuous Epidural Infusion in Major Upper Abdominal Surgery: A Retrospective Comparative Study

2021 ◽  
Vol 10 (22) ◽  
pp. 5382
Author(s):  
Yeon-Ju Kim ◽  
Do-Kyeong Lee ◽  
Hyun-Jung Kwon ◽  
Hye-Mee Kwon ◽  
Jong-Hyuk Lee ◽  
...  
Keyword(s):  
Adverse Events ◽  
Abdominal Surgery ◽  
Local Anesthetic ◽  
Opioid Consumption ◽  
Epidural Infusion ◽  
Continuous Epidural Infusion ◽  
Pain Scores ◽  
Upper Abdominal Surgery ◽  
Significant Difference ◽  
Upper Abdominal

Although recent evidence shows that the programmed intermittent epidural bolus can provide improved analgesia compared to continuous epidural infusion during labor, its usefulness in major upper abdominal surgery remains unclear. We evaluated the effect of programmed intermittent epidural bolus versus continuous epidural infusion on the consumption of postoperative rescue opioids, pain intensity, and consumption of local anesthetic by retrospective analysis of data of patients who underwent major upper abdominal surgery under ultrasound-assisted thoracic epidural analgesia between July 2018 and October 2020. The primary outcome was total opioid consumption up to 72 h after surgery. The data of postoperative pain scores, epidural local anesthetic consumption, and adverse events from 193 patients were analyzed (continuous epidural infusion: n = 124, programmed intermittent epidural bolus: n = 69). There was no significant difference in the rescue opioid consumption in the 72-h postoperative period between the groups (33.3 mg [20.0–43.3] vs. 28.3 mg [18.3–43.3], p = 0.375). There were also no significant differences in the pain scores, epidural local anesthetic consumption, and incidence of adverse events. Our findings suggest that the quality of postoperative analgesia and safety following major upper abdominal surgery were comparable between the groups. However, the use of programmed intermittent epidural bolus requires further evaluation.

scholarly journals Temperament Trait Changes in Japanese Black Cows Under Grazing and Confined Conditions

2021 ◽  
Vol 8 ◽  
Author(s):  
Noriaki Nakajima ◽  
Hiroki Mitsuishi ◽  
Masato Yayota
Keyword(s):  
Body Weight ◽  
Blood Sample ◽  
Visual Analog Scale ◽  
Head Movement ◽  
The Body ◽  
Blood Sampling ◽  
Analog Scale ◽  
Temperament Traits ◽  
Resistance Score ◽  
Temperament Trait

The objective of the present study was to reveal the effects of grazing on the temperament traits of cows. Nine Japanese Black cows [344 ± 32 kg body weight (BW), 7.7 ± 3.0 year of age], which had various experiences, such as tethering, handling, and grazing, were used in this experiment. Five of the nine cows were grazed for 3 months on a 1.8-ha field composed of a sown pasture with forestland. The remaining cows were fed in confinement. On days 38, 52, 72, and 86 after the start of grazing, the temperament traits observed in various situations, such as moving to the body weight scale, weighing, handling, moving to the stock for blood sampling, holding in the stock, and obtaining a blood sample, were assessed with a visual analog scale (VAS: 1–10) or score (1–5). During weighing and handling, the intensity of resistance exhibited by the grazing cows, as evaluated by head movement, walking/stepping, tail flicking, rope tension, and overall movement, was lower than that exhibited by confined cows (P < 0.05). The resistance score exhibited by the grazing cows during blood sampling was also lower than that exhibited by confined cows (P < 0.01). These results suggest that grazing enhances docility in cows with various experiences in different situations encountered in daily management.

Patient-controlled Regional Analgesia (PCRA) at Home

2002 ◽  
Vol 96 (6) ◽  
pp. 1290-1296 ◽  
Author(s):  
Narinder Rawal ◽  
Renée Allvin ◽  
Kjell Axelsson ◽  
Jan Hallén ◽  
Gustav Ekbäck ◽  
...  
Keyword(s):  
Visual Analog Scale ◽  
Local Anesthetic ◽  
Analgesic Efficacy ◽  
Hand Surgery ◽  
Telephone Call ◽  
Analog Scale ◽  
Regional Analgesia ◽  
Blinded Study ◽  
Double Blinded

Background The aim of this randomized, double-blinded study was to compare the analgesic efficacy of bupivacaine versus ropivacaine brachial plexus analgesia after ambulatory hand surgery. An additional aim was to study the feasibility and safety of patient-controlled regional analgesia (PCRA) outside the hospital. Methods Sixty patients scheduled for ambulatory hand surgery underwent surgery with axillary plexus blockade. After surgery, the plexus catheter was connected to an elastomeric, disposable "homepump," containing 100 ml of either 0.125% bupivacaine or 0.125% ropivacaine. When patients experienced pain, they self-administered 10 ml of the study drug. Analgesic efficacy of PCRA was evaluated by self-assessment of pain intensity by visual analog scale (VAS) and verbal scale. Patients recorded adverse effects, technical problems, use of rescue analgesic tablets, and overall satisfaction. A follow-up telephone call was made the day after surgery. Results Visual analog scale scores decreased after each treatment in both groups, but there were no significant differences between the two drugs. One patient in each group took rescue dextropropoxyphene tablets. In both groups, 87% patients expressed their desire to have the same treatment again. On the day of surgery, significantly more patients were satisfied with ropivacaine PCRA. None of the patients had any signs or symptoms of local anesthetic toxicity or catheter infection. Conclusions This double-blinded study has demonstrated the feasibility of self-administration of local anesthetic to manage postoperative pain outside the hospital. Ropivacaine and bupivacaine provided effective analgesia, and patient satisfaction with PCRA was high. Patient selection, follow-up telephone call, and 24-h access to anesthesiology services are prerequisites for PCRA at home.

scholarly journals A Meta-Analysis of Comparing Intermittent Epidural Boluses and Continuous Epidural Infusion for Labor Analgesia

2020 ◽  
Vol 17 (19) ◽  
pp. 7082
Author(s):  
I-Shiang Tzeng ◽  
Ming-Chang Kao ◽  
Po-Ting Pan ◽  
Chu-Ting Chen ◽  
Han-Yu Lin ◽  
...  
Keyword(s):  
Local Anesthetic ◽  
Meta Analysis ◽  
Labor Analgesia ◽  
Epidural Infusion ◽  
Instrumental Delivery ◽  
Maternal Satisfaction ◽  
Continuous Epidural Infusion ◽  
Second Stage Of Labor ◽  
Mean Differences ◽  
Cesarean Delivery Rate

With the development of medical equipment and techniques in labor anesthesia, it is a major issue to investigate the risks and treatment effects among techniques such as continuous epidural infusion (CEI) and intermittent epidural bolus (IEB). However, there is a controversial result regarding two techniques. This study was conducted through meta-analysis of randomized controlled trials (RCTs) for labor analgesia between the CEI and IEB techniques. The pooled results were presented as weighted mean differences (WMDs) together with 95% confidence intervals (CIs) and odds ratios (ORs) together with 95% CIs, respectively. Eleven RCTs were included in this meta-analysis. Four hundred sixty-five parturients accepted CEI, whereas 473 parturients accepted IEB labor analgesia. Elven identified low- risk bias studies were recruited for meta-analysis. The results presented no statistical difference in cesarean delivery rate between IEB and CEI (OR, 0.96; 95% CI, 0.67–1.37) and duration of second stage of labor (WMD, −3.82 min; 95% CI, −8.28 to 0.64). IEB had statistically significant lessened risk of instrumental delivery (OR, 0.59; 95% CI, 0.39–0.90) and for the use in local anesthetic (WMD, −1.71 mg bupivacaine equivalents per hour; 95% CI, −1.88 and −1.55). Accepted IEB had a higher score of maternal satisfaction (WMD, −6.95 mm; 95% CI, −7.77 to −6.13). Based on evidence, IEB showed a greater benefit for slightly reducing the use in local anesthetic, reduced risk of instrumental delivery, and improved maternal satisfaction for the requirement of labor epidural analgesia for healthy women. In the future, more studies need to be conducted to practice the IEB regimen and explore its influence on labor analgesia.

scholarly journals Comparisons of cancer detection rate and complications between transrectal and transperineal prostate biopsy approaches - a single center preliminary study

BMC Urology ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Guan-Lin Huang ◽  
Chih-Hsiung Kang ◽  
Wei-Ching Lee ◽  
Po-Hui Chiang
Keyword(s):  
Prostate Cancer ◽  
Local Anesthesia ◽  
Visual Analog Scale ◽  
Cancer Detection ◽  
Local Anesthetic ◽  
Prostate Biopsy ◽  
Detection Rate ◽  
Cancer Detection Rate ◽  
Analog Scale ◽  
Detection Rates

Abstract Background Prostate biopsy remains the gold standard approach to verify prostate cancer diagnosis. Transrectal (TR) biopsy is a regular modality, while transperineal (TP) biopsy is an alternative for the patients who display persistently high levels of prostate-specific antigen (PSA) and thus have to undergo repeat biopsy. This study aimed to compare the cancer detection rates between TR and TP approaches and assess the post-bioptic complications of the two procedures. Besides, the feasibility of performing TP biopsies under local anesthesia was also evaluated. Methods A total of 238 outpatient visits meeting the criteria for prostate cancer biopsy were enrolled for this study. They were divided into two groups: the TP group (n = 130) consists of patients destined to undergo local anesthetic TP biopsy; and the TR group (n = 108) contained those who received TR biopsy as comparison. Age, PSA level, digital rectal exam (DRE) finding, prostate volume, and biopsy core number were used as the parameters of the multivariable analyses. The comparable items included cancer detection rate, complication rate, admission rate and visual analog scale (VAS) score. Results The cancer detection rates between TP and TR groups were quite comparable (45% v.s. 49%) (p = 0.492). However, the TP group, as compared to the TR group, had significantly lower incidence of infection-related complications (except epididymitis and prostatitis) that commonly occur after biopsies. None of the patients in the TP group were hospitalized due to the post-bioptic complications, whereas there was still a minor portion of those in the TR group (7.4%) requiring hospitalization after biopsy. Medians (25–75% quartiles) of visual analog scale (VAS) were 3 [3, 4] and 4 [3–5] respectively for the TP and TR procedures under local anesthesia, but no statistical significance existed between them (p = 0.085). Conclusions Patients receiving TP biopsy are less likely to manifest infection-related complications. Therefore, TP biopsy is a more feasible local anesthetic approach for prostate cancer detection if there are concerns for infectious complications and/or the risk of general anesthesia.

scholarly journals Anterior and middle superior alveolar block is efficient for maxillary premolar teeth extractions regardless of the injection system or anesthetic with adrenaline used

2016 ◽  
Vol 144 (9-10) ◽  
pp. 470-473 ◽  
Author(s):  
Slavoljub Tomic ◽  
Ivana Simic ◽  
Mihael Stanojevic ◽  
Svetlana Jankovic ◽  
Ljubomir Todorovic
Keyword(s):  
Clinical Application ◽  
Nerve Block ◽  
Visual Analog Scale ◽  
Local Anesthetic ◽  
Rating Scale ◽  
Extraction Methods ◽  
Injection System ◽  
Analog Scale ◽  
Pain Ratings ◽  
Computer Controlled

Introduction. The anterior and middle superior alveolar nerve block was claimed to be unpredictably efficient for clinical application. Objective. The aim of this report was to establish the efficacy of the anterior and middle superior alveolar nerve block, applied with a computer-controlled injection system or a conventional syringe, for upper premolars extraction. Methods. Sixty healthy adults were divided into two groups regarding the device used as follows: the first group was injected by a computer-controlled injection system, and the second group by a conventional syringe. Pain ratings were obtained via a visual analog scale (VAS) and a verbal rating scale (VRS). Results. Anterior and middle superior alveolar injection enabled a painless extraction in all patients, regardless of the local anesthetic or injection system used. It was slightly less painful when administered by a computer-controlled injection system, but insignificantly when evaluated by VRS. Conclusion. The anterior and middle superior alveolar nerve block may be recommended if maxillary permanent premolars have to be extracted.

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