Patient-Controlled Epidural Levobupivacaine with or without Fentanyl for Post-Cesarean Section Pain Relief

Purpose.The purpose of this study was to compare the analgesic properties of levobupivacaine with or without fentanyl for patient-controlled epidural analgesia after Cesarean section in a randomized, double-blinded study.Methods.We enrolled American Society of Anesthesiologists class I/II, full-term pregnant women at National Taiwan University Hospital who received patient-controlled epidural analgesia after Cesarean section between 2009 and 2010. Eighty women were randomly assigned into two groups. In group A, the 40 subjects received drug solutions made of 0.6 mg/ml levobupivacaine plus 2 mcg/ml fentanyl, and in group B the 40 subjects received 1 mg/ml levobupivacaine. Maintenance was self-administered boluses and a continuous background infusion.Results.There were no significant differences in the resting and dynamic pain scales and total volume of drug used between the two groups. Patient satisfaction was good in both groups.Conclusion.Our study showed that pure epidural levobupivacaine can provide comparative analgesic properties to the levobupivacaine-fentanyl combination after Cesarean section. Pure levobupivacaine may serve as an alternative pain control regimen to avoid opioid-related adverse events in parturients.

Download Full-text

Management of Pain During Propofol Injection Using Intravenous Nitroglycerine

KYAMC Journal ◽

10.3329/kyamcj.v10i4.45720 ◽

2020 ◽

Vol 10 (4) ◽

pp. 202-205

Author(s):

Muhammad Sazzad Hossain ◽

Mohammad Mamunur Rashid ◽

Md Anisur Rahman Babu ◽

Afsana Sultana ◽

Md Sirajul Islam Mahfuz ◽

...

Keyword(s):

Placebo Group ◽

Venous Occlusion ◽

Saline Group ◽

Injection Pain ◽

Group A ◽

American Society ◽

Group B ◽

Double Blinded ◽

American Society Of Anesthesiologists ◽

To Receive

Background: Propofol is an intravenous (IV) anesthetic agent, can irritate the skin, mucous membrane and venous intima. The main drawback is the pain at injection site following its intravenous injection. Objectives: This study was performed to evaluate the effect of intravenous nitroglycerine on pain in patients following propofol injection. Materials and Methods: Eighty adult patients of both sexes, aged 20-50 years, according to American Society of Anesthesiologists (ASA) physical status were divided into two equal groups (n=40) to receive 200 mcg intravenous nitroglycerine diluted in 10 ml saline (group A) and 10 ml normal saline as placebo (group B) at an ambient operating room temperature in a randomized and double blinded fashion to compare the pain-relieving effects of the drugs during propofol injection before the patients lost consciousness. The pain on propofol injection was assessed according to the Mc Crirrick and Hunter scale. Results: The overall incidence and severity of pain were significantly less in Groups A (nitroglycerine group) than group B (placebo group) (p< 0.05). The incidence of mild and moderate pain in Group A versus group B was 25% vs 45% and 15% vs 30% respectively (p<0.05). The incidence of score '0' (no pain) was higher in Group A (60%) than Group B (25%) (p<0.05). Conclusion: Pretreatment with 200 mcg nitroglycerine with venous occlusion for one minute is effective pretreatment in alleviating propofol injection pain when compared to placebo. KYAMC Journal Vol. 10, No.-4, January 2020, Page 202-205

Download Full-text

Obstetric Anesthesia Work Force Survey, 1981 versus 1992

Anesthesiology ◽

10.1097/00000542-199707000-00018 ◽

1997 ◽

Vol 87 (1) ◽

pp. 135-143 ◽

Cited By ~ 154

Author(s):

Joy L. Hawkins ◽

Charles P. Gibbs ◽

Miriam Orleans ◽

Gallice Martin-Salvaj ◽

Brenda Beaty

Keyword(s):

Cesarean Section ◽

Epidural Analgesia ◽

General Anesthesia ◽

Obstetric Anesthesia ◽

The United States ◽

Nurse Anesthetists ◽

Regional Analgesia ◽

American Hospital ◽

American Society ◽

American Society Of Anesthesiologists

Background In 1981, with support from the American Society of Anesthesiologists and the American College of Obstetricians and Gynecologists, anesthesia and obstetric providers were surveyed to identify the personnel and methods used to provide obstetric anesthesia in the United States. The survey was expanded and repeated in 1992 with support from the same organizations. Methods Comments and questions from the American Society of Anesthesiologists Committee on Obstetrical Anesthesia and the American College of Obstetricians and Gynecologists Committee on Obstetric Practice were added to the original survey instrument to include newer issues while allowing comparison with data from 1981. Using the American Hospital Association registry of hospitals, hospitals were differentiated by number of births per year (stratum I, > or = 1,500 births; stratum II, 500-1,499 births; stratum III, < 500 births) and by U.S. census region. A stratified random sample of hospitals was selected. Two copies of the survey were sent to the administrator of each hospital, one for the chief of obstetrics and one for the chief of anesthesiology. Results Compared with 1981 data, there was an overall reduction in the number of hospitals providing obstetric care (from 4,163 to 3,545), with the decrease occurring in the smallest units (56% of stratum III hospitals in 1981 compared with 45% in 1992). More women received some type of labor analgesia and there was a 100% increase in the use of epidural analgesia. However, regional analgesia was unavailable in 20% of the smallest hospitals. Spinal analgesia for labor was used in 4% of parturients. In 1981, obstetricians provided 30% of epidural analgesia for labor; they provided only 2% in 1992. Regional anesthesia was used for 78-85% (depending on strata) of patients undergoing cesarean section, resulting in a marked decrease in the use of general anesthesia. Anesthesia for cesarean section was provided by nurse anesthetists without the medical direction of an anesthesiologist in only 4% of stratum I hospitals but in 59% of stratum III hospitals. Anesthesia personnel provided neonatal resuscitation in 10% of cesarean deliveries compared with 23% in 1981. Conclusions Compared with 1981, analgesia is more often used by parturients during labor, and general anesthesia is used less often in patients having cesarean section deliveries. In the smallest hospitals, regional analgesia for labor is still unavailable to many parturients, and more than one half of anesthetics for cesarean section are provided by nurse anesthetists without medical direction by an anesthesiologist. Obstetricians are less likely to personally provide epidural analgesia for their patients. Anesthesia personnel are less involved in newborn resuscitation.

Download Full-text

Intrathecal clonidine added to small-dose bupivacaine prolongs

Canadian Urological Association Journal ◽

10.5489/cuaj.325 ◽

2013 ◽

Vol 6 (1) ◽

pp. 25

Author(s):

Agreta Gecaj-Gashi ◽

Hasime Terziqi ◽

Tune Pervorfi ◽

Arben Kryeziu

Keyword(s):

Spinal Anesthesia ◽

Postoperative Analgesia ◽

Motor Block ◽

Sensory Block ◽

Analgesia Requirement ◽

American Society ◽

Group B ◽

Double Blinded ◽

Intrathecal Clonidine ◽

American Society Of Anesthesiologists

Introduction: The aim of this prospective, double-blinded studywas to investigate the effects of clonidine in co-administrationwith bupivacaine during spinal anesthesia, regarding the onset and regression of motor and sensory block, postoperative analgesia and possible side effects.Methods: We randomly selected 66 male patients (age 35 to 70), from the American Society of Anesthesiologists (ASA) class I-II; these patients were scheduled for transurethral surgical procedures. These patients were randomly allocated into two groups of 33 patients each: group B (bupivacaine) only received 0.5% isobaric bupivacaine 7.5 mg intrathecally and group BC (bupivacaine + clonidine) received bupivacaine 7.5 mg and clonidine 25 μg intrathecally. We performed the spinal anesthesia at a level of L3-L4 with a 25-gauge needle. We assessed the sensory block with a pinprick,the motor block using the Bromage scale, analgesia with thevisual analog scale and sedation with the modified Wilson scale.We also recorded the hemodynamic and respiratory parameters.Results: The groups were demographically similar. The mean time of achievement of moto block (Bromage 3) and sensory block at level T9 was significantly shorter in the BC group compared with B group (p = 0.002, p = 0.000, respeectively). The motor block regression time was not significantly different between the two groups (p = 0.237). The postoperative analgesia requirement was significantly longer in group BC compared with group B (p = 0.000). No neurological deficit, sedation or other significant adverse effects were recorded.Conclusion: The intrathecal application of clonidine in combination with bupivacaine improves the duration and quality of spinal anesthesia; it also provides longer duration of postoperative analgesia, without significant side effects.

Download Full-text

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

Anesthesiology ◽

10.1097/aln.0000000000001669 ◽

2017 ◽

Vol 127 (1) ◽

pp. 50-57 ◽

Cited By ~ 3

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.

Download Full-text

Patient-Controlled Epidural Analgesia in Labour — is a Continuous Infusion of Benefit?

Anaesthesia and Intensive Care ◽

10.1177/0310057x9202000103 ◽

1992 ◽

Vol 20 (1) ◽

pp. 15-20 ◽

Cited By ~ 61

Author(s):

M. J. Paech

Keyword(s):

Side Effects ◽

Epidural Analgesia ◽

Patient Controlled Analgesia ◽

Self Administration ◽

High Quality ◽

Active Labour ◽

Background Infusion ◽

Significant Difference ◽

Continuous Background ◽

Single Blind

A randomised, single-blind study was conducted among 52 gravida in active labour, to investigate two variants of patient-controlled epidural analgesia — bolus only versus bolus plus infusion. Patient-controlled analgesia variables, using an epidural solution of 0.125% bupivacaine plus fentanyl 3 mcg per ml, were a 4 ml incremental bolus with 15 minute lockout, plus or minus a 4 ml per hour infusion. Up to three additional staff-administered supplements of 0.5% bupivacaine 4 ml (20 mg) were allowed. There was no significant difference between groups with respect to pain relief, supplementary boluses required, satisfaction, side-effects or details of patient-controlled epidural analgesia, with the exception of greater fentanyl usage in the bolus plus infusion group (P < 0.003). Both groups had high quality analgesia, low rates of bupivacaine usage and were highly satisfied. However, under the conditions of the study, the addition of a continuous background infusion to self-administration conferred no benefit.

Download Full-text

Obtenção de Consentimento Informado para Anestesia em Cirurgia Eletiva num Hospital Terciário: Práticas e Contexto Ético-Legal

Acta Médica Portuguesa ◽

10.20344/amp.10592 ◽

2019 ◽

Vol 32 (1) ◽

pp. 53

Author(s):

Luís Guilherme Casimiro ◽

Sara Marisa Pereira ◽

Sofia Cardoso Pires ◽

Joana Mourão

Keyword(s):

Informed Consent ◽

Elective Surgery ◽

University Hospital ◽

Anesthetic Technique ◽

Patient Relationship ◽

Active Process ◽

Legal Principles ◽

American Society ◽

American Society Of Anesthesiologists ◽

Written Informed Consent

Introduction: Informed consent is an active process of the doctor-patient relationship, based on ethical and legal principles. The anesthetic act has inherent risks, which should be subject of specific consent. The aim of this study was to evaluate the degree of implementation of written specific informed consent for anesthesia in the context of elective surgery.Material and Methods: An observational prospective study, at a tertiary university hospital, in 230 patients aged 60 years or older, undergoing elective surgery between May and July 2017. Eligible patients who consented to participate were interviewed clinically on the day before surgery. In the postoperative period, the anesthetic technique and the existence of the written informed consent for the anesthetic and surgical procedures were assessed. Patients who were unable to give informed consent or those admitted in the Intensive Care Unit after surgery were excluded. Results: Written informed consent for the surgical procedure was obtained for 225 (97.8%), while it was obtained in just 96 (41.7%) patients for the anesthetic act. There was a higher prevalence of stroke, anemia, and higher Charlson and physical American Society of Anesthesiologists scores in patients without written informed consent for the anesthetic act.Discussion: We identified a low implementation of written informed consent for anesthesia. This situation may have important implications in the context of disciplinary, civil or criminal liability.Conclusion: Despite its importance, the practice of written informed consent for anesthesia in this institution is not yet implemented on a regular basis.

Download Full-text

Effect of Different Cost Drivers on Cost per Anesthesia Minute in Different Anesthesia Subspecialties

Anesthesiology ◽

10.1097/00000542-200412000-00026 ◽

2004 ◽

Vol 101 (6) ◽

pp. 1435-1443 ◽

Cited By ~ 39

Author(s):

Martin Schuster ◽

Thomas Standl ◽

Joachim A. Wagner ◽

Jürgen Berger ◽

Hajo Reißmann ◽

...

Keyword(s):

Multiple Regression Model ◽

University Hospital ◽

Cost Drivers ◽

Personnel Costs ◽

Facial Surgery ◽

American Society ◽

The Cost ◽

American Society Of Anesthesiologists ◽

Cost Differences ◽

Nose And Throat

Background Little is known about differences in costs to provide anesthesia care for different surgical subspecialties and which factors influence the subspecialty-specific costs. Methods In this retrospective study, the authors determined main cost components (preoperative visit, intraoperative personnel costs, material and pharmaceutical costs, and others) for 10,843 consecutive anesthesia cases from a 6-month period in the 10 largest anesthesia subspecialties in their university hospital: ophthalmology; general surgery; obstetrics and gynecology; ear, nose, and throat surgery; oral and facial surgery; neurosurgery; orthopedics; cardiovascular surgery; traumatology; and urology. Using regression analysis, the effect of five presumed cost drivers (anesthesia duration, emergency status, American Society of Anesthesiologists physical status of III or higher, patient age younger 6 yr, and placement of invasive monitoring) on subspecialty-specific costs per anesthesia minute were analyzed. Results Both personnel costs for anesthesiologists and total costs calculated per anesthesia minute were inversely correlated with the duration of anesthesia (adjusted R2 = 0.75 and 0.69, respectively), i.e., they were higher for subspecialties with short cases and lower for subspecialties with longer cases. The multiple regression model showed that differences in anesthesia duration alone accounted for the majority of the cost differences, whereas the other presumed cost drivers added only little to explain subspecialty-specific cost differences. Conclusions Different anesthesia subspecialties show significant and financially important differences regarding their specific costs. Personnel costs and total costs are highest for subspecialties with the shortest cases. Other analyzed cost drivers had little effect on subspecialty-specific costs. In the light of these cost differences, a detailed cost analysis seems necessary before the profitability of an anesthesia subspecialty can be assessed.

Download Full-text

Postoperative Course After Emergency Colorectal Surgery for Secondary Peritonitis in the Elderly Is Often Complicated by Delirium

International Surgery ◽

10.9738/cc125.1 ◽

2012 ◽

Vol 97 (2) ◽

pp. 129-134 ◽

Cited By ~ 5

Author(s):

Stephan Engelberger ◽

Manuel Zürcher ◽

Jochen Schuld ◽

Carsten Thomas Viehl ◽

Christoph Kettelhack

Keyword(s):

Postoperative Delirium ◽

Statistical Significance ◽

The Elderly ◽

Morbidity And Mortality ◽

University Hospital ◽

Colorectal Origin ◽

American Society ◽

Emergency Colorectal Surgery ◽

American Society Of Anesthesiologists ◽

The University

Abstract Postoperative delirium, morbidity, and mortality in our elderly patients with secondary perionitis of colorectal origin is described. This is a chart-based retrospective analysis of 63 patients who were operated on at the University Hospital Basel from April 2001 to May 2004. Postoperative delirium occurred in 33%. Overall morbidity was 71.4%. Surgery-related morbidity was 43.4%. Mortality was 14.4%. There was no statistical significance between delirium, morbidity and mortality (P = 0.279 and P = 0.364). There was no statistically significant correlation between the analyzed scores (American Society of Anesthesiologists classification, Mannheimer Peritonitis Index, Acute Physiology and Chronic Health Evaluation score II, physiological and operative surgical severity and enumeration of morbidity and mortality score‚ or short ‚cr-POSSUM’) and postoperative delirium, morbidity or mortality. Postoperative delirium occurred in one-third of the patients, who seem to have a trend to higher morbidity. Even if the different scores already had proven to be predictive in terms of morbidity and mortality, they do not help the risk stratification of postoperative delirium, morbidity, or mortality in our collective population.

Download Full-text

A comparative evaluation of efficacy of epidural dexmedetomidine and fentanyl as adjunct to 0.2% ropivacaine for post-operative analgesia in elective abdominal surgeries

International Journal of Clinical Trials ◽

10.18203/2349-3259.ijct20205450 ◽

2020 ◽

Author(s):

Pushpal Gandhi ◽

Mahendra Agrawal ◽

Bhavika Agrawal ◽

Simarn Behl

Keyword(s):

Epidural Analgesia ◽

Comparative Evaluation ◽

Hemodynamic Parameters ◽

Regional Technique ◽

Significant Difference ◽

Group 2 ◽

Reversible Loss ◽

American Society ◽

The One ◽

American Society Of Anesthesiologists

Background: Epidural analgesia as a central nuraxial technique which involves use of local anesthetics injected into the epidural space to produce a reversible loss of sensation and is the one of the most common regional technique used for lover abdominal and lover limb surgeries epidural analgesia provides excellent pain relief for surgical procedures below the umbilicus. This study compared the efficacy of epidural dexmedetomidine and fentanyl in addition to 0.2% ropivacaine for post-operative analgesia in elective abdominal surgeries.Methods: Total of 150 patients American Society of Anesthesiologists (ASA) I and II between 20-60 years, undergoing major abdominal surgery were included in this study. The patients divided in three groups of 50 patients each. First group R (ropivaciain 0.2% 9 ml with 1ml normal saline) second group RF (ropivacain 0.2% 9 ml with fentanyl 1 ml) and third group RD (ropivaciain 0.2% 9 ml with dexmedetomidine 1 μ/kg).Results: There is no significant difference in age, weight, sex, and ASA grade in all three groups.Hypotension was observed in 4 (8%) patients of R group, 2 (4%) in RD group and 4 (8%) in RF group. The shivering was present in 2 (4%) R group and 2 (4%) in RD group. Nausea, vomiting was present in R group 2 (4%) and 2 (4%) in RF group. There was no significant difference between the three groups with respect to hemodynamic parameters like heart rate, systolic and diastolic blood pressure and respiratory rate.Conclusions: Dexmedetomidine is a better adjuvant to ropivacaine through epidural route when compared to fentanyl for providing early onset prolonged post-operative analgesia, sedation and stable hemodynamic parameters in intra-abdominal surgeries.

Download Full-text

A Randomized Control Trial of Patient-Controlled Intravenous Analgesia (PCIA) with and Without a Background Infusion Using Sufentanil for Cesarean Section Analgesia

10.21203/rs.3.rs-455428/v1 ◽

2021 ◽

Author(s):

Zhong-Biao Nie ◽

Xian-Mei Cui ◽

Ran Zhang ◽

Bin Lu ◽

Su-Xian Li ◽

...

Keyword(s):

Cesarean Section ◽

Postpartum Hemorrhage ◽

Sedation Score ◽

Total Consumption ◽

Pain Scores ◽

Background Infusion ◽

Intravenous Analgesia ◽

Wound Pain ◽

Group A ◽

Group B

Abstract Purpose: Patient-controlled intravenous analgesia (PCIA) is an option for pain cesarean section analgesia. However, the effect of a background infusion on the analgesic requirements of parturients is still debated. In order to attempt to identify the optimal cesarean section analgesia infusion regime, we evaluated the benefit of the background infusion in this randomized study.Patients and methods: 60 Parturients had a PCIA analgesia protocol initiated consisting of a 0.5mL bolus, and compared 2 Groups: no background infusion, 6 min lockout time (Group A). 2 mL/h infusion, 10 min lockout time (Group B). The total amount of sufentanil consumed, two categories of pain scores, sedation score, postpartum hemorrhage, Injection/attempt (I/A) ratio, side effects, satisfaction were calculated for both groups.Results: Group B significantly reduce visual analog scale（VAS）pain scores 6, 12h. Group A and Group B were not significantly different regarding wound pain at rest (VAS-R) and uterine cramping pain (VAS-U) at postoperative 24, 36 hours. In terms of I/A, Group A was lower than Group B, there was no significant difference. Group B showed significantly higher satisfaction than Group A. Total consumption of sufentanil at 36 hours postoperative was much greater in Group B. Group B can significantly reduce the postpartum hemorrhage within 1 hour. The minimal respiration rates were not significantly different among groups. The side effect were not observed among groups. All parturients had the same Ramsey sedation score.Conclusion: In comparison with the without background infusion, total consumption of sufentanil at 36 hours postoperative was much greater in the background infusion, but it can significantly reduce the uterine contraction pain and wound pain of 12 hours after cesarean section, significantly improve patient satisfaction, reduce the postpartum hemorrhage within 1 hour, and does not increase the incidence of PONV and respiratory depression in parturients.

Download Full-text