A Small Preoperative Test Dose of Intravenous Fentanyl Can Predict Subsequent Analgesic Efficacy and Incidence of Side Effects in Patients Due to Receive Epidural Fentanyl

Background The purpose of this study was to determine if epidural fentanyl produces analgesia in laboring patients by a primary spinal or supraspinal action. Methods Fifty-four parturients were randomized to receive epidural 0.125% bupivacaine plus one of three treatments: epidural saline-intravenous saline, epidural fentanyl (20 microg/h)-intravenous saline, or epidural saline-intravenous fentanyl (20 microg/h). The study treatments were administered by continuous infusion, whereas epidural bupivacaine use was patient controlled. Results Epidural bupivacaine use was significantly reduced by epidural (11.5+/-4.6 ml/h) but not by intravenous fentanyl (15.9+/-4.5 ml/h) compared with saline control (16+/-5.9 ml/ h). Analgesia characteristics and side effects were similar among groups. Conclusions Low-dose epidural infusions of fentanyl produce labor analgesia by a primary spinal action.

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

Anesthesiology ◽

10.1097/aln.0b013e31818aa6cb ◽

2008 ◽

Vol 109 (5) ◽

pp. 890-894 ◽

Cited By ~ 11

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 < 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.

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Effect of Intravenous versus Epidural Fentanyl on the Minimum Local Analgesic Concentration of Epidural Bupivacaine in Labor

Anesthesiology ◽

10.1097/00000542-200007000-00022 ◽

2000 ◽

Vol 93 (1) ◽

pp. 122-128 ◽

Cited By ~ 46

Author(s):

Linda S. Polley ◽

Malachy O. Columb ◽

Norah N. Naughton ◽

Deborah S. Wagner ◽

Deanna M. Dorantes ◽

...

Keyword(s):

Confidence Interval ◽

Epidural Analgesia ◽

Local Anesthetic ◽

Analgesic Efficacy ◽

Epidural Fentanyl ◽

Double Blind ◽

Intravenous Fentanyl ◽

Epidural Catheter Placement ◽

Dermatomal Level ◽

Fentanyl Group

Background The minimum local analgesic concentration (MLAC) has been defined as the median effective local analgesic concentration (EC50) in a 20-ml volume for epidural analgesia in the first stage of labor. The aim of this study was to determine the relative local anesthetic sparing efficacies of intravenous and epidural fentanyl by comparison of their effects on the MLAC of bupivacaine. Methods In this double-blind, randomized, prospective study, 84 parturients at < or = 7-cm cervical dilation who requested epidural analgesia were allocated to one of two groups. After lumbar epidural catheter placement, 20 ml bupivacaine (n = 44) or bupivacaine with 3 microg/ml (60 microg) fentanyl (n = 40) was administered. The plain bupivacaine group then received 60 microg intravenous fentanyl. The bupivacaine-fentanyl group received intravenous saline. The concentration of bupivacaine was determined by the response of the previous patient in that group to a higher or lower concentration using up-down sequential allocation. Analgesic efficacy was assessed using 100-mm visual analog pain scores, with < or = 10 mm within 30 min define as effective. Results The MLAC of bupivacaine-intravenous fentanyl was 0.064% wt/vol (95% confidence interval, 0.049-0.080), and the MLAC of bupivacaine-epidural fentanyl was 0.034% wt/vol (95% confidence interval, 0.017-0.050). Epidural fentanyl significantly increased the analgesic potency of bupivacaine by a factor of 1.88 (95% confidence interval, 1.09-3.67) compared with intravenous fentanyl. The epidural fentanyl group demonstrated significantly higher dermatomal spread (P = 0.0064) and increased pruritus (P = 0. 01). Conclusions Epidural fentanyl significantly reduced the MLAC of bupivacaine when compared with intravenous fentanyl for the parturients in this study. The significantly enhanced local anesthetic sparing, dermatomal level, and pruritus with epidural fentanyl suggest a primarily spinal site of action.

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Epidural and Intravenous Fentanyl Produce Equivalent Effects during Major Surgery

Anesthesiology ◽

10.1097/00000542-199502000-00008 ◽

1995 ◽

Vol 82 (2) ◽

pp. 377-382 ◽

Cited By ~ 30

Author(s):

Jean-Phillipe Guinard ◽

Randall L. Carpenter ◽

Pierre-Guy Chassot

Keyword(s):

Epidural Fentanyl ◽

Major Surgery ◽

Epidural Administration ◽

Hemodynamic Stability ◽

Double Blind ◽

Urinary Catecholamines ◽

Intravenous Fentanyl ◽

Clinical Advantage ◽

Fentanyl Administration ◽

To Receive

Background The benefit of epidural versus intravenous fentanyl administration for postoperative analgesia is controversial. In the current study, the intraoperative effects of epidural versus intravenous fentanyl administration were compared during major surgery. Methods Twenty elective patients scheduled for thoracoabdominal esophagectomy under general anesthesia with propofol infusion were randomly allocated to receive either intravenous or epidural boluses of 50-100 micrograms fentanyl in a double-blind fashion to maintain hemodynamic stability. Plasma cortisol and fentanyl, as well as total urinary catecholamines, were obtained at the end of the operations. Results Hemodynamic variations were similar except that patients receiving epidural fentanyl had a lower incidence of heart rate reduction (> 20% reduction from baseline, P < 0.05). There were no differences in mean intraoperative fentanyl (1,115 +/- 430 and 1,010 +/- 377 micrograms, epidural and intravenous, respectively) or propofol (2,281 +/- 645 and 2,452 +/- 1,169 mg) doses, number of boluses of fentanyl (nine in both groups), plasma fentanyl concentration (1.13 +/- 0.4 and 1.02 +/- 0.46 ng/ml), or number of anesthesiologists correctly identifying the site of fentanyl administration. Similarly, there were no differences in plasma glucose (8.9 +/- 1.8 and 9.3 +/- 1.8 mM) and cortisol (696 +/- 446 and 846 +/- 257 mM), or urinary epinephrine (12 +/- 3.7 and 13.1 +/- 9.2, micrograms/sample) and norepinephrine (42.7 +/- 26.7 and 39.1 +/- 27.6, micrograms/sample). Conclusions There appears to be no clinical advantage to epidural administration of fentanyl over intravenous administration during anesthesia for major surgery.

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Epidural Neostigmine Combined with Sufentanil Provides Balanced and Selective Analgesia in Early Labor

Anesthesiology ◽

10.1097/00000542-200408000-00025 ◽

2004 ◽

Vol 101 (2) ◽

pp. 439-444 ◽

Cited By ~ 27

Author(s):

Fabienne Roelants ◽

Patricia M. Lavand’homme

Keyword(s):

Side Effects ◽

Average Duration ◽

Demographic Data ◽

Test Dose ◽

Pain Scores ◽

Analgesic Dose ◽

To Receive ◽

Effective Analgesia ◽

Vital Parameters ◽

First Stage Of Labor

Background This study evaluated the efficacy of an epidural single dose of neostigmine combined with sufentanil to provide selective and balanced analgesia at the beginning of labor. Methods After informed consent, 125 healthy parturients were randomly allocated to receive, after a test dose, a single injection of either epidural sufentanil 20 micrograms (minimal analgesic dose) or 10 micrograms or a combination of sufentanil 10 micrograms with neostigmine 250, 500, or 750 micrograms in a total volume of 12 ml. Pain scores were recorded at regular intervals to determine onset and duration of analgesia. Maternal and fetal vital parameters as well as side effects were closely monitored. Results Parturients did not differ concerning demographic data. Epidural neostigmine 500 micrograms with sufentanil 10 micrograms produced effective analgesia (visual analog scale <30 mm within 10 min in 72% parturients and within 15 min in 85% parturients; average duration of 119 min, confidence interval 96-142 min) that was as effective as epidural sufentanil 20 micrograms. Epidural combination with neostigmine 250 micrograms was ineffective, whereas 750 micrograms did not produce higher effect than 500 micrograms. No motor block was recorded. Maternal and fetal vital parameters remained stable during labor. Conclusions Epidural combination of neostigmine 500 micrograms (e.g., 6-7 micrograms/kg) with sufentanil 10 micrograms provides similar duration of analgesia as epidural sufentanil 20 micrograms and allows effective and selective analgesia devoid of side effects in the first stage of labor.

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Side effects of the metacognitive training for depression compared to a cognitive remediation training in patients with depression

Scientific Reports ◽

10.1038/s41598-021-87198-8 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Mona Dietrichkeit ◽

Marion Hagemann-Goebel ◽

Yvonne Nestoriuc ◽

Steffen Moritz ◽

Lena Jelinek

Keyword(s):

Side Effects ◽

Side Effect ◽

Statistical Power ◽

Controlled Trial ◽

Treatment Options ◽

Cognitive Remediation ◽

Negative Effects ◽

Metacognitive Training ◽

To Receive

AbstractAlthough awareness of side effects over the course of psychotherapy is growing, side effects are still not always reported. The purpose of the present study was to examine side effects in a randomized controlled trial comparing Metacognitive Training for Depression (D-MCT) and a cognitive remediation training in patients with depression. 84 patients were randomized to receive either D-MCT or cognitive remediation training (MyBrainTraining) for 8 weeks. Side effects were assessed after the completion of each intervention (post) using the Short Inventory of the Assessment of Negative Effects (SIAN) and again 6 months later (follow-up) using the Negative Effects Questionnaire (NEQ). D-MCT and MyBrainTraining did not differ significantly in the number of side effects. At post assessment, 50% of the D-MCT group and 59% of the MyBrainTraining group reported at least one side effect in the SIAN. The most frequently reported side effect was disappointment in subjective benefit of study treatment. At follow-up, 52% reported at least one side effect related to MyBrainTraining, while 34% reported at least one side effect related to the D-MCT in the NEQ. The most frequently reported side effects fell into the categories of “symptoms” and “quality”. Our NEQ version was missing one item due to a technical error. Also, allegiance effects should be considered. The sample size resulted in low statistical power. The relatively tolerable number of side effects suggests D-MCT and MyBrainTraining are safe and well-received treatment options for people with depression. Future studies should also measure negative effects to corroborate our results.

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Clinical analgesic efficacy and side effects of dexmedetomidine in the early postoperative period after arthroscopic knee surgery

Journal of Clinical Anesthesia ◽

10.1016/j.jclinane.2007.06.013 ◽

2007 ◽

Vol 19 (8) ◽

pp. 576-582 ◽

Cited By ~ 29

Author(s):

Maria E. Gómez-Vázquez ◽

Eduardo Hernández-Salazar ◽

Abel Hernández-Jiménez ◽

Arturo Pérez-Sánchez ◽

Vilma A. Zepeda-López ◽

...

Keyword(s):

Side Effects ◽

Postoperative Period ◽

Analgesic Efficacy ◽

Early Postoperative Period ◽

Knee Surgery ◽

Arthroscopic Knee Surgery ◽

Arthroscopic Knee

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A hybrid for pain, i.e. bifunctional analgesics in neuropathy

Ból ◽

10.5604/01.3001.0014.8073 ◽

2021 ◽

Vol 21 (4) ◽

pp. 17-24

Author(s):

Joanna Starnowska-Sokół

Keyword(s):

Neuropathic Pain ◽

Side Effects ◽

Pain Therapy ◽

Analgesic Efficacy ◽

Hybrid Structure ◽

Multimodal Approach ◽

Pharmacological Profile ◽

Hybrid Compounds ◽

Therapeutic Outcomes ◽

Promising Perspective

The need of developing new neuropathic pain therapies results from limited potency of currently available treatments, which is underlain by low efficacy of conventional analgesics, complex etiology and pathogenesis of neuropathy, diversity of its symptoms, as well as heightened side effects risk that accompanies the polypharmaceutical strategy, employed commonly to improve the therapeutic outcomes. Designing hybrid compounds, i.e. multimodal molecules that present the affinity to more than one receptor target, offers a promising perspective in this context. The multimodal approach allows to increase the analgesic efficacy of a given compound thanks to aiming at the very pathomechanisms specific for neuropathic pain, and to optimize the pharmacological profile of the drug. Thanks to the hybrid structure, analgesic properties of its moieties can be maximized, even if their action as separate pharmacophores tends to be limited or inconsistent under nerve injury conditions, such as in the case of opioid agonists. The present review discusses selected targets of hybrid compounds in the view of potential neuropathic pain therapy, along with the gains, limitations and challenges related to the use of hybrid compounds.

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Oral Misoprostol vs Intravenous Oxytocin Infusion for Induction of Labor in Prelabor Rupture of Membranes

Journal of SAFOG with DVD ◽

10.5005/jp-journals-10006-1375 ◽

2016 ◽

Vol 8 (1) ◽

pp. 4-7

Author(s):

Rajyashri Sharma

Keyword(s):

Side Effects ◽

Cesarean Delivery ◽

Fetal Distress ◽

Induction Of Labor ◽

Oral Misoprostol ◽

Oxytocin Infusion ◽

Misoprostol Group ◽

The Difference ◽

Prelabor Rupture Of Membranes ◽

To Receive

ABSTRACT Objectives To compare the efficacy, side effects and safety of oral misoprostol to intravenous oxytocin infusion for induction of labor in prelabor rupture of membranes (PROM). Materials and methods Two hundred and sixty-six women of prelabor rupture of membranes were assigned to receive either oral misoprostol 100 μg 6 hourly to a maximum 3 doses (misoprostol group, n = 142), or escalating doses of oxytocin infusion up to 20 mIU/min in primigravida and up to 10 mIU/min in multigravida (oxytocin group, n = 114). Results Demographic characteristics were similar in both the groups. The difference in mean induction to delivery interval (8.2 ± 6 hours in misoprostol group vs 12.2 ± 6 hours in oxytocin group) was statistically significant when two groups were compared. The incidence of vaginal delivery (86.1% in misoprostol group vs 84.2% in oxytocin group), and cesarean delivery (13.9% in misoprostol group vs 15.8% in oxytocin group), was almost similar in both the groups. The indication of cesarean delivery was dystocia (40% in misoprostol group vs 67% in oxytocin group), and fetal distress (60% in misoprostol group vs 33% in oxytocin group) and the difference was statistically significant (p < 0.01). Maternal and neonatal safety outcomes were similar for the two treatments. Conclusion Oral misoprostol in prelabor rupture of membrane have almost similar results as intravenous oxytocin in safety, efficacy and side effects except induction delivery interval, which is less in misoprostol group. How to cite this article Anjum S, Sharma R. Oral Misoprostol vs Intravenous Oxytocin Infusion for Induction of Labor in Prelabor Rupture of Membranes. J South Asian Feder Obst Gynae 2016;8(1):4-7.

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