scholarly journals Effects of Nalbuphine and Fentanyl as Adjuvants to (0.5 %) Isobaric Levobupivacaine in Subarachnoid Block for Elective Transurethral Endoscopic Surgeries

2021 ◽  
Vol 10 (38) ◽  
pp. 3380-3386
Author(s):  
Dinesh G ◽  
Shilpa G.B ◽  
Greeshma N. Murdeshwar
Keyword(s):  
Adverse Effects ◽  
Spinal Anaesthesia ◽  
Motor Blockade ◽  
Male Adult ◽  
Hemodynamic Variables ◽  
Positional Variation ◽  
Blinded Study ◽  
Neurotoxic Effects ◽  
American Society ◽  
Double Blinded

BACKGROUND Isobaric levobupivacaine has minimal effect on positional variation of sensory and motor blockade given intrathecally. Also, it has lesser cardiotoxic and neurotoxic effects. Present study was done to compare efficacy, analgesia haemodynamic effects and any adverse effects after spinal anaesthesia with isobaric levobupivacaine with nalbuphine and fentanyl as adjuvants in transurethral endoscopic surgeries. METHODS 60 male adult patients of American Society of Anaesthesiologists (ASA class I-III) of age group 40 - 80 years were randomized into 2 groups (n = 30) in this prospective, double blinded study. 10 mg of 0.5 % levobupivacaine with 25 µg fentanyl in group LF and 10 mg of 0.5 % levobupivacaine with 0.8 mg nalbuphine in group LN. Parameters assessed were sensory and motor blockade characteristics and hemodynamic variables in both the groups. Adverse effects were recorded if any. RESULTS Onset of sensory and motor blockade were significantly faster in group LF compared to group LN. In both the groups, time for two segment regression was comparable. Statistically significant prolonged analgesic duration was noticed in group with nalbuphine than fentanyl as adjuvant to isobaric levobupivacaine. Difference in haemodynamic variation was not significant in both the groups. CONCLUSIONS Intrathecal nalbuphine 0.8 mg as an adjuvant with isobaric levobupivacaine 0.5 % 10 mg is as efficacious as fentanyl 25µg in transurethral endoscopic surgeries in elderly population with better hemodynamic stability. KEY WORDS Levobupivacaine; Fentanyl; Nalbuphine; Spinal anaesthesia.

Intrathecal Ropivacaine and Clonidine for Ambulatory Knee Arthroscopy

2001 ◽  
Vol 94 (4) ◽  
pp. 574-578 ◽  
Author(s):  
Marc De Kock ◽  
Philippe Gautier ◽  
Luc Fanard ◽  
Jean Luc Hody ◽  
Patricia Lavand’homme
Keyword(s):  
Small Dose ◽  
Knee Arthroscopy ◽  
Systemic Effects ◽  
Motor Blockade ◽  
Arterial Blood ◽  
Group 2 ◽  
American Society ◽  
Double Blinded ◽  
Intrathecal Clonidine

Background The aim of this study was to evaluate the association of a small dose of intrathecal ropivacaine with small doses of intrathecal clonidine for ambulatory surgery. Methods One hundred twenty patients, classified as American Society of Anesthesiologists physical status I and scheduled for knee arthroscopy, were studied. Patients were randomly assigned to receive 4 ml of one of the following double-blinded isobaric intrathecal solutions: 8 mg of ropivacaine (group 1; n =30); 8 mg ropivacaine plus 15 microg clonidine (group 2; n =30); 8 mg ropivacaine plus 45 microg clonidine (group 3; n =30); and 8 mg ropivacaine plus 75 microg clonidine (group 4; n =30). The level and duration of sensory anesthesia were recorded, along with the intensity and duration of motor block. Patient and surgeon were interviewed to evaluate the quality of anesthesia. Results Intrathecal ropivacaine (8 mg alone) produced short sensory anesthesia and motor blockade (132 +/- 38 min and 110 +/- 35 min; mean +/- SD). However, the quality of anesthesia was significantly lower than in any other group (P < 0.05). Ropivacaine (8 mg) plus 75 microg clonidine produced significantly longer sensory and motor anesthesia (195 +/- 40 min and 164 +/- 38 min; P < 0.05). However, this was associated with systemic effects, such as sedation and reduction of arterial blood pressure. Ropivacaine (8 mg) plus 15 microg clonidine did not prolong sensory or motor blockade, afforded high quality anesthesia, and was not associated with detectable systemic effects. Conclusion Small-dose intrathecal clonidine (15 microg) plus 8 mg intrathecal ropivacaine produces adequate and short-lasting anesthesia for knee arthroscopy.

scholarly journals Lumbar Intrathecal Administration of the Quaternary Lidocaine Derivative, QX-314, Produces Irritation and Death in Mice

2010 ◽  
Vol 113 (2) ◽  
pp. 438-444 ◽  
Author(s):  
Stephan K. W. Schwarz ◽  
Helen M.-C. Cheung ◽  
Craig R. Ries ◽  
Sang Mook Lee ◽  
Jimmy T. C. Wang ◽  
...  
Keyword(s):  
Treatment Group ◽  
Adverse Effects ◽  
Intrathecal Administration ◽  
Motor Blockade ◽  
Sensory Blockade ◽  
Suitable Candidate ◽  
Neural Blockade ◽  
Normal Behavior ◽  
Blinded Study ◽  
Positive Controls

Background We recently found that peripheral administration of the quaternary lidocaine derivative, QX-314, produces long-lasting sensory and motor blockade in animals. The goal of this study was to test whether intrathecal QX-314 has similar properties. Methods We conducted a randomized, double-controlled, blinded study with female CD-1 mice. Animals in the treatment group received lumbar intrathecal QX-314 (0.5-10 mM; volume, 2 microl; each concentration, n = 6). Normal saline and lidocaine (70 mM) served as negative and positive controls (each group, n = 12), respectively. Animals were tested for up to 3 h for lumbosacral neural blockade and observed for adverse effects. Results No animal injected with saline and 11 of 12 (92%) animals injected with lidocaine displayed reversible lumbosacral motor blockade (P < 0.001). QX-314 (5 mM) produced motor blockade in four of the six (67%) and sensory blockade in five of the six animals (83%; P < 0.05 vs. saline). However, six of the six mice (100%) at 5 mM QX-314 and five of the six (83%) at 10 mM exhibited marked irritation; one of the six animals at 5 mM (17%) and two of the six at 10 mM (33%) died. We observed no neural blockade without adverse effects in any animal injected with QX-314. All animals injected with saline and 11 of the 12 (92%) animals injected with lidocaine demonstrated normal behavior. Conclusion Lumbar intrathecal QX-314 concentration-dependently produced irritation and death in mice, at lower concentrations than those associated with robust motor blockade. Although QX-314 did produce long-lasting neural blockade, these findings indicate that QX-314 is unlikely to be a suitable candidate for spinal anesthesia in humans.

Comparative study between the effect of intrathecal bupivacaine versus bupivacaine dexmedetomidine combination in spinal anaeshtesia for lower abdominal surgeries

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mervat M Marzouk ◽  
Wael R Thabet ◽  
Tarek M Ashoor ◽  
Ahmed Morsy Ahmed
Keyword(s):  
Blood Pressure ◽  
Spinal Anaesthesia ◽  
Primary Outcome ◽  
Sensory Block ◽  
University Hospital ◽  
Rescue Analgesia ◽  
Blinded Study ◽  
Hospital Patients ◽  
Block Level ◽  
Double Blinded

Abstract Study objectives We compared effect of intrathecal bupivacaine versus bupivacaine Design This is a prospective, randomized, double-blinded study. Setting The setting is at an operating room in Ain Shams University Hospital. Patients: 50 patients scheduled for general anesthesia were randomly allocated to the following 2 groups in equal numbers. Interventions Spinal anaesthesia will be performed in the sitting position at L3-L4 or L4-L5 level using a 25-gauge Quincke spinal needle by the most competent experts. The sensory block level will be assessed along the mid-clavicular line bilaterally. The motor block will be assessed according to Bromage scale Measurements Post operative (VAS) score and Time to first requested analgesia.(primary outcome), Systolic blood pressure, diastolic blood pressure, mean blood pressure and heart rate will be recorded every 5 minutes for 20 minutes then every 15 minutes till the end of surgery, Nausea and/ or vomiting as yes/no, Level of highest sensory block, Bromage score ≥3, Onset of sensory block and Two segment regression time (secondary outcomes) were recorded.. Main results Results of this study showed that the addition of dexmedetomidine to bupivacaine in spinal anaesthesia significantly prolonged both sensory and motor blockades duration compared with bupivacaine alone. They also prolonged the time of postoperative analgesia as evidenced by significantly longer time to first rescue analgesia and lower NRS scores with minimal adverse effects and haemodynamic stability. Conclusions We concluded that intrathecal dexmedetomidine increases the duration of analgesia and reduces postoperative pain without changes in the hemodynamic parameters and adverse side effects. It can be considered as an appropriate adjuvant to intrathecal local anesthetics for lower abdominal surgeries.

COMPARATIVE STUDY OF DEXMEDETOMIDINE, TRAMADOL AND PETHIDINE FOR THE TREATMENT OF SHIVERING IN POST-NEURAXIAL ANAESTHESIA

2021 ◽  
pp. 80-83
Author(s):  
Rupesh Kumar Mishra ◽  
Rajeev Krishan ◽  
Chandeshwar Choudhary ◽  
Debarshi Jana
Keyword(s):  
Comparative Study ◽  
Response Rate ◽  
Elective Surgery ◽  
Intrathecal Injection ◽  
Hyperbaric Bupivacaine ◽  
Neuraxial Anaesthesia ◽  
Blinded Study ◽  
American Society ◽  
Double Blinded ◽  
American Society Of Anesthesiologists

Objective: This study was done for comparative study of dexmedetomidine with that o tramadol and pethidine in the treatment of post-neuraxial anaesthesia shivering. Design: This was a prospective, randomised, double-blinded study. Setting And Subjects: Hundred patients of both genders, aged 18–70 years with American Society of Anesthesiologists physical status I and II undergoing neuraxial a( spinal or combined spinal and epidural)anaesthesia for elective surgery were enrolled in this study. Sixty of them developed shivering after an intrathecal injection of 0.5% hyperbaric bupivacaine 15 mg. They were then randomly allocated to receive either intravenous dexmedetomidine 0.5 μg/kg, pethidine 0.5 mg/kg or tramadol 0.5 mg/kg. Outcome measures: The response rate to treatment, the degree of sedation and the side-effects were recorded. Results: The response rate to treatment was highest in the dexmedetomidine group, and it was only signicant when compared to tramadol group (p = 0.0012). It was noted that the response rate was higher in the pethidine than in the tramadol group. This difference was not statistically signicant (p = 0.082). The sedation score post treatment was similar in all three groups, but more patients in the dexmedetomidine group developed hypotension and bradycardia (p< 0.05). Conclusion: Dexmedetomidine 0.5 μg/ml was more effective than tramadol 0.5 mg/ml and pethidine 0.5 mg/ml, and both tramadol and pethidine were found to have similar efcacy, in the treatment of post-neuraxial anaesthesia shivering. However, dexmedetomidine caused a higher incidence of hypotension and bradycardia.

Results of a Randomized Study of IM862 Nasal Solution in the Treatment of AIDS-Related Kaposi’s Sarcoma

2000 ◽  
Vol 18 (4) ◽  
pp. 716-716 ◽  
Author(s):  
Anil Tulpule ◽  
David T. Scadden ◽  
Byron M. Espina ◽  
Suzanne Cabriales ◽  
Walter Howard ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Kaposi's Sarcoma ◽  
Systemic Chemotherapy ◽  
Randomized Study ◽  
Kaposi’S Sarcoma ◽  
Days Of Therapy ◽  
Blinded Study ◽  
Male Patients ◽  
Double Blinded ◽  
Unacceptable Toxicity

PURPOSE: Although advances have been made in the treatment of AIDS-related Kaposi’s sarcoma (AIDS-KS) with systemic chemotherapy, less toxic therapies are needed. IM862 is a naturally occurring peptide with antiangiogenic properties and was thus studied in patients with AIDS-KS. PATIENTS AND METHODS: IM862 was given as intranasal drops at a dose of 5 mg. Patients were randomized to two dosing schedules given in repeated cycles until disease progression or unacceptable toxicity: 5 days of therapy followed by 5 days off (n = 18) and every other day dosing (n = 26). RESULTS: Forty-two male patients and two female patients with a median age of 38 years (range, 22 to 53 years) were accrued. Twenty-one patients (47%) had more than 50 mucocutaneous lesions, 14 (32%) had lymphedema, and none had visceral involvement. Thirty-three patients (75%) had received prior systemic chemotherapy. Twenty-four patients (55%) had CD4+ lymphocyte count ≤ 200/mm3. All but five patients were being treated with concurrent protease inhibitor(s), for a median of 10 months (range, 0 to 24 months). Major responses were documented in 36%, with five complete and 11 partial remissions, occurring after a median of 6 weeks (range, 3 to 26 weeks) and lasting a median of 33+ weeks (range, 12+ to 95+ weeks). Twenty-one patients had stable disease for periods of 7 to 72+ weeks. Adverse effects to IM862 were limited to mild and transient headache, fatigue, tingling, and nausea. No hematologic adverse effects attributed to treatment were reported. CONCLUSION: IM862 given as intranasal drops is well tolerated and has antitumor activity in patients with AIDS-KS. A randomized double-blinded study to define the activity of IM862 in patients with AIDS-KS is in progress.

scholarly journals A Study to Compare the Analgesic Efficacy of Intrathecal Bupivacaine Alone with Intrathecal Bupivacaine Midazolam Combination in Patients Undergoing Elective Infraumbilical Surgery

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Anirban Chattopadhyay ◽  
Souvik Maitra ◽  
Suvadeep Sen ◽  
Sulagna Bhattacharjee ◽  
Amitava Layek ◽  
...  
Keyword(s):  
Spinal Anaesthesia ◽  
Local Anesthetic ◽  
Analgesic Efficacy ◽  
Open Label ◽  
Hyperbaric Bupivacaine ◽  
Open Label Study ◽  
Parallel Group ◽  
American Society ◽  
Group B ◽  
Double Blinded

Spinal anaesthesia, which is one of the techniques for infraumbilical surgeries, is most commonly criticized for limited duration of postoperative analgesia. Several adjuvants have been tried along with local anesthetic for prolonging the duration of analgesia. In this study, we have observed the effect of midazolam as an adjuvant in patients undergoing infraumbilical surgery. In this prospective, randomized, double blinded, and parallel group and open label study of 90 adult patients aged 18–60 years, of American Society of Anaesthesiologists (ASA) status I and II, scheduled for elective infraumbilical surgery, were randomly allocated in two groups. Each patient in group “B” received hyperbaric bupivacaine 12.5 mg along with 0.4 mL of normal saline in the subarachnoid block, and patients of group “BM” received 12.5 mg hyperbaric bupivacaine along with preservative free midazolam 0.4 mL (2 mg). We found that use of midazolam as adjuvant with the local anesthetic in spinal anaesthesia significantly increases the duration of analgesia (median 320 min versus 220 min) and motor block (median 255 min versus 195 min) but decreases the incidence of postoperative nausea-vomiting (PONV).

The Effect of Adding a Minidose of Clonidine to Intrathecal Sufentanil for Labor Analgesia

1998 ◽  
Vol 89 (3) ◽  
pp. 594-601. ◽  
Author(s):  
Frederic J. Mercier ◽  
Mokhtar Dounas ◽  
Herve Bouaziz ◽  
Veronique Des Mesnards-Smaja ◽  
Christine Foiret ◽  
...  
Keyword(s):  
Heart Rate ◽  
Primary Outcome ◽  
Intrathecal Injection ◽  
Labor Analgesia ◽  
Motor Blockade ◽  
Pain Scores ◽  
Nulliparous Women ◽  
Blinded Study ◽  
Double Blinded ◽  
Effective Analgesia

Background Preliminary studies have suggested that the addition of clonidine to intrathecal sufentanil prolongs analgesia without producing motor blockade. Methods Fifty-three nulliparous women in painful labor were included in this prospective, randomized, double-blinded study. Parturients at 2- to 5-cm cervical dilation received either 5 microg sufentanil plus 30 microg clonidine or 5 microg sufentanil intrathecally, followed by 5 mg bupivacaine epidurally. The primary outcome was time until first request for additional analgesia. Visual analog pain scores, sensory changes, blood pressure, heart rate, ephedrine requirements, motor blockade, sedation, pruritus, and nausea were also recorded. Results All parturients but one had effective analgesia in both groups, with similar sensory levels never exceeding T2. The duration (mean +/- SD) of analgesia was longer in the sufentanil-clonidine group: 125+/-46 versus 97+/-30 min (P = 0.007). The incidence of hypotension and the ephedrine requirements (median with range) were higher in the sufentanil-clonidine group: 63% versus 12% (P &lt; 0.001) and 7.5 mg [range, 0-25.5 mg] versus 0 mg [range, 0-6 mg] (P &lt; 0.0001). The incidence of fetal heart rate abnormalities during the first 30 min after intrathecal injection was similar in both groups (17% vs. 19%). No parturient had motor blockade. Conclusions The addition of 30 microg clonidine to 5 microg intrathecal sufentanil extended the duration of labor analgesia without producing motor blockade. However, as previously reported with 100-200 microg clonidine, the incidence of hypotension and the ephedrine requirements were also increased, even when 30 microg clonidine only was added.

Sign in / Sign up

Export Citation Format

Share Document