scholarly journals Labor analgesia with ropivacaine added to clonidine: a randomized clinical trial

2008 ◽  
Vol 126 (2) ◽  
pp. 102-106 ◽  
Author(s):  
Giane Nakamura ◽  
Eliana Marisa Ganem ◽  
Norma Sueli Pinheiro Módolo ◽  
Ligia Maria Suppo de Souza Rugolo ◽  
Yara Marcondes Machado Castiglia
Keyword(s):  
Epidural Analgesia ◽  
Adaptive Capacity ◽  
Apgar Score ◽  
Motor Block ◽  
Low Dose ◽  
Sensory Block ◽  
Labor Analgesia ◽  
Latency Time ◽  
Time Duration ◽  
Block Level

CONTEXT AND OBJECTIVE: Previous studies have led to speculation that the association between ropivacaine and clonidine might be more effective than ropivacaine alone. We examined the maternal-fetal effects of two pharmacological approaches: a low dose of ropivacaine or a lower dose of ropivacaine plus clonidine for epidural analgesia during labor. DESIGN AND SETTING: Prospective study at Department of Anesthesiology, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista. METHODS: Thirty-two pregnant women in American Society of Anesthesiologists physical status I and II randomly underwent epidural analgesia using 15 ml of ropivacaine 0.125% (R group) or 15 ml of ropivacaine 0.0625% plus 75 µg clonidine (RC group). Pain intensity, sensory block level, latency time, motor block intensity, duration of labor analgesia and duration of epidural analgesia were evaluated. The newborns were evaluated using Apgar scores and the Amiel-Tison method (neurological and adaptive capacity score). RESULTS: There were no statistically significant differences between the groups regarding pain score, sensory block level, duration of epidural analgesia or Apgar score. The latency time, duration of labor analgesia and motor block were R group < RC group. The half-hour and two-hour neurological and adaptive capacity scores were higher in the R group. All of the R group newborns and 75% of the RC group newborns were found to be neurologically healthy at the 24-hour examination. RESULTS: There were no statistically significant differences between the groups regarding pain score, sensory block level, duration of epidural analgesia or Apgar score. The latency time, duration of labor analgesia and motor block were R group < RC group. The half-hour and two-hour neurological and adaptive capacity scores were higher in the R group. All of the R group newborns and 75% of the RC group newborns were found to be neurologically healthy at the 24-hour examination. CONCLUSION: Both low-dose ropivacaine and a lower dose plus clonidine relieved maternal pain during obstetric labor. Newborns of mothers who received only ropivacaine showed better neurological and adaptive capacity scores.

scholarly journals Comparison of 0.5% Ropivacaine and 0.5% Bupivacaine in Lumbar Epidural Anaesthesia for Lower Limb Orthopaedic Surgery

1997 ◽  
Vol 25 (3) ◽  
pp. 262-266 ◽  
Author(s):  
D. P. McGlade ◽  
M. V. Kalpokas ◽  
P. H. Mooney ◽  
M. R. Buckland ◽  
S. K. Vallipuram ◽  
...  
Keyword(s):  
Lower Limb ◽  
Orthopaedic Surgery ◽  
Motor Block ◽  
Onset Time ◽  
Sensory Block ◽  
Pressure Profile ◽  
Technical Failure ◽  
Time Duration ◽  
Double Blind ◽  
Multi Centre Study

The purpose of this study was to compare the epidural use of 0.5% ropivacaine and 0.5% bupivacaine in patients undergoing lower limb orthopaedic surgery. In a double-blind, randomized, multi-centre study involving 67 patients, thirty-two patients received 20 ml of 0.5% ropivacaine and 35 patients received 20 ml of 0.5% bupivacaine at the L2,3 or L3,4 interspace. Parameters measured were the onset time, duration and spread of sensory block, the onset time, duration and degree of motor block, the quality of anaesthesia and the heart rate and blood pressure profile during block onset. Four patients (3 ropivacaine, 1 bupivacaine) were excluded from the study due to technical failure of the block. The onset and duration of analgesia at the T10 dermatome (median, interquartile range) was 10 (5-15) minutes and 3.5 (2.7-4.3) hours respectively for ropivacaine, and was 10 (6-15) minutes and 3.4 (2.5-3.8) hours respectively for bupivacaine. Maximum block height (median, range) was T6 (T2-T12) for ropivacaine and T6 (C7-T10) for bupivacaine. Nine patients receiving ropivacaine and eight patients receiving bupivacaine developed no apparent motor block. The incidence of complete motor block (Bromage grade 3) was low in both groups, being 4/27 for ropivacaine and 6/34 for bupivacaine. In the ropivacaine group, motor and sensory block were judged to be satisfactory in 78% of patients. In the bupivacaine group, motor and sensory block were judged to be satisfactory in 71% and 62% of patients respectively. Cardiovascular changes were similar in both groups. No statistical differences were found between the two groups regarding any of the study parameters.

scholarly journals Influence of Positioning on Plain Levobupivacaine Spinal Anesthesia in Cesarean Section

2010 ◽  
Vol 2010 ◽  
pp. 1-4 ◽  
Author(s):  
Fabio Gori ◽  
Francesco Corradetti ◽  
Vittorio Cerotto ◽  
Vito Aldo Peduto
Keyword(s):  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Supine Position ◽  
Motor Block ◽  
Sensory Block ◽  
Sensory Level ◽  
Physical Status ◽  
Gravitational Forces ◽  
Block Level ◽  
Dermatomal Level

Background. The behaviour of isobaric levobupivacaine in relation to gravity when used in obstetric spinal anesthesia is unclear.Methods. 46 women with ASA physical status 1 undergoing cesarean section were randomly allocated to 2 groups. Spinal anesthesia with 12.5 mg levobupivacaine was performed in the sitting position in all women. Those in the first group were placed in the supine position immediately after the injection, while those in the second group were asked to remain seated for 2 minutes before assuming the supine position. The sensory block level, the onset of sensory and motor blocks, the regression of the sensory block for 2 dermatomes of the sensory block, the first request for analgesics, and the regression of motor block were recorded.Results. No differences in onset times, sensory level, or Bromage score were observed between the two groups. The time of first analgesic request was earlier in the seated group (supine131±42 min, seated106±29 min,P=.02).Conclusion. Isobaric levobupivacaine in women at term produces a subarachnoid block the dermatomal level of which does not depend on gravitational forces.

scholarly journals Labour with low dose epidural analgesia: maternal perception and fetal outcome

2018 ◽  
Vol 7 (2) ◽  
pp. 689 ◽  
Author(s):  
Vasudha Sawant ◽  
Archana Kumbhar
Keyword(s):  
Epidural Analgesia ◽  
Apgar Score ◽  
Low Dose ◽  
Mode Of Delivery ◽  
Fetal Outcome ◽  
Natural Phenomenon ◽  
Second Stage ◽  
Second Stage Of Labour ◽  
Significant Difference ◽  
Vertex Presentation

Background: Experiencing labour pains and giving birth to infant is normal physiological process. Though it is a natural phenomenon, it produces severe pain which requires analgesia to relieve pain during labour. The objective of this study was to compare effects of low dose epidural analgesia verses no analgesia during labour on mother and fetus.Methods: Here in this study we have assessed effect of epidural analgesia on mother and fetus. Total we have taken 60 women in age group of 20-26 years with full term pregnancy (37-42 weeks). Those who have entered spontaneous labour with vertex presentation, without any previous uterine surgery, clinically adequate pelvis. We had divided these women in 2 groups, 30 were given epidural analgesia and 30 without any analgesia. Variables recorded were pain score during labour using VAS, duration of labour during each stage, mode of delivery, Apgar score of newborn at 1 minute and 5 minutes.Results: Present study shows that duration of first stage of labour in epidural and non-analgesia group are same. Second stage of labour is prolonged in epidural group than non-analgesia group. Both groups had normal APGAR score. Epidural analgesia is not associated with any change in mode of delivery. Visual analogue scale is good with epidural analgesia.Conclusions: There was no significant difference in first stage of labour in both group. Second stage of labour was slightly prolonged in EA group than control, but it was less than two hours. No harmful neonatal outcome in epidural analgesia.

scholarly journals Tramadol versus placebo for labor analgesia in low risk women: a randomized controlled trial

2019 ◽  
Vol 9 (1) ◽  
pp. 342
Author(s):  
Aastha Raheja ◽  
Krishna Agarwal ◽  
Rini Pachori ◽  
Gauri Gandhi
Keyword(s):  
Side Effects ◽  
Epidural Analgesia ◽  
Apgar Score ◽  
Controlled Trial ◽  
Caesarean Section Rate ◽  
Mode Of Delivery ◽  
Study Drug ◽  
Visual Analogue Score ◽  
Labor Analgesia ◽  
Eligibility Criteria

Background: In low- and middle-income countries epidural analgesia is generally not available and practically no form of labor analgesia is given to the majority of the parturient. The purpose of study was to evaluate the safety and efficacy of tramadol as a labor analgesic during first stage of labor.Methods: Pregnant women admitted in the labor room satisfying the eligibility criteria were randomized to receive intramuscular injection of either 100 mg tramadol or 2 ml distilled water. Visual analogue score (VAS) was assessed at the beginning and every hour till 4 hours. Pain satisfaction, duration of second stage of labor, fetal heart rate, mode of delivery, and any maternal side effects of the study drug were recorded. Neonatal evaluation using Apgar score at 1 and 5 minutes was done. For statistical analysis Student t-test, Chi Square test and Fisher’s exact test were used.Results: Total of 86 women were included in the study. The VAS scores were significantly lower in the tramadol group at 1, 2 and 3 hours after the administration. Pain relief satisfaction was significantly higher in the tramadol group. Rate of cervical dilatation, duration of the second and the third stage, need for instrumental delivery or lower segment caesarean section, rate of fetal distress and Apgar score at one and five minutes were comparable in both the groups. Nausea was significantly higher in tramadol group.Conclusions: Tramadol is a safe and efficacious drug which is inexpensive, easily available and easy to administer with few minor side effects. It can be used as a labour analgesic as an alternative to epidural analgesia in settings where epidural analgesia is not available. Trial registration: Clinicaltrials.gov PRS registration number: NCT02999594. 

scholarly journals Effect of single low dose intrathecal labor analgesia on maternal and fetal outcome

2019 ◽  
Vol 8 (11) ◽  
pp. 4543
Author(s):  
Poonam Samyal ◽  
Rama Thakur ◽  
Rohini Rao ◽  
Gian Chauhan ◽  
Sharad Kaushik ◽  
...  
Keyword(s):  
Apgar Score ◽  
Low Dose ◽  
Labor Analgesia ◽  
Cervical Dilatation ◽  
P Value ◽  
Single Shot ◽  
Rescue Analgesia ◽  
The Mean ◽  
Group 2 ◽  
Group 1

Background: Labour is one of the most painful experiences women encounter during their lifetime and the experience is different for each women. Aim of the study was to evaluate the effect of low dose intrathecal labour analgesia using fentanyl, bupivacaine and morphine on maternal and fetal outcome.Methods: 100 parturients with uncomplicated pregnancy in spontaneous or induced labor at cervical dilatation 4-6cm were enrolled for the study. They were randomized into two groups of 50 each, using computer based block randomization. Group 1 (N=50) received intrathecal labor analgesia using. Fentanyl (25µg), bupivacaine (2.5mg) and morphine (250µg) and Group 2 (N=50) received programmed labor. The two groups were well matched in terms of age, weight, height, parity, baseline vitals and mean cervical dilatation at the time of administration of labor analgesia . Progress of labor, duration of analgesia, and neonatal APGAR score were recorded. Feto-maternal and neonatal outcomes were studied and compared between the two groups.Results: The mean duration of analgesia in group1 was 238.96±21.888 min whereas the mean duration of analgesia in group 2 was 98.4±23.505 min. The difference was significant P value 0.00. One out of 50 (2%) of the parturients required rescue analgesia in Group 1. On the contrary all 44 parturients in Group 2 required rescue analgesia. Difference was significant (p value=0.00) However duration of the stages of labor, operative and instrumental deliveries and APGAR score did not differ in the two groups.Conclusions: Single shot intrathecal labor analgesia is a safe, effective, reliable, cheap and satisfactory method of pain relief for labor and delivery. Moreover, it is devoid of major side effects.

scholarly journals Addition of low-dose sufentanil to ropivacaine for reducing shivering and visceral traction pain during cesarean section

2021 ◽  
Vol 49 (5) ◽  
pp. 030006052110170
Author(s):  
Xiao-Rong Chen ◽  
Tao Gao ◽  
Yin Zhang ◽  
Ming-Qing Peng
Keyword(s):  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Low Dose ◽  
Sensory Block ◽  
Controlled Study ◽  
Blood Oxygen Saturation ◽  
Time Duration ◽  
Significant Difference ◽  
Block Time ◽  
Time Motor

Objective To investigate the efficacy of low-dose sufentanil for preventing shivering and visceral traction pain during cesarean section under spinal anesthesia. Methods This was a prospective, randomized, controlled study. A total of 112 full-term parturients who underwent elective caesarean delivery were randomly divided into two groups. Group R received 0.75% isobaric ropivacaine intrathecally and group RS received 0.75% isobaric ropivacaine plus 5 µg sufentanil intrathecally. Results There were no significant differences in the maximum sensory block time, motor block time, duration of the surgery, and heart rate, mean arterial pressure, and blood oxygen saturation before and 1, 5, and 10 minutes after spinal anesthesia, and at the end of the surgery between the two groups. Shivering was significantly more common in group R (n = 30) than in group RS (n = 8). The incidence of visceral traction pain in group R (46.43%) was significantly higher than that in group RS (14.29%). There was no significant difference in the newborns’ Apgar scores between the groups. Conclusion Adding low-dose sufentanil to ropivacaine can significantly reduce the incidence of shivering and visceral traction pain after spinal anesthesia.

scholarly journals DEXMEDETOMIDINE VERSUS FENTANYL IN LOWER LIMB ORTHOPEDIC SURGERIES: A COMPARATIVE EVALUATION

2021 ◽  
Vol 5 (9) ◽  
Author(s):  
Sukumar Misra
Keyword(s):  
Side Effects ◽  
Epidural Analgesia ◽  
Lower Limb ◽  
Local Anesthetics ◽  
Comparative Evaluation ◽  
Motor Block ◽  
Sensory Block ◽  
Comparative Assessment ◽  
Epidural Fentanyl ◽  
Viable Option

Abstract: opioids and local anesthetics have been the traditional choice in epidural analgesia. However opioids suffer from the issue of side effects and res piratory depression. The use of newer agent like dexmedetomidine is a viable option. The present study was formulated to provide a comparative assessment of whether fentanyl or dexmedetomidine is a better adjuvant for lower limb surgeries in which epidural route is used. The study included a pool of 30 subjects who were divided in two equal groups and administered fentanyl or dexmedetomidine. The results displayed a shorter duration of sensory block and motor block in dexmedetomidine group as compared to fentanyl. The overall efficacy of dexmedetomidine was better in the present study. Keywords: analgesia, dexmedetomidine, epidural, fentanyl

Ambulatory Combined Spinal-Epidural Analgesia for Labor: Influence of Epinephrine on Bupivacaine-Sufentanil Combination

1997 ◽  
Vol 22 (2) ◽  
pp. 143-149
Author(s):  
Philippe E. Gautier ◽  
François Debry ◽  
Luc Fanard ◽  
Albert Van Steenberge ◽  
Jean-Luc Hody
Keyword(s):  
Motor Block ◽  
Randomized Study ◽  
Sensory Block ◽  
Cervical Dilation ◽  
Double Blind ◽  
Late Side Effect ◽  
Combined Spinal Epidural ◽  
Block Level ◽  
Spinal Epidural ◽  
Late Side

Background and ObjectivesSubarachnoid sufentanil 5 μg during labor is known to have variable results. However, subarachnoid sufentanil 5 μg plus bupivacaine 1 mg provides good quality labor analgesia of 100 minutes' average duration. The objective of this study was to examine the effects of adding epinephrine 25 μg to this mixture.MethodsForty-two parturients with less than 5 cm cervical dilation participated in this double-blind, randomized study. A combined spinal-epidural technique was used for subarachnoid administration of sufentanil 5 μg and bupivacaine 1 mg with or without epinephrine 25 μg. Analgesia was assessed by visual analog scores. Time elapsed until first request for additional analgesia, blood pressure, heart rate, sensory levels, motor block, and incidence of pruritus, nausea, and sedation were noted.ResultsAddition of epinephrine prolonged the duration of analgesia from 103.8 ± 28.2 minutes to 142 ± 54.3 minutes and lowered the median cephalad level of sensory block from T3 to T6. The incidence of side effects was similar in both groups, as was the motor performance; 19 patients were able to ambulate in each group.ConclusionsThis minimal bupivacaine-sufentanil-epinephrine mixture allows high-quality analgesia of 142 ± 54.3 minutes' duration, with a low sensory block level and no motor block. However, hypotension can occur as a late side effect.

scholarly journals Programmed intermittent epidural boluses (pieb) for labor analgesia: study of the sensor block and effects on maternal motor function

2020 ◽  
Vol 14 (2) ◽  
pp. 63-71
Author(s):  
Ekaterina Y. Upryamova ◽  
E. M. Shifman ◽  
V. I. Krasnopolskij ◽  
A. M. Ovezov
Keyword(s):  
Epidural Analgesia ◽  
Sensory Block ◽  
Labor Analgesia ◽  
Cervical Dilation ◽  
Continuous Epidural Infusion ◽  
Prick Test ◽  
Group 4 ◽  
Group 5 ◽  
High Level ◽  
Sensor Block

Background. Programmed intermittent epidural boluses (PIEB) technique is a promising approach that demonstrates certain advantages over traditional techniques of epidural analgesia. We compared the dynamics of the sensory block of PIEB + parturient-controlled epidural analgesia (PCEA) with continuous epidural infusion (CEI) + PCEA for maintenance labor analgesia and the incidence of motor block (MB) in women who received PIEB or traditional techniques. Methods. A total of 165 subjects were studied. All parturients were divided into five groups: manual boluses, PCEA, PCEA + CEI, PIEB + PCEA; levobupivacaine 0.25 mg/mL; 1.25 mg/mL; 0.625 mg/mL. The level of the MB was evaluated by the classic Bromage scale (0-1-2-3). The level of the sensor block was evaluated by the pin-prick test. Results. MB was reported in 80% in group 1 120 min after analgesia, 78% and 52% in groups 2 and 3 at the 150th min (p 0.001); in group 4, the MB frequency was 6% 15 min after the start and was increasing to 40% at full cervical dilation (p 0.001). In group 5, the relative MB frequency did not exceed 10% at the 120th min and was 0% at full cervical dilation (p 0.00001). The results indicate that in the PIEB group, the level of sensory block in patients was higher 15 min after the start of analgesia and remained so until the end of the observation period [median PIEB Th5 versus Th8 in the CEI group, (p 0.0004)]. Conclusions. PIEB + PCEA technique maintained a consistently high level of sensor block throughout the study compared to PCEA + CEI, which ensured effective analgesia in the first and second stages of labor with minimal MB.

scholarly journals Comparison of 0.5% Bupivacaine and 0.5% Ropivacaine epidurally in lower limb orthopaedic surgeries

2017 ◽  
Vol 6 (2) ◽  
pp. 271
Author(s):  
Ushma D. Shah ◽  
Krunal N. Dudhwala ◽  
Mukesh S. Vakil
Keyword(s):  
Epidural Anaesthesia ◽  
Lower Limb ◽  
Motor Block ◽  
Randomized Study ◽  
Onset Time ◽  
Sensory Block ◽  
Pressure Profile ◽  
Peak Time ◽  
Time Duration ◽  
Double Blind

Background: Ropivacaine in equi-potent concentrations with bupivacaine, the degree of motor blockade is less pronounced with ropivacaine, and there is a greater propensity for blocking pain transmitting A-delta and C fibres rather than A-α motor fibres. It appears to have most of the blocking characteristics of bupivacaine. So we have undertaken the study to compare ropivacaine 0.5% (20ml) and bupivacaine 0.5% (20ml) for epidural anaesthesia in patients undergoing lower limb orthopaedic surgeries.Methods: This double-blind, randomized study involves 60 patients who were undergone orthopaedic surgery, having ASA-I or ASA-II physical status. Out of 60, 30 patients received 20 ml of 0.5% ropivacaine and 30 patients received 20 ml of 0.5% bupivacaine at the L3, 4 interspace. Parameters measured were the onset time, duration and spread of sensory block, the onset time, peak time, duration and degree of motor block, the quality of anaesthesia and the heart rate and blood pressure profile during block onset.Results: Epidurally, Ropivacaine in comparison to Bupivacaine provides quicker onset, early peak effect and prolonged duration of sensory block and shorter duration of motor block. Ropivacaine provides prolonged effective analgesia. It reduces requirement of rescue analgesics and related side effects.Conclusions: Ropivacaine 0.5% is safer and effective alternative to Bupivacaine in epidural anaesthesia and post operative pain relief.

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