scholarly journals Comparison of analgesic effect of intrathecal morphine alone or in combination with bupivacaine and fentanyl in patients undergoing total gastrectomy: A prospective randomised, double blind clinical trial

2013 ◽  
Vol 70 (6) ◽  
pp. 541-547 ◽  
Author(s):  
Zoran Slavkovic ◽  
Dusica Stamenkovic ◽  
Veselin Geric ◽  
Milic Veljovic ◽  
Nebojsa Ivanovic ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Epidural Catheter ◽  
Total Gastrectomy ◽  
Analgesic Effect ◽  
Catheter Removal ◽  
Anesthesia Induction ◽  
Double Blind Study ◽  
Double Blind ◽  
Combined Spinal Epidural ◽  
Spinal Epidural

Background/Aim. Combined spinal-epidural-general anesthesia has several advantages over general anesthesia alone. This study was designed to compare the efficacy of intrathecal (IT) morphine alone, or in combination with bupivacaine and fentanyl, as part of a combined spinal-epidural (CSE) analgesia, in patients undergoing elective total gastrectomy. Methods. This prospective, randomized double-blind study included 60 patients undergoing total gastrectomy under general anesthesia and CSE. We compared the analgesic effect of lumbar IT morphine 300 ?g (the group M, n = 20) vs morphine 300 ?g + bupivacaine 2 mg (the group MB, n = 20) vs morphine 300 ?g + bupivacaine 2 mg + fentanyl 25 ?g (the group MBF, n = 20) given after thoracic epidural catheter placement (T6-7) but before general anesthesia induction. Pain visual analogue scale (VAS) at rest (R), with movement (M) and with cough (C), and the number of analgesia requests were assessed for 72 h and after epidural catheter removal. Results. Compared to other groups, the MBF group required significantly fewer additional intra-operative epidural bupivacaine doses (p < 0.001), whereas the M group required significantly more supplemental intraoperative intravenous fentanyl, compared with the MBF (p = 0.022) and MB groups (p = 0.005). Postoperative pain relief was satisfactory in all the groups at all the time. VAS-R and VAS-M did not differ significantly among the groups. Compared to the M group, VAS-C scores 30 min postoperatively were significantly lower in the MBF (p = 0.029) and MB groups (p = 0.002). Duration of analgesia was longer in the MBF and MB groups, but the difference reached no significance. The number of supplemental analgesia requests was similar in all the groups in the first 12 h and during 72 h. Additional analgesia requests after epidural catheter removal were similar in all the groups, and side effects were infrequent. Conclusion. Compared to IT morphine alone, triple IT combination administered as part of CSE provided better intraoperative analgesia, but conferred no benefit with regards to postoperative analgesia.

scholarly journals Combined spinal-epidural technique: Single-space vs double distant space technique

2013 ◽  
Vol 70 (10) ◽  
pp. 953-958
Author(s):  
Zoran Slavkovic ◽  
Dusica Stamenkovic ◽  
Veselin Geric ◽  
Milic Veljovic ◽  
Nebojsa Ivanovic ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Epidural Catheter ◽  
Test Dose ◽  
Anesthesia Induction ◽  
Procedure Time ◽  
Body Habitus ◽  
Epidural Catheter Placement ◽  
Combined Spinal Epidural ◽  
Space Technique ◽  
Spinal Epidural

Background/Aim. Several combined spinal-epidural (CSE) anesthesia techniques have been described. This study was designed to compare the single space (?needle-throughneedle?) technique (SST) and the double distant space technique (DDS) with regards to the time needed for the procedure, patient discomfort during the procedure and patient's preference technique. Methods. This prospective, randomized single-blind study included 156 patients undergoing colorectal surgery under general anesthesia and CSE. All neuraxial blocks were performed before general anesthesia induction. DDS group of patients had thoracic epidural catheter placed at T6-7 or T7-8, followed by subarachnoid injection at the L2-3 interspace. The SST group of patients had a single injection using the needle-through-needle technique (Espocan? needle) at L2-3. The epidural catheter was used for postoperative analgesia for 72 hours. Body habitus, spinal anatomy and spinal landmarks were assessed preoperatively. The number of epidural and spinal punctures, the feeling that the dura is perforated (dural perforation click) and the time needed to perform CSE were also recorded. Complications during epidural catheter placement and perioperative and postoperative epidural catheter function and patient preference for the anesthetic procedure were recorded. Results. Epidural and subarachnoid spaces were successfully identified in all the patients. Duration of CSE procedure, the number of spinal punctures, dural click feeling and the effects of test dose did not differ between the groups. The patients in both groups (90% of DDS and 87% of SST) would choose CSE as preferred method in the future. The CSE procedure was painful for 16% of DDS vs 20% of SST patients. A significant correlation between time needed for CSE technique performance and body habitus (r = 0.338, p < 0.01), spinal landmarks (r = 0.452, p < 0.001) and anatomy (r = 0.265, p < 0.05) was found in the SST group. There was no correlation between the number of epidural/spinal punctures and epidural bacteriological findings. There was no correlation between the patients? choice of the CSE technique and the number of spinal punctures, duration of CSE procedure and epidural catheter stay. Conclusion. The two CSE techniques did not differ with regards to the procedure time and patient's preference. Procedure time correlated with body habitus, spinal landmarks and the anatomy in the SST group.

scholarly journals Fetal effects of combined spinal-epidural vs epidural labour analgesia: a prospective, randomised double-blind study

Anaesthesia ◽  
2014 ◽  
Vol 69 (5) ◽  
pp. 458-467 ◽  
Author(s):  
N. P. Patel ◽  
N. El-Wahab ◽  
R. Fernando ◽  
S. Wilson ◽  
S. C. Robson ◽  
...  
Keyword(s):  
Labour Analgesia ◽  
Blind Study ◽  
Double Blind Study ◽  
Double Blind ◽  
Combined Spinal Epidural ◽  
Spinal Epidural

scholarly journals Effects of Esketamine on Acute and Chronic Pain After Thoracoscopy Pulmonary Surgery Under General Anesthesia: A Multicenter-Prospective, Randomized, Double-Blind, and Controlled Trial

2021 ◽  
Vol 8 ◽  
Author(s):  
Yishan Lei ◽  
Huayue Liu ◽  
Fan Xia ◽  
Shulin Gan ◽  
Yulan Wang ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
General Anesthesia ◽  
Analgesic Effect ◽  
Secondary Outcome ◽  
Control Group ◽  
Anesthesia Induction ◽  
Double Blind ◽  
Vas Score ◽  
Pulmonary Surgery

Background: Post-operative pain management for patients undergoing thoracoscopy surgery is challenging for clinicians which increase both health and economic burden. The non-selective NMDA receptor antagonist esketamine possesses an analgesic effect twice that of ketamine. The application of esketamine might be beneficial in alleviating acute and chronic pain after thoracic surgery. The current study describes the protocol aiming to evaluate the analgesic effect of esketamine after pulmonary surgery via visual analog scale (VAS) score for acute and chronic pain.Methods: A multi-center, prospective, randomized, controlled, double-blind study is designed to explore the analgesic effect of esketamine in randomized patients undergoing video-assisted thoracoscopic surgery (VATS) with general anesthesia. Patients will be randomly assigned to Esketamine Group (Group K) and Control Group (Group C) in a ratio of 1:1. Group K patients will receive esketamine with a bolus of 0.1 mg/kg after anesthesia induction, 0.1 mg/kg/h throughout the operation and 0.015 mg/kg/h in PCIA after surgery while Group C patients will receive the same volume of normal saline. The primary outcome is to measure the pain intensity through the VAS score at 3 months after the operation. The secondary outcome includes VAS score at 1, 4, 8, 24, and 48 h and on the 7th day and 1 month after the operation, complications, ketamine-related neurological side effects, recovery time of bowel function, and total amount of supplemental analgesics.Discussion: The results of the current study might illustrate the analgesic effect of esketamine for patients undergoing thoracoscopy pulmonary surgery and provide evidence and insight for perioperative pain management.Study Registration: The trial was registered with Chinese Clinical Trial Registry (CHICTR) on Nov 18th, 2020 (ChiCTR2000040012).

scholarly journals Comparison of the Efficacy and Safety of Intrathecal Fentanyl 20 μg vs Sufentanil 5 μg as Adjuvant to Bupivacaine 0.5% (12.5 mg) using Combined Spinal Epidural Technique for Lower Limb Orthopedic Surgeries

2016 ◽  
Vol 1 (1) ◽  
pp. 1-4
Author(s):  
Sanjeeta R Umbarkar ◽  
Manju N Gandhi ◽  
Hemlata R Iyer ◽  
Roshan S Thawale
Keyword(s):  
Side Effects ◽  
Lower Limb ◽  
Motor Block ◽  
Demographic Data ◽  
Double Blind Study ◽  
Efficacy And Safety ◽  
Hyperbaric Bupivacaine ◽  
Double Blind ◽  
Combined Spinal Epidural ◽  
Spinal Epidural

ABSTRACT Aim To compare the efficacy and safety of intrathecal fentanyl 20 μg vs sufentanil 5 μg as adjuvant to bupivacaine 0.5% (12.5 mg) using combined spinal epidural (CSE) technique for lower limb orthopedic surgeries. Background Use of local anesthetics along with opioids intrathecally has been widely reported. We aimed to compare two commonly used opioids as adjuvants to local anesthetic agents in combined spinal epidural techniques. Materials and methods A total of 60 patients were recruited in this prospective, randomized, double-blind study to receive either intrathecal sufentanil 5 μg (Group S) or fentanyl 20 μg (Group F) as adjuvants to 12.5 mg of 0.5% hyperbaric bupivacaine. The onset and duration of sensory and motor block and the pain scores were assessed perioperatively. Duration of analgesia was recorded. The incidence of side effects such as nausea, vomiting, pruritus, shivering. and postdural puncture headache (PDPH) were recorded. Results Demographic data and hemodynamic and respiratory parameters were comparable in both the groups. Onset of analgesia—time to reach highest level of analgesia—was faster in the sufentanil group. Sufentanil group patients had higher grade of motor block. Patients in fentanyl group had higher score of sedation than those of sufentanil group. None of the patients in any group had nausea, vomiting, or pruritus. Conclusion Addition of either fentanyl or sufentanil to intrathecal bupivacaine as an adjuvant in CSE technique enhances the quality of analgesia and motor block with minimal side effects. Hence, this is useful in orthopedic patients, especially in the geriatric age group. How to cite this article Umbarkar SR, Gandhi MN, Iyer HR, Thawale RS. Comparison of the Efficacy and Safety of Intrathecal Fentanyl 20 μg vs Sufentanil 5 μg as Adjuvant to Bupivacaine 0.5% (12.5 mg) using Combined Spinal Epidural Technique for Lower Limb Orthopedic Surgeries. Res Inno Anaesth 2016;1(1):1-4.

scholarly journals Advantageous usage combined spinal, epidural and general anesthesia versus general anesthesia in abdominal surgery

2003 ◽  
Vol 131 (5-6) ◽  
pp. 232-237 ◽  
Author(s):  
Vesna Malenkovic ◽  
Sava Zoric ◽  
Tomislav Randjelovic
Keyword(s):  
Intensive Care ◽  
Side Effects ◽  
Abdominal Surgery ◽  
General Anesthesia ◽  
Controlled Study ◽  
General Anesthetics ◽  
Subjective Effect ◽  
Combined Spinal Epidural ◽  
Spinal Epidural

Type and technique of anesthesia have an important effect on per operative surgical course. The aim of the study was prospective analyses of advantages of combined spinal, epidural and general anesthesia (CSEGA) versus general anesthesia (GA) in abdominal surgery according to: 1. operative course (haemodynamic stability of patients, quality of analgesia, undesirables effects), 2. postoperative course (quality of analgesia, unfavorable effects, temporary abode of patients in intensive care). Using prospective randomized double blind controlled study, we evaluated two groups of patients whom the same type of abdominal surgical intervention was planed and the only difference was the type of technique of anesthesia. First group of patients (n=34), was treated with CSEGA and second group of patients (n=33), was treated only with standard (GA). Both groups had intraoperative and 24-hour-long postoperative continued monitoring of blood pressure central venous pressure, and dieresis. In the 24 hours postoperative period the following parameters were analyzed: vigilance conditions, motor block level, pain intensity in rest and movement, necessity for a complementary analgesia, side effects and final subjective effect of analgesia. There was important difference in waking up the patients after a general anesthesia in the first group this period was shorter. In the first 24 hours, patients from the first group didn't get any systemic analgesic, while the patients from the second group needed fractionary application of parenteral analgesics in the period of 4-6 hours. Patients from the first group were also physically faster and easier recovered and they had less respiratory complications and there was not any example of thromboembolysm and the intestine motility was faster re-established. First group of patients spent less time in intensive care (three days) than second group (six days). Final subjective effect of analgesia, according to verbal descriptive scale (VDS) of pain was satisfying with 75% of patients of the first group and 15% of patients of the second group. According to results investigation advantages of CSEDGA versus GA in abdominal surgery manifold: better hemodynamic stability and perfusion of operative region, decrease of single doses of opioid analgesics, local and general anesthetics followed by the decrease of their side effects, better intensity and longer duration of analgesia, improved total functional capability of patients.

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