Epidural dexamethasone for postoperative analgesia in patients of carcinoma rectum undergoing lower anterior resection (LAR)

JMS SKIMS ◽  
2019 ◽  
Vol 22 (1) ◽  
Author(s):  
Sheikh Irshad Ahmad ◽  
Gowhar Hameed ◽  
Tanveera Gani ◽  
Tantry Tariq Gani ◽  
Wasim Mohammad Bhat ◽  
...  
Keyword(s):  
Postoperative Analgesia ◽  
Anterior Resection ◽  
Double Blind Study ◽  
Double Blind ◽  
Rescue Analgesia ◽  
Carcinoma Rectum ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
To Receive ◽  
Lower Anterior Resection

Background and Aims: This prospective, randomized, double blind study was undertaken to establish the effect of addition of dexamethasone as an adjunct to epidural ropivacaine in patients of carcinoma rectum undergoing lower anteriorresection. Materials and Methods: Sixty ASA (American Society of Anesthesiologists) class I and II patients undergoing lower anterior resection were enrolled to receive either 6mg or 8mg or 10mg of dexamethasone along with epidural ropivacaine to a total of 10ml test solution in each group for epidural analgesia. Hemodynamic parameters, postoperative analgesia, total requirement of rescue analgesia and adverse events were monitored. Results: Analgesia in the postoperative period was better in Group receiving 10mg of dexamethasone associated with less postoperative rescue analgesic consumption Conclusion: Hence, addition of dexamethasone 10mg to epidural ropivacaine can be advantageous with respect to better postoperative analgesia.

scholarly journals Effectiveness of Intravenous Dexmedetomidine vs. Fentanyl for Attenuation of Haemodynamic Response to Pneumoperitoneum in Laparoscopic Cholecystectomy: A Randomised Double Blind Study

2020 ◽  
Author(s):  
Reema Meena ◽  
Chandrakant Parashar ◽  
Priyanka Jain ◽  
Manoj Soni
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Analgesia ◽  
Minimal Invasive ◽  
Double Blind Study ◽  
Double Blind ◽  
Rescue Analgesia ◽  
Haemodynamic Changes ◽  
Group A ◽  
American Society ◽  
Group B

Introduction: Laparoscopy is a widely performed minimal invasive surgical procedure, wherein various haemodynamic changes are faced by anaesthesiologists during Pneumoperitoneum (PNP). Aim: To compare the effectiveness of dexmedetomidine vs fentanyl for attenuating the haemodynamics response to PNP in Laparoscopic Cholecystectomy (LC). Materials and Methods: A total of 84 patients of 18-50 years age, American Society of Anaesthesiologists (ASA) Class I/II of either sex for elective LC were included. The patients were divided into two groups (A, B) of 42 patients each. Group A received dexmedetomidine and Group B received fentanyl. Both the drugs were given as loading dose of one μg/kg over ten min followed by maintenance 0.2 μg/kg/h throughout the surgery. Haemodynamic parameters were recorded at different time intervals throughout the surgery. In recovery room patients were observed for postoperative analgesia by using Visual Analogue Scale (VAS), sedation level using RAMSAY Sedation score at every 30 minutes till the time of giving first rescue analgesia and side effects, if any. Results: Intraoperatively, throughout the period of PNP, Group A showed statistically better attenuation of haemodynamic responses in comparison to Group B (p<0.05). After creating PNP, rise in Mean Arterial Pressure (MAP) was observed in both group A and group B, 99.38±6.32 and 103.43±9.81, respectively but this rise was more in group B which was statistically significant (p<0.05) throughout the surgery except 40 minutes after PNP creation. Time to first rescue analgesia or mean duration of postoperative analgesia (VAS>3) was significantly longer in dexmedetomidine group (102.14±32.50 minutes) than fentanyl group (42.86±15.03 minutes). There was better control of pain but more sedation in Group A than in Group B. Conclusion: This study concludes that intravenously administered dexmedetomidine shows better attenuation of haemodynamic responses to CO2 insufflation as compared to fentanyl. Dexmedetomidine also provides better sedation and has more analgesic sparing effect.

scholarly journals Prophylactic ondansetron eight milligrams versus four milligrams against post spinal anaesthesia shivering

2021 ◽  
Vol 8 (5) ◽  
pp. 1545
Author(s):  
Ajay Kumar ◽  
Anuj Singh ◽  
Shamabhu P. Sharma ◽  
Amitava Dutta ◽  
Amit Kumar Sharma
Keyword(s):  
Spinal Anesthesia ◽  
Spinal Anaesthesia ◽  
Double Blind Study ◽  
Double Blind ◽  
Prophylactic Administration ◽  
American Society ◽  
Group B ◽  
Control And Management ◽  
American Society Of Anesthesiologists ◽  
To Receive

Background: Shivering is one of the commonly encountered adverse affect after spinal anaesthesia. Shivering can be very discomforting to the patient and hampers operative maneuvering. Pharmacological therapies have been studied for control and management of shivering. One such drug is ondansetron, a 5-HT3 antagonist. Aim of current study is to evaluate the efficacy of prophylactic administration of ondansetron 8 mg vs. 4 mg for prevention of shivering.Methods: A prospective, randomized, and double blind study was conducted on 100 patients, from either gender, aged 20-60 years, of the American society of anesthesiologists grade I or II, scheduled for various surgeries under spinal anesthesia. The patients were randomly divided into two groups of 50 each to receive either ondansetron 8 mg (group E) or ondansetron 4 mg, (group F) as slow intravenous infusion prior to spinal anesthesia. The primary end point were intraoperative shivering and secondary outcomes included hypotension, adverse reaction, cardiac dysrhythmia’s.Results: A total of 10 patients in group E (20%) and 20 (40%) patients in group F experienced shivering (p=0.029). Incidence of nausea was similar in both groups, total of 8 (16%) patients in group E and 5 (10%) in group B had hypotension (p=0.27). 1 (2%) patient in group E experienced bradycardia.Conclusions: Prophylactic administration of ondansetron 8 mg has better efficacy in prevention of spinal anaesthesia induced shivering with minimal side effects as compared to 4 mg dosage.

scholarly journals Comparison of Effect of Intrathecal Fentanyl-bupivacaine and Tramadol-bupivacaine Combination on Postoperative Analgesia in Lower Abdominal Surgeries

2016 ◽  
Vol 1 (2) ◽  
pp. 35-40 ◽  
Author(s):  
Naina P Dalvi ◽  
Narendra Patil
Keyword(s):  
Blood Pressure ◽  
Postoperative Analgesia ◽  
Total Duration ◽  
Double Blind Study ◽  
Motor Blockade ◽  
Hyperbaric Bupivacaine ◽  
Double Blind ◽  
Sensory Blockade ◽  
Prolonged Duration ◽  
American Society

ABSTRACT Introduction This single-center, prospective, randomized, double-blind study compares the effect of intrathecal fentanylbupivacaine and tramadol-bupivacaine on the onset and duration of sensory and motor blockade, as well as postoperative analgesia in lower abdominal surgeries. Materials and methods Patients of either sex, aged 18 to 60 years, American Society of Anesthesiologists (ASA) grade I/II undergoing lower abdominal surgeries like appendicectomy, inguinal hernia repair surgery, and hydrocele surgery were administered either 2.5 mL of 0.5% bupivacaine + 0.5 mL (25 μg) of fentanyl citrate (group F) or 2.5 mL of 0.5% bupivacaine + 0.5 mL (25 mg) of tramadol (group T) intrathecally. Monitoring of the vital parameters, onset and duration of sensory and motor block, duration of postoperative analgesia, visual analog scale (VAS) score, sedation score, and any adverse drug reactions was done at predetermined intervals. Results Sixty patients were randomized to the group F (n = 30) and group T (n = 30). The duration of sensory blockade was significantly prolonged in group F (314.66 ± 49.25 minutes) as compared to group T (261.66 ± 27.92 minutes). Similarly, duration of motor blockade was longer in group F (263.66 ± 40.97 minutes) compared to group T (214.66 ± 26.61 minutes). The total duration of analgesia was significantly prolonged (p < 0.001) in group F (412 ± 97.888 minutes) compared to group T (301 ± 38.75 minutes). Hemodynamic parameters, such as pulse, systolic blood pressure, diastolic blood pressure and oxygen saturation were comparable in both the groups. Visual analog scores were significantly lower in the group F patients as compared to the group T patients. The group F patients had got significantly higher sedation scores as compared to Group T patients. Discussion Fentanyl 25 μg, when added to 2.5 mL of 0.5% hyperbaric bupivacaine, confers prolonged duration of sensory and motor blockade than 25 mg tramadol added to 2.5 mL of 0.5% hyperbaric bupivacaine. The bupivacaine-fentanyl combination prolonged duration of sensory and motor blockade, improved analgesia, as manifested by lower pain scores, and prolonged duration of postoperative analgesia. How to cite this article Dalvi NP, Patil N. Comparison of Effect of Intrathecal Fentanyl-bupivacaine and Tramadol-bupivacaine Combination on Postoperative Analgesia in Lower Abdominal Surgeries. Res Inno in Anesth 2016;1(2):35-40.

scholarly journals The Influence of Adrenaline on Postoperative Analgesia after Subarachnoid Morphine

1993 ◽  
Vol 21 (1) ◽  
pp. 79-84 ◽  
Author(s):  
M. J. Paech
Keyword(s):  
Side Effects ◽  
Postoperative Analgesia ◽  
Saline Group ◽  
Control Group ◽  
Double Blind Study ◽  
Gynaecological Surgery ◽  
Normal Saline Group ◽  
Double Blind ◽  
Significant Difference ◽  
To Receive

A randomised, double-blind study was conducted to investigate the postoperative effects of subarachnoid morphine, with or without adrenaline, after major gynaecological surgery. Seventy-five women having spinal anaesthesia combined with either sedation or general anaesthesia were randomised to receive subarachnoid morphine 0.25 mg with (group MA) or without (group M) adrenaline 200 ūg; or normal saline (group C). Groups M (n=22) and MA (n=25) differed significantly from control (n=23) with respect to the quality and duration of postoperative analgesia (P<0.0002) and to a higher incidence of pruritus (P<0.02). Groups were similar with respect to the incidence of other postoperative side-effects and respiratory data, although the latter showed a trend to less hypoxaemia in the control group. There was no significant difference in any outcome between groups MA and M. It was concluded that, under the study conditions in a post-gynaecological surgery population, the addition of adrenaline to subarachnoid morphine was of no benefit.

Sufentanil Sublingual Tablet System for the Management of Postoperative Pain after Knee or Hip Arthroplasty

2015 ◽  
Vol 123 (2) ◽  
pp. 434-443 ◽  
Author(s):  
Maurice Jove ◽  
David W. Griffin ◽  
Harold S. Minkowitz ◽  
Bruce Ben-David ◽  
Mark A. Evashenk ◽  
...  
Keyword(s):  
Pain Intensity ◽  
Hip Arthroplasty ◽  
Intensity Difference ◽  
Double Blind Study ◽  
Double Blind ◽  
Sublingual Tablet ◽  
Pain Intensity Difference ◽  
Major Orthopedic Surgery ◽  
American Society ◽  
American Society Of Anesthesiologists

Abstract Background: Complications with IV patient-controlled analgesia include programming errors, invasive access, and impairment of mobility. This study evaluated an investigational sufentanil sublingual tablet system (SSTS) for the management of pain after knee or hip arthroplasty. Methods: This prospective, randomized, parallel-arm, double-blind study randomized postoperative patients at 34 U.S. sites to receive SSTS 15 μg (n = 315) or an identical placebo system (n = 104) and pain scores were recorded for up to 72 h. Adult patients with American Society of Anesthesiologists status 1 to 3 after primary total unilateral knee or hip replacement under general anesthesia or with spinal anesthesia that did not include intrathecal opioids were eligible. Patients were excluded if they were opioid tolerant. The primary endpoint was the time-weighted summed pain intensity difference to baseline over 48 h. Secondary endpoints included total pain relief, patient and healthcare professional global assessments, and patient and nurse ease-of-care questionnaires. Results: Summed pain intensity difference (standard error) was higher (better) in the SSTS group compared with placebo (76 [7] vs. −11 [11], difference 88 [95% CI, 66 to 109]; P &lt; 0.001). In the SSTS group, more patients and nurses responded “good” or “excellent” on the global assessments compared with placebo (P &lt; 0.001). Patient and nurse ease-of-care ratings for the system were high in both groups. There was a higher incidence of nausea and pruritus in the SSTS group. Conclusion: SSTS could be an effective patient-controlled pain management modality in patients after major orthopedic surgery and is easy to use by both patients and healthcare professionals.

Dilution of Spinal Lidocaine Does Not Alter the Incidence of Transient Neurologic Symptoms 

1999 ◽  
Vol 90 (2) ◽  
pp. 445-450 ◽  
Author(s):  
Julia E. Pollock ◽  
Spencer S. Liu ◽  
Joseph M. Neal ◽  
Carol A. Stephenson
Keyword(s):  
Postoperative Complications ◽  
Knee Arthroscopy ◽  
Physical Status ◽  
Double Blind ◽  
Neurologic Symptoms ◽  
The Third ◽  
Ambulatory Patients ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
To Receive

Background Although it has been suggested that the dilution of 5% hyperbaric lidocaine before injection for spinal anesthesia may decrease the incidence of transient neurologic symptoms, previous studies have not noted a decreased incidence between 5% and 2% lidocaine. The aim of the current study was to determine whether the incidence of transient neurologic symptoms could be altered by further diluting spinal lidocaine from 2.0% to 0.5%. Methods One hundred nine patients with American Society of Anesthesiologists physical status 1 or 2 undergoing outpatient knee arthroscopy were randomized in a double-blind fashion to receive 50 mg hyperbaric spinal lidocaine as a 2.0%, 1.0%, or 0.5% concentration. On the third postoperative day, patients were contacted by a blinded investigator and questioned regarding the incidence of postoperative complications, including transient neurologic symptoms, defined as pain or dysthesia in one or both buttocks or legs occurring within 24 h of surgery. Results The incidence of transient neurologic symptoms did not differ among patients receiving 2.0% (incidence of 15.8%), 1.0% (incidence of 22.2%), and 0.5% (incidence of 17.1%) lidocaine (P = 0.756). Conclusions For ambulatory patients undergoing arthroscopy, the incidence of transient neurologic symptoms is not reduced by decreasing spinal lidocaine concentrations from 2.0% to 1.0% or 0.5%. The incidences of transient neurologic symptoms with the 0.5%, 1.0%, and 2.0% solutions are similar to previously reported incidences for 5.0% lidocaine, suggesting that dilution of lidocaine from 5.0% to 0.5% does not change the incidence of these symptoms.

scholarly journals Comparison between intrathecal nalbuphine and butorphanol as adjuvants to isobaric ropivacaine in elective lower limb orthopedic surgeries: A prospective, randomized, double blind study

2020 ◽  
Author(s):  
Akash Nirmal ◽  
Yashpal Singh ◽  
Sharad Kumar Mathur ◽  
Satish Patel
Keyword(s):  
Postoperative Analgesia ◽  
Lower Limb ◽  
Primary Outcome Measure ◽  
Blind Study ◽  
Double Blind Study ◽  
Motor Blockade ◽  
Chi Square ◽  
Double Blind ◽  
Lower Limb Surgery ◽  
To Receive

Background: Intrathecal ropivacaine is now routinely used for lower limb surgery. Adjuvants e.g. fentanyl, dexmedetomidine or morphine etc. are commonly used to prolong the intraoperative anesthesia or postoperative analgesia. The available literature lacks information on use of butorphanol and nalbuphine as adjuvants with 0.75% isobaric ropivacaine. We aimed to compare nalbuphine and butorphanol as adjuvant with isobaric ropivacaine in lower limb orthopedic surgeries. Methodology: After institutional ethical committee approval and informed written consent, a total of 108 patients of ages between 18 to 65 y, of either sex, American Society of Anesthesiologists (ASA) grade ӏ & ӏӏ, scheduled for elective lower limb orthopedic surgeries, were enrolled and  randomly allocated into two groups: Group RN; to receive isobaric ropivacaine (0.75%, 7.5 mg/ml) 2.5 ml plus nalbuphine 500 µg (0.5 ml), and Group RB; to receive isobaric ropivacaine 2.5 ml plus butorphanol 100 µg (0.5 ml) intrathecally. Primary outcome measure was the duration of sensory‑motor blockade from the time of intrathecal drug administration. Statistical analysis was performed by using t-test and chi-square test as applicable. A p < 0.05 was considered as significant. Results: Duration of sensory (p < 0.001) and motor blockade (p = 0.02) was significantly prolonged in nalbuphine group than butorphanol group. Onset of blockade was earlier in nalbuphine group. Duration of motor block and sensory analgesia was prolonged in group RN (p < 0.001). Perioperative hemodynamic parameters and the observed side effects including bradycardia, hypotension, nausea and vomiting, sedation and shivering were comparable between the two groups (p = 0.77). Conclusion: Intrathecal nalbuphine produces prolonged motor blockade as well as postoperative analgesia than intrathecal butorphanol when used as adjuvants to isobaric 0.75% ropivacaine. Citation: Nirmal A, Singh Y, Mathur SK, Patel S. Comparison between intrathecal nalbuphine and butorphanol as adjuvants to isobaric ropivacaine in elective lower limb orthopedic surgeries: A prospective, randomized, double blind study. Anaesth pain & intensive care 2019;23(4)__ Received: 22 August 2019; Reviewed: 8, 9 October 2019; 6, 7 November 2019; Revised: 18 November 2019; Reviewed: 19 November 2019; Accepted: 20 November 2019

Preoperative Multimodal Analgesia for Laparoscopic Cholecystectomy

2018 ◽  
pp. 217-222
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Pain ◽  
Study Groups ◽  
Multimodal Analgesia ◽  
Double Blind Study ◽  
Double Blind ◽  
Same Day Discharge ◽  
Elective Laparoscopic Cholecystectomy ◽  
American Society ◽  
American Society Of Anesthesiologists

This case focuses on the use of local anesthesia, nonsteroidal anti-inflammatory or opioid drugs, for laparoscopic cholecystectomy by asking the question: Does prophylactic multimodal nociceptive blockade delay the onset of postoperative pain, decrease analgesic requirements, speed recovery, and facilitate same-day discharge in patients undergoing elective laparoscopic cholecystectomy? In this randomized, double-blind study, intraoperative anesthetic care and postoperative pain and nausea management were standardized for all patients. Study groups were similar in terms of patient age, gender, weight, American Society of Anesthesiologists class, baseline and preinduction pain and nausea scores, duration of surgery, and total dose of propofol received. This study demonstrated the benefit of preoperative multimodal analgesia on recovery and discharge.

A Double-blind Comparison of 0.125% Ropivacaine with Sufentanil and 0.125% Bupivacaine with Sufentanil for Epidural Labor Analgesia 

1999 ◽  
Vol 90 (3) ◽  
pp. 772-778 ◽  
Author(s):  
Philippe Gautier ◽  
Marc De Kock ◽  
Albert Van Steenberge ◽  
Dominique Miclot ◽  
Luc Fanard ◽  
...  
Keyword(s):  
Motor Impairment ◽  
Epidural Injection ◽  
Motor Blockade ◽  
Double Blind ◽  
Patient Satisfaction Scores ◽  
Severe Motor ◽  
American Society ◽  
Blind Comparison ◽  
American Society Of Anesthesiologists ◽  
To Receive

Background This study intends to evaluate the benefits of the administration of intermittent bolus doses of ropivacaine (0.125%) compared with bupivacaine (0.125%) after addition of sufentanil for analgesia during labor. Methods One hundred thirty American Society of Anesthesiologists physical status 1 or 2 parturients were studied. The 90 initial patients were assigned randomly to receive 10 ml bupivacaine, 0.125%, plus 7.5 microg sufentanil (initial bupivacaine 0.125% group) or ropivacaine, 0.125%, plus 7.5 microg sufentanil (ropivacaine 0.125% group). Forty additional patients were recruited and received 0.125% bupivacaine plus 7.5 microg sufentanil (additional bupivacaine 0.125% group) or 0.100% bupivacaine plus 7.5 microg sufentanil (additional bupivacaine 0.100% group). The duration of analgesia, visual analogue scores for pain, motor blockade (using a six-point modified Bromage scale), patient satisfaction scores, nausea, pruritus, heart rate, and blood pressure were recorded. Results Bupivacaine 0.125% and ropivacaine 0.125% coadministered with sufentanil provided rapid and complete analgesia. Onset of analgesia occurred after +/-15 min and lasted +/-90 min. After the third epidural injection, patients in the ropivacaine group experienced significantly less severe motor blockade than patients in the initial bupivacaine 0.125% group. At this point, 93% of the patients in the ropivacaine group were free from motor impairment versus 66% in the bupivacaine group (P&lt;0.05). Comparable levels of motor blockade were obtained in both additional groups. Patients' evaluation of their analgesia was worst in the bupivacaine 0.100% group. Conclusions Ropivacaine 0.125% with sufentanil affords reliable analgesia with minimal motor blockade.

scholarly journals Clinical efficacy of clonidine versus nalbuphine as intrathecal adjuvants to 0.5% hyperbaric bupivacaine for subarachnoid block during gynaecological procedures: a double blind study

2017 ◽  
Vol 5 (6) ◽  
pp. 2540 ◽  
Author(s):  
Manoranjan Bansal ◽  
Shikha Agarwal ◽  
Kumkum Gupta ◽  
Prashant K. Gupta ◽  
Salony Agarwal ◽  
...  
Keyword(s):  
Regional Anesthesia ◽  
Clinical Efficacy ◽  
Postoperative Analgesia ◽  
Sensory Block ◽  
Double Blind Study ◽  
Hyperbaric Bupivacaine ◽  
Double Blind ◽  
Rescue Analgesia ◽  
Intrathecal Clonidine ◽  
Increasing Trends

Background: Regional anesthesia techniques for gynaecological procedures are on increasing trends due to their advantage of postoperative analgesia owing to intrathecal adjuvants. The present study was aimed to comparatively evaluate the clinical efficacy of clonidine with nalbuphine when co-administered intrathecally with 0.5% hyperbaric bupivacaine for gynaecological procedures.Methods: Regional anesthesia techniques for gynaecological procedures are on increasing trends due to their advantage of postoperative analgesia owing to intrathecal adjuvants. The present study was aimed to comparatively evaluate the clinical efficacy of clonidine with nalbuphine when co-administered intrathecally with 0.5% hyperbaric bupivacaine for gynaecological procedures.Results: The onset of sensory block was earlier in patients of Group BN (3.91±2.25 min vs 4.30±0.87 min, p=0.039). The onset of motor block was also earlier in patients of Group BN (p=0.042). The time to first rescue analgesia in patients receiving intrathecal clonidine was significantly delayed (283±14.18 min vs 231.50±26.18 min, p=0.001). Intraoperative hemodynamic changes were comparable and none of the patient suffered from respiratory depression, shivering, nausea or vomiting.Conclusions: Intrathecal clonidine as adjuvant to bupivacaine provided was clinically more effective than nalbuphine for prolonging the duration of analgesia for gynaecological procedures.

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