scholarly journals Effects of Combination of Intrathecal Fentanyl Clonidine with Bupivacaine in Patients for Operative Knee Arthroscopic Procedure

2016 ◽  
Vol 1 (2) ◽  
pp. 52-57
Author(s):  
Meenoti Pramod Potdar ◽  
Laxmi Laxman Kamat ◽  
Manjeet Prakash Save ◽  
Tanya R Jha
Keyword(s):  
Side Effects ◽  
P Value ◽  
Hyperbaric Bupivacaine ◽  
Fentanyl Citrate ◽  
Analgesic Requirement ◽  
Duration Of Action ◽  
Additional Advantage ◽  
Arthroscopic Procedure ◽  
Intrathecal Clonidine

ABSTRACT Introduction The addition of neuraxial fentanyl or clonidine potentiates the effect of local anesthetic and increases the duration of action and quality of intraoperative and postoperative analgesia. We decided to conduct this study to analyze the synergistic effect of clonidine and fentanyl with bupivacaine on the duration of analgesia surgies. The primary aim is to determine the duration of analgesia for a combination of intrathecal clonidine and fentanyl with bupivacaine in knee arthroscopic surgeries. Materials and methods We included 100 patients undergoing operative arthroscopio procedure and randomly allocated the patients into four different groups of 25 each. Group S: 15 mg 0.5% hyperbaric bupivacaine with 1.0 mL normal saline (NS). Group F: 15 mg 0.5% HB with 25 μcg fentanyl citrate and 0.5 mL NS. Group C: 15 mg 0.5% HB with 75 μcg clonidine and 0.5 mL NS. Group FC: 15 mg 0.5% HB with 25 μcg fentanyl citrate and 75 μcg clonidine. All the patients received the spinal dosage of 4 mL. Results The duration of spinal analgesia was greatest in group FC (458.4 ± 179.96 minutes, p-value 0.001). The rescue analgesic requirement in 24 hours was significantly less in group FC, and the incidence of side effects was comparable. Conclusion The combination of clonidine and fentanyl with bupivacaine intrathecally does augment its sensory, motor, and analgesic action further, and hence it has an additional advantage with similar side effects. How to cite this article Potdar MP, Kamat LL, Save MP, Jha TR. Effects of Combination of Intrathecal Fentanyl Clonidine with Bupivacaine in Patients for Operative Knee Arthroscopic Procedure. Res Inno in Anesth 2016;1(2):52-57.

scholarly journals Evaluation of adjunctive analgesia with intrathecal fentanyl along with hyperbaric bupivacaine in spinal anesthesia for elective cesarean section

2020 ◽  
Vol 8 (8) ◽  
pp. 2924
Author(s):  
Ranu Neelamchand Surana ◽  
Trishala Jain
Keyword(s):  
Side Effects ◽  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Analgesic Efficacy ◽  
Sensory Block ◽  
Elective Cesarean Section ◽  
P Value ◽  
Hyperbaric Bupivacaine ◽  
Analgesic Requirement ◽  
Elective Cesarean

Background: Cesarean section (CS) is one of the most common surgical procedures in female patients. Authors aimed to evaluate the postoperative analgesic efficacy of adding intrathecal fentanyl to bupivacaine, and its effect on the onset and duration of spinal anesthesia along with its effect on mother and neonate.Methods: Study was performed on 60 cesarean section parturients divided into two groups. Group F received 2 ml of 0.5% hyperbaric bupivacaine (10 mg) plus 0.4 ml fentanyl (20 µg), and Group B received 2 ml of 0.5% hyperbaric bupivacaine (10 mg) plus 0.4 ml of normal saline. The parameters taken into consideration were pain scores, analgesic requirement, hemodynamic stability and side effects.Results: It was found that duration of sensory block was prolonged in fentanyl group (111 minutes vs 86 minutes, p<0.001). Duration of effective analgesia (174.36 minutes vs 127.81; p value <0.001) were also found to be prolonged in Group F with requirement of fewer postoperative analgesics (1.02 vs 2.76, p=0.03). There was not much difference in the occurrence of side effects in both the groups.Conclusions: Addition of fentanyl to intrathecal bupivacaine for cesarean section increases the duration of postoperative analgesia without increasing maternal or neonatal side effects.

Comparative study of postoperative analgesia intrathecal addition of fentanyl versus clonidine in lower limb surgeries

2021 ◽  
Vol 18 (2) ◽  
pp. 83-87
Author(s):  
Palak Gupta ◽  
Keyword(s):  
Spinal Anaesthesia ◽  
Lower Limb ◽  
Hyperbaric Bupivacaine ◽  
Duration Of Action ◽  
Medical College ◽  
Anesthetic Drugs ◽  
Prolonged Duration ◽  
The Difference ◽  
Intrathecal Clonidine

Background: Local anesthetic drugs like bupivacaine are commonly used in spinal anesthesia for lower limb surgeries but the duration of spinal anaesthesia is very short. However, the duration of action of bupivacaine in spinal anaesthesia can be prolonged by using adjuvants such as midazolam, opioids, neostigmine, dexmedetomidine and clonidine. The present study is being undertaken to evaluate and compare the effects of clonidine and fentanyl as intrathecal adjuvants to hyperbaric bupivacaine in patients undergoing lower limb orthopaedic surgery. Material and Methods: Present study was conducted in the Department of Anaesthesiology and Intensive Care, Government Medical College, Jammu in patients of either sex ranging in age from 20-60 years belonging to ASA I/ II scheduled for lower limb orthopaedic surgeries. 90 patients were randomly allocated in three groups of 30 each in order to compare the duration and quality of analgesia of clonidine and fentanyl used as adjuvants to intrathecal bupivacaine. Results: All the three groups were comparable in age, gender, height, weight, ASA grade distribution and the difference between them was not statistically significant. The difference between the time to reach the T10 block, mean time taken for first request for analgesia and duration of motor block in all three groups were found out to be statistically significant (p<0.0001). It was found that group with clonidine had better results than fentanyl and bupivacaine alone. In our study 1 patient in bupivacaine (15mg) with fentanyl (25µg) group and 2 patients in clonidine(37.5ugm) group had hypotension but the difference was statistically insignificant. Only 1 patient in each fentanyl and clonidine group had 1 episode of bradycardia but no patient in bupivacaine alone group had bradycardia and the difference was also insignificant. Postoperative vomiting was experienced by 3.33% of patients receiving Bupivacaine (15mg) with fentanyl (25µg) and it was treated by giving injection Ondansetron 4 mg i/v whereas no case was reported in clonidine group. This difference was statistically insignificant. 2 patients in bupivacaine (15mg) with fentanyl (25µg) group had itching but no such case was reported in clonidine group and the difference was also statistically insignificant. No respiratory depression, nausea was noted in study patients. Conclusion: It can be concluded that intrathecal clonidine (37.5ugm) provides quicker onset and prolonged duration of sensory and motor blocks simultaneously increasing the duration of analgesia when compared to fentanyl (25ugm).

scholarly journals Perbandingan Efektivitas Anestesi Spinal dengan Bupivacain 12,5 Mg dan Bupivacain 5 Mg yang ditambah Fentanyl 50 Mcg pada Seksio Sesarea

2021 ◽  
Vol 4 (1) ◽  
pp. 11-7
Author(s):  
Fritzky Indradata ◽  
Heri Dwi Purnomo ◽  
Muh. Husni Thamrin ◽  
Sugeng Budi Santoso ◽  
Ardana Tri Arianto ◽  
...  
Keyword(s):  
Side Effects ◽  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Randomized Control Trial ◽  
Hyperbaric Bupivacaine ◽  
Chi Square ◽  
Double Blind ◽  
Duration Of Action ◽  
Significant Difference ◽  
Randomized Control

Latar Belakang: Anestesi spinal mempunyai efek samping berupa hipotensi dan mual muntah. Tujuan: penelitian ini adalah membandingkan efek anestesi spinal bupivacain dosis normal 12,5 mg dan bupivacain dosis rendah 5 mg dengan fentanyl 50 mg pada seksio sesarea terhadap perubahan hemodinamik, ketinggian blok, onset, durasi dan efek samping. Subjek dan Metode: Penelitian double blind randomized control trial pada 36 pasien yang memenuhi kriteria. Pasien dibagi menjadi dua kelompok, yang masing-masing terdiri 18 pasien, kelompok 1 dilakukan anestesi spinal dengan bupivacain hiperbarik 5 mg ditambah adjuvan fentanyl 50 mcg, sedangkan kelompok 2 diberikan bupivacain hiperbarik 12,5 mg. Penilaian meliputi saat mula kerja blokade sensorik, mula kerja blokade motorik, durasi, tekanan darah, laju nadi, dan saturasi oksigen, lama kerja dan efek samping. Data hasil penelitian diuji secara statistik dengan uji chi-square. Hasil: Terdapat perbedaan signifikan pada onset dan durasi blokade sensorik dan motorik, bupivacain 12,5 mg lebih baik dibandingkan bupivacain 5 mg + fentanyl 50 mcg (p<0.05). Tidak ada perbedaan signifikan pada perubahan tanda vital dan efek samping (p>0.05). Simpulan: Bupivacain 12,5 mg menghasilkan onset lebih cepat dan durasi lebih lama dibandingkan bupivacain 5 mg + fentanil 50 mcg pada anestesi spinal untuk seksio sesarea   Comparison of The Effectiveness Spinal Anesthesia with Bupivacaine 12,5 Mg and Bupivacaine 5 Mg added Fentanyl 50 Mcg in Caesarean Section Abstract Background: Spinal anesthesia has side effects such as hypotension and nausea and vomiting. Objective: The aim of this study was to compare the effects of spinal anesthesia with normal doses of 12,5 mg of bupivacaine and 5 mg of low-dose bupivacaine with fentanyl 50 mg in the cesarean section on hemodynamic changes, block height, onset, duration, and side effects. Subjects and Methods: Double-blind randomized control trial in 36 patients who met the criteria. Patients were divided into two groups, each consisting of 18 patients, group 1 underwent spinal anesthesia with 5 mg of hyperbaric bupivacaine plus 50 mcg of fentanyl adjuvant, while group 2 was given 12,5 mg of hyperbaric bupivacaine. Assessments include the initiation of sensory block action, onset of motor block action, duration, blood pressure, pulse rate, and oxygen saturation, duration of action, and side effects. The research data were statistically tested with the chi-square test. Results: There were significant differences in the onset and duration of sensory and motor blockade, bupivacaine 12,5 mg was better than bupivacaine 5 mg + fentanyl 50 mcg (p <0.05). There was no significant difference in changes in vital signs and side effects (p> 0.05). Conclusion: Bupivacaine 12,5 mg resulted in a faster onset and longer duration than bupivacaine 5 mg + fentanyl 50 mcg in spinal anesthesia for cesarean section.

scholarly journals A comparative study of low doses of intrathecal ketamine and midazolam with bupivacaine for postoperative analgesia in infraumbilical surgeries

2019 ◽  
Vol 6 (2) ◽  
pp. 197
Author(s):  
Rajabhushanam M. ◽  
Sunil Kumar K. ◽  
Syed Ali Aasim ◽  
Venkatesh S.
Keyword(s):  
Postoperative Analgesia ◽  
Cost Effective ◽  
Rapid Onset ◽  
Spinal Block ◽  
P Value ◽  
Sensory Level ◽  
Hyperbaric Bupivacaine ◽  
First Choice ◽  
Mean Time

Background: Infra-umbilical surgeries may be performed under local, regional (spinal or epidural) or general anaesthesia, spinal block is still a first choice, because of its rapid onset, high quality of blockade, lack of catheter related infection, less failure rate and also cost effective but the duration of block and postoperative analgesia is limited. The purpose of study was to compare the efficacy of adding ketamine to 0.5% hyperbaric bupivacaine with midazolam to 0.5% hyperbaric bupivacaine in elective infraumbilical procedures.Methods: A randomized, single blinded, clinical study. 60 subjects were enrolled from the patients presenting for elective infraumbilical surgeries after following the inclusion and exclusion criteria laid down for the study. Sixty ASA Grade I and II patients undergoing infra umbilical surgeries were randomly divided into one of the two equal groups (n=30).Results: Total 60 patients were included in this study. The mean time to achieve T10 sensory level and modified bromage scale III was prolonged in group M (4.33±1.09, 6.66±1.26 min) as compared to group K (3.3±0.7, 4.96±1.21 min) which was statistically significant (P value <0.05).Conclusions: The present study concludes that addition of intrathecal midazolam to hyperbaric bupivacaine provide very good and prolonged post-operative analgesia without significant intra-operative and post-operative side effects compared to intrathecal ketamine.

scholarly journals Epidural butorphanol for post operative analgesia in lower limb surgeries: A comparative study with epidural tramadol

2017 ◽  
Vol 6 (3) ◽  
pp. 26-32
Author(s):  
G P Deo ◽  
S K Shrestha ◽  
I N Shrestha
Keyword(s):  
Patient Satisfaction ◽  
Side Effects ◽  
Lower Limb ◽  
Analgesic Efficacy ◽  
Epidural Injection ◽  
Double Blind ◽  
Duration Of Action ◽  
Number Of Patients ◽  
Group B

To compare the efficacy of epidural butorphanol and tramadol for post operative analgesia in lower limb surgeries. Randomized, controlled, double blind, prospective study conducted at Department of Anaesthesia and Critical Care, Chitwan Medical College from September 1st 2015 to August 31st 2016. 60 patients of ASA Grade I and II of either sex, aged between 18-65 years willing for epidural analgesia for post operative analgesia were included in the study. They were divided into two groups: Group B- Butorphanol group and Group T- Tramadol group. Subjects of Group B received 2mg of Butorphanol and 0.25% Bupivacaine making a total volume of 10 ml and that of Group T received 100mg of Tramadol and 0.25% Bupivacaine also making a total volume of 10 ml. Analgesic efficacy was assessed by Visual Analogue Scale (VAS). The onset and duration of analgesia along with side effects were also assessed. The quality of analgesia was studied using time to independent mobilization and overall patient satisfaction. Total number of patients was 60, of ASA Grade I and II, aged between 18-65 years. The mean age of patients in Group B was 42.6±11.7 years and 46.1±11.2 years in Group T. Time of onset of analgesia after epidural injection was 7.4±0.9 minutes in Group B and 12.7±1.5 minutes in Group T and the difference was found to be statistically significant. Duration of analgesia was 317.1±99.1 minutes and 438.8±136.6 minutes in Butorphanol and Tramadol groups respectively which was also statistically significant. Sedation was significantly higher in butorphanol group whereas nausea and vomiting was higher in tramadol group. Quality of analgesia in terms of patient satisfaction was better with epidural butorphanol. Both epidural tramadol and butorphanol were effective in relieving post operative pain however butorphanol had lesser side effects and greater patient satisfaction compared to tramadol but the duration of action was relatively short.

scholarly journals Effect Intravenous Dexamethasone as an Adjuvant to Caudal Block on post operative analgesia:  Prospective Cohort study design

2020 ◽  
Author(s):  
Mohammed Suleiman Obsa ◽  
Meron ABrar Awol ◽  
Timsel Girma Simie
Keyword(s):  
Postoperative Analgesia ◽  
Categorical Variables ◽  
P Value ◽  
Anesthetic Techniques ◽  
Caudal Block ◽  
Chi Square ◽  
Analgesic Requirement ◽  
Duration Of Action ◽  
Dexamethasone Group ◽  
American Society

Abstract Introduction Caudal block is by far the most commonly employed regional anesthetic techniques to maintain postoperative analgesia in pediatric urogenital surgeries. However, its short duration of action can be prolonged by adding Adjuvants. The aim of this study was to compare the efficacy of dexamethasone administered through intravenous on post-operative analgesia in pediatric patients who underwent infra umbilical surgeries. Method In this prospective study, sixty American Society of Anesthesiologists Physical Status I and II patients aged 1–7 years were randomly allocated into two groups of thirty each. Both groups were compared for the duration of postoperative analgesia and analgesic requirement. Severity of postoperative pain was measured by FLACC score. Mann –Whitney U test was used to compare the pain severity and total analgesic consumption. Independent sample t test was used for analgesia duration as well as Chi-square test was used to analyze independent categorical variables between two groups and a p-value of less than 0.05 was considered as statistically significant. Result Analgesia duration was significantly prolonged in caudal block with IV dexamethasone group than caudal block with bupivacaine alone group ( P < 0.001). Total analgesia consumption was significantly lower ( P < 0.001) in caudal block with IV dexamethasone compared to with bupivacaine alone group. Postoperative severity of pain was significantly lower in caudal block with IV dexamethasone group at 4 th , 6 th and 12 th hours (P<0.001, P<0.001 and P<0.003) respectively. Conclusion Addition of intravenous dexamethasone as an adjuvant to caudal block with 0.25% Bupivacaine significantly reduced the intensity of post-operative pain and prolonged the duration of post-operative analgesia.

scholarly journals Quality of Life of Breast Cancer Women During Chemotherapy with Fluorouracil, Doxorubicin and Cyclophosphamide (FAC) Regimen

2017 ◽  
Vol 35 (4) ◽  
pp. 373
Author(s):  
Sophit Korpunsilp ◽  
Tipaporn Pongmesa
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Side Effects ◽  
Physical Functioning ◽  
P Value ◽  
Life Questionnaire ◽  
Appetite Loss ◽  
Eortc Qlq C30 ◽  
Eortc Qlq

Objective: To assess quality of life (QoL) of female breast cancer patients undergoing chemotherapy with a fluorouracil, doxorubicin, and cyclophosphamide (FAC) regimen.Material and Method: This prospective analytical study was performed among 40 Thai female patients receiving the FAC regimen at Pranangklao Hospital, Nonthaburi province. Their QoL was assessed using the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and Breast Cancer Module (EORTC QLQ-BR23).Results: Most patients were aged 50 years or over (77.5%) and had been diagnosed with stage 2 breast cancer (47.5%). According to the EORTC QLQ-C30, the patients’ QoL significantly decreased compared to the baseline after cycle 3 for global health status (p-value=0.002) and QoL (p-value=0.001), as well as physical functioning (p-value=0.015) and role functioning (p-value=0.001), while symptoms of fatigue, nausea/vomiting, and appetite loss increased (p-value<0.001). After cycle 5, the patients’ QoL was still significantly lower than at baseline, for physical functioning (p-value=0.009) and symptoms of fatigue, nausea/vomiting, appetite loss (p-value<0.001) and dyspnea (p-value=0.005). The EORTC QLQ-BR23 reported significantly worse systemic therapy side effects for both cycles 3 and 5 (p-value<0.001), and distress due to hair loss also appeared after cycle 5 (p-value=0.016). No significant differences were revealed on any scales between cycles 3 and 5.Conclusion: The patients’ QoL significantly decreased after chemotherapy with the FAC regimen, with some side effects from treatment and reduction in some functioning.

COMPARISONS OF EFFECTS OF DIFFERENT DOSES OF DEXMEDETOMIDINE AS ADDITIVE IN INTRATHECAL BLOCKADE WITH 0.5% HYPERBARIC BUPIVACAINE IN LOWER LIMB ORTHOPEDIC SURGERIES

2021 ◽  
pp. 21-23
Author(s):  
Shantanu Hazra ◽  
Debabanhi Barua ◽  
Sudeshna Mondal ◽  
Arpita Laha
Keyword(s):  
Lower Limb ◽  
Controlled Study ◽  
Sensory Level ◽  
Hyperbaric Bupivacaine ◽  
Duration Of Action ◽  
Stable Conditions ◽  
Study Results ◽  
The Mean ◽  
Group D

INTRODUCTION Lower limb surgeries may be performed under local, regional (spinal or epidural) or general anaesthesia, but neuraxial blockade is the preferred mode of anaesthesia. Spinal block is still therst choice because of its rapid onset, superior blockade, low risk of infection as from catheter in situ, 1 less failure rates and cost-effectiveness. Intrathecal local anaesthesia alone is associated with relatively short duration of action and thus early analgesic intervention is needed in post-operative period. AIMS AND OBJECTIVES With use of dexmedetomidine in 3 different graded doses with hyperbaric bupivacaine intrathecally as regional anaesthesia for lower limb surgeries. MATERIALS AND METHODOLOGY This Prospective double blinded randomized controlled study. The study will be conducted in adult patients aged between 18-50 years undergoing lower limb surgeries under spinal anaesthesia in orthopedic OT, dept. of Anaethesiology, Medical college & hospital, Kolkata. Duration of the study One year (9 months for data collection & 3 months for data analysis, review& report writing). Total 63 patients in our study. RESULTS We found the mean of two segment regression time from highest sensory level in Group B was 130.56min; in group C was 171.34min; ingroup D was 217.85min So, block regression was signicantly slower with the addition of intrathecal dexmedetomidine (Group D) as compared to group C & B ( P < 0.0001) The mean regression time to S1 from highest sensory level for Group Bwas 289.43 min ( SD- 12.43) For Group C, the mean regression time to S1 from highest sensory level was 402.71 min ( SD- 28.60) For Group D, the mean regression time to S1 from highest sensory level was 584.43min ( SD- 38.92) Overall the mean regression time to S1 from highest sensory level was 425.52 min ( SD- 125.71) The sensory regression time to S1 from highest sensory level was signicantly higher with increasing dose of dexmedetomidine i. e. D>C>B . (P< 0.0001). CONCLUSION We recommend the use of 10mcg of intrathecal dexmedetomidine as an adjuvant to bupivacaine as it seems to be a good alternative to other additives for long duration surgical procedures due to its profound intrathecal anesthetic and analgesic properties. It provides good quality of intraoperative analgesia, thermodynamically stable conditions, minimal side effects, and excellent quality of postoperative analgesia.

AB0336 IMPACT OF SUBJECTIVE INTOLERANCE TO METHOTREXATE ON THE QUALITY OF LIFE OF PATIENTS WITH RHEUMATOID ARTHRITIS: SIDE EFFECTS AND AVOIDANCE COPING STRATEGIES THROUGH SELF-ADMINISTRATION IN THE EVENING OR DURING THE WEEKEND

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1466.1-1467
Author(s):  
G. Cavalli ◽  
M. Biggioggero ◽  
A. Cariddi ◽  
G. De Luca ◽  
E. Agape ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Rheumatoid Arthritis ◽  
Side Effects ◽  
Social Participation ◽  
Disease Duration ◽  
P Value ◽  
Self Administration ◽  
Cross Sectional ◽  
The Impact

Background:Methotrexate (MTX) represents theanchor drugfor the treatment of rheumatoid arthritis (RA), as well as other rheumatological diseases such as psoriatic arthritis (PsA) and spondyloarthritides (SpA). Despite consolidated clinical efficacy, the use of MTX suffers from relevant limitations. Common issues include subjective intolerance, nausea, malaise, and fatigue, which negatively impact on quality of life and work/social participation.Objectives:In this study, we evaluated the frequency with which patients on MTX therapy opt for self-administration over the weekend or in the evening hours, in order to minimize interference with daily activities, work productivity, and social participation.Methods:A cross-sectional, prospective study was performed in two tertiary referral Rheumatology clinics, which included consecutive patients with RA, PsA, or SpA on MTX therapy. Enrolled patients had not previously received instructions by their healthcare provider as to when during the week or day MTX ought to be administered, and were free to choose or change the weekday and time for self-administration. Data on the route and timing of MTX self-administration was collected using dedicated questionnaires, which included queries on the dose and route of administration, day of the week and time of self-administration, reasons for the patient’s choice, use of folic acid supplementation, and concomitant therapies. Statistical analyses were conducted using a chi-square test; a p-value <0.05 was considered significant.Results:A total of 275 consecutive patients treated with MTX were included, mostly with RA (86%). Patients had an average age of 59.8 years (SD 14.0) and an average disease duration of 134.5 months (SD 127.3). The average MTX dose was 15 mg/wk (SD 4.4); MTX was administered subcutaneously in 68.2% of cases, orally in 17.8%, and intramuscularly in 5%. Regarding the timing of MTX self-administration, 157 patients (57.1%) took MTX in the evening and 119 patients (44.3%) took it during the weekend; even among patients taking MTX in the evening, weekend administration was preferred (93/157, 59.2%, p <0.001). The most frequent reasons leading to MTX self-administration during the evening or weekend were gastrointestinal side effects/nausea (85% of cases), fatigue (63%), interference with work activities (36%) and interference with social activities (29%). Patients who opted for MTX self-administration in the evening or over the weekend were significantly younger (p <0.001), with no significant gender differences or disease duration.Conclusion:The majority of patients with inflammatory arthritis opt for self-administration of MTX in the evening (absolute majority) or during the weekend (relative majority). This choice is dictated by the need to avoid side effects and detrimental repercussions on the individual’s social or working life. The adoption of these strategies for minimizing the adverse effects of MTX is more frequent among younger patients, and provides an indirect, yet powerful indicator of the impact of MTX therapy on patients’ quality of life.Disclosure of Interests:Giulio Cavalli Consultant of: SOBI, Pfizer, Sanofi, Novartis, Paid instructor for: SOBI, Novartis, Speakers bureau: SOBI, Novartis, Martina Biggioggero: None declared, adriana cariddi: None declared, Giacomo De Luca Speakers bureau: SOBI, Novartis, Celgene, Pfizer, MSD, Elena Agape: None declared, nicola boffini: None declared, Elena Baldissera Speakers bureau: Novartis, Pfizer, Roche, Alpha Sigma, Sanofi, Lorenzo Dagna: None declared, Ennio Giulio Favalli Consultant of: Consultant and/or speaker for BMS, Eli-Lilly, MSD, UCB, Pfizer, Sanofi-Genzyme, Novartis, and Abbvie, Speakers bureau: Consultant and/or speaker for BMS, Eli-Lilly, MSD, UCB, Pfizer, Sanofi-Genzyme, Novartis, and Abbvie

scholarly journals Anesthetic effects of varying doses of Fentanyl combined with spinal Bupivacaine in caesarean delivery

2018 ◽  
Vol 17 (2) ◽  
pp. 3
Author(s):  
Puja Thapa ◽  
Amir Babu Shrestha ◽  
Mallika Rayamajhi
Keyword(s):  
Side Effects ◽  
Adverse Effects ◽  
Caesarean Delivery ◽  
Motor Block ◽  
Optimal Dose ◽  
Sensory Level ◽  
Hyperbaric Bupivacaine ◽  
Spinal Opioids ◽  
Effective Analgesia

<p><strong>Introduction</strong></p><p>Spinal opioids have gained popularity in recent years as they augment the analgesia produced by local anesthetics. Fentanyl is one of the opioids used for such purpose however the optimal dose has not been described adequately in the literature available so far in our setup. The aim of this study is to find out the effect of adding various doses of Fentanyl to low dose hyperbaric Bupivacaine intrathecally.</p><p><strong>Materials and methods</strong></p><p>Seventy-five parturients scheduled for caesarean delivery were randomly allocated into three groups (Bupivacaine-Fentanyl) BF10, BF20 and BF30 who received intrathecal 0.5% hyperbaric Bupivacaine 1.6 ml with Fentanyl 10µg, 20 µg and 30 µg respectively. Total volume was made to 2.2ml by adding normal saline. The outcomes measured were peak sensory level, degree of motor block, quality of intraoperative anesthesia, duration of effective analgesia, neonatal APGAR score and side effects were noted if any.</p><p><strong>Results</strong></p><p>Peak sensory level and degree of motor block was similar in all the groups. Peak sensory level (Thoracic Dermatome) was 4.52± 0.82, 4.32± 0.62 and 4.32± 0.74 (p=0.540) in BF10, BF20 and BF30 respectively. Degree of motor block was not significantly different (p=1.000). Quality of intraoperative anesthesia improved from BF10 to BF20 (P=0.040) but did not improve significantly from BF20 and BF30 (P=0.189). Duration of effective analgesia prolonged as the dose of Fentanyl increased which was in minutes 173.64±41, 216.80±32 and 273.16±35 (p=0.000) in BF10,BF20 and BF30 respectively. Neonatal APGAR scores were similar in all groups and very little adverse effects in higher doses.</p><p> <strong>Conclusion</strong></p><p>The combination of 1.6 ml of 0.5% hyperbaric Bupivacaine and 20 µg of Fentanyl intrathecally provides excellent surgical anesthesia, prolonged postoperative effective analgesia with very few side effects. Increasing the dose of Fentanyl beyond it could prolong the postoperative pain relief but at the cost of increased adverse effects.</p>

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