Anesthesia and analgesia
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Anesthesia and analgesia · Sep 1998
Randomized Controlled Trial Clinical TrialEffective analgesia after bilateral tubal ligation.
Postpartum bilateral tubal ligation is a brief surgical procedure with minimal tissue injury, yet postoperative recovery times and analgesia requirements are often disproportionately large. To evaluate the analgesic efficacy of local anesthetic infiltration, 20 parturients scheduled for elective minilaparotomy and bilateral tubal ligation with either spinal or epidural anesthesia participated in this prospective, randomized, controlled, double-blind trial. All patients received IV metoclopramide 10 mg and ketorolac 60 mg intraoperatively, as well as preincisional infiltration of the infraumbilical skin incision with 0.5% bupivacaine. Infiltration of bilateral uterine tubes and mesosalpinx was performed with either 0.5% bupivacaine (n = 10) or isotonic sodium chloride solution (saline) (n = 10). IV meperidine (25 mg every 3 min as needed) was given to treat pain in the postanesthesia care unit (PACU). The total amount of meperidine administered in the PACU was significantly larger in the saline group than in the bupivacaine group. Pain scores at 30, 45, 60, 75, and 90 min postoperatively and on the seventh postoperative day were significantly lower in the bupivacaine group than in the saline group. During tubal ligation, infiltration of uterine tubes and mesosalpinx with 0.5% bupivacaine significantly enhanced analgesia both in the immediate postoperative setting and on the seventh postoperative day compared with infiltration with sodium chloride. ⋯ During bilateral tubal ligation with either spinal or epidural anesthesia, preemptive analgesia using IV ketorolac, IV metoclopramide, and infiltration of the incised skin and uterine tubes with 0.5% bupivacaine allowed 9 of 10 patients to recover with no pain, nausea, vomiting, or cramping and to maintain good analgesia for 7 days postoperatively.
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Anesthesia and analgesia · Sep 1998
Randomized Controlled Trial Multicenter Study Clinical TrialIntrathecal clonidine and fentanyl with hyperbaric bupivacaine improves analgesia during cesarean section.
Seventy-eight pregnant women at term, scheduled for elective cesarean section, were enrolled in this multicenter trial to compare the analgesic efficacy and side effect profile of a spinal block with hyperbaric bupivacaine alone (Group B) or combined with 75 microg of clonidine (Group BC) or with clonidine 75 microg and fentanyl 12.5 microg (Group BCF). Intraoperatively, clonidine increased the spread of the sensory block and decreased pain (pain scores 23+/-7 mm vs 17+/-6 and 2+/-1 mm for Group B versus Groups BC and BCF; P < 0.05) and analgesic supplementation. This improved analgesia was best with the clonidine-fentanyl combination (Group BC versus Group BCF; P < 0.05). Postoperative analgesia was prolonged only in Group BCF (215+/-79 min vs 137+/-35 and 183+/-80 min for Group BCF versus Groups B and BC; P < 0.05). Blood pressure and heart rate changes were not significantly different among groups, whereas sedation and pruritus were significantly more frequent in Group BCF. Nausea and vomiting were decreased in Groups BC and BCF. Apgar scores and umbilical artery blood pH were not different among groups. We conclude that adding a small dose of intrathecal clonidine to bupivacaine increases the quality of intraoperative analgesia and decreases pain during cesarean section. Combining clonidine with fentanyl further improved analgesia. ⋯ In this study, we demonstrate improved intraoperative spinal analgesia by adding 75 microg of clonidine to bupivacaine; side effects were not increased. The combination of clonidine and fentanyl further improved analgesia but moderately increased sedation and pruritus.
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Anesthesia and analgesia · Sep 1998
Randomized Controlled Trial Clinical TrialThe effects of maternal position during induction of combined spinal-epidural anesthesia for cesarean delivery.
Combined spinal-epidural anesthesia (CSE) is a popular technique for cesarean delivery. Regional blocks in obstetrics are often performed with the parturient in the sitting position because the midline may be recognized more easily than in the lateral decubitus position. When conventional spinal anesthesia is performed in the sitting position, the patient is placed supine immediately after drug injection. In contrast, when CSE is performed with the woman sitting, there is a delay in assuming the supine position because of epidural catheter placement, which may affect the incidence of hypotension. Healthy women, at term of pregnancy, about to undergo an elective cesarean section under CSE, were randomly assigned to the sitting or lateral recumbent position for initiation of the block. All parturients were given 1000 mL of lactated Ringer's solution in the 15 min preceding induction and an additional 300-500 mL while the actual block was being performed. On completion of the CSE, they were turned to the supine position with left uterine displacement. A second anesthesiologist, blinded to the woman's position during CSE, evaluated the sensory level of anesthesia, maternal heart rate, blood pressure, oxygen saturation, need for ephedrine, and occurrence of nausea and vomiting. Results are expressed as mean +/- SD. Twelve women were studied in the sitting group and 10 were studied in the lateral recumbent group. The severity and duration of hypotension were greater in those parturients who had CSE induced in the sitting (47%+/-7% and 6+/-3 min, respectively) compared with the lateral recumbent position (32%+/-14% and 3+/-2 min, respectively). Women in the sitting group also required twice as much ephedrine (38+/-18 mg) to correct hypotension compared with the other group (17+/-12 mg). In conclusion, the severity and duration of hypotension were greater when CSE was induced in the sitting compared with the lateral decubitus position. ⋯ We studied the induction of combined spinal-epidural anesthesia (CSE) in the sitting versus lateral recumbent positions in healthy women undergoing a scheduled cesarean delivery. The severity and duration of hypotension were greater when CSE was induced in the sitting position. Thus, the position used for induction of CSE should be among the factors considered when there is greater maternal or fetal risk from hypotension.
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Anesthesia and analgesia · Sep 1998
Randomized Controlled Trial Clinical TrialThe influence of scalp infiltration with bupivacaine on hemodynamics and postoperative pain in adult patients undergoing craniotomy.
After craniotomy, hypertension may contribute to intracerebral hemorrhage. We studied whether scalp infiltration with bupivacaine during craniotomy reduces postoperative pain and hypertension. In a double-blind fashion, 36 adult patients (ASA physical status II or III) undergoing elective craniotomy were randomly assigned to receive scalp infiltration with either bupivacaine (0.25%) and epinephrine (1:200,000) or saline/ epinephrine (1:200,000) for skeletal fixation, skin incision, and wound closure. Heart rate (HR) and mean arterial pressure (MAP) were measured after anesthesia induction, after skull-pin insertion, after scalp infiltration, during dural closure, during skin closure, on admission to postanesthesia care unit (PACU), and 1 h after admission. Visual analog pain scores were recorded in the PACU. MAP was significantly greater in the saline group at scalp infiltration. HR was significantly faster in the saline group at dural and skin closure. The bupivacaine group reported significantly less pain than the saline group at PACU admission and 1 h after admission. Pain scores did not correlate with hemodynamic measurements. We conclude that scalp infiltration with 0.25% bupivacaine with 1:200,000 epinephrine blunts certain intraoperative hemodynamic responses and reduces postoperative pain but has no effect on postoperative hemodynamics. ⋯ We sought to evaluate whether scalp infiltration with bupivacaine and epinephrine at the beginning and end of craniotomy would afford more intra- and postoperative hemodynamic stability and influence immediate postoperative pain. We found that intraoperative hemodynamics were not influenced greatly; however, craniotomy patients do have significant postoperative pain, which does not seem to have an influence on hemodynamics in the postanesthesia care unit.
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Anesthesia and analgesia · Sep 1998
Randomized Controlled Trial Comparative Study Clinical TrialIntrathecal ropivacaine for labor analgesia: a comparison with bupivacaine.
Ropivacaine has less potential for central nervous system and cardiovascular toxicity than bupivacaine; in pregnant patients and volunteers, it produces less motor block in equianalgesic doses than bupivacaine. We compared two doses of intrathecal ropivacaine combined with sufentanil with a standard dose of intrathecal bupivacaine plus sufentanil for labor analgesia using a combined spinal-epidural (CSE) technique. In a prospective, randomized, double-blind fashion, 48 patients requesting labor analgesia received either 2.5 mg of intrathecal bupivacaine plus sufentanil 10 microg (B), 2 mg of intrathecal ropivacaine plus sufentanil 10 microg (R2), or 4 mg of intrathecal ropivacaine plus sufentanil 10 microg (R4). Duration of analgesia and side effects, such as motor block, pruritus, hypotension, ephedrine requirements and fetal bradycardia, were recorded. Duration of analgesia (mean +/- SD) was 79+/-30 min for R2, 98+/-19 min for R4, and 92+/-38 min for B (P = not significant). No differences in motor block or side effects were detected among the groups. We conclude that ropivacaine, when combined with sufentanil, is effective for providing CSE labor analgesia and offers no advantage over bupivacaine in the studied doses. ⋯ In this study, we compared a standard dose of intrathecal bupivacaine with sufentanil for combined spinal epidural analgesia with two doses of the new local anesthetic ropivacaine. Both local anesthetics provided similar labor analgesia duration with equivalent side effect profiles in the doses studied.