comparison among Doxapram, Nulbuphine and Meperidine for treatment of postanesthetic shivering

Postanesthetic shivering [PS] is distressing for patients and may induce a variety of complications. We carried out our study to evaluate the value of Doxapram, Nulbuphine and Meperidine for treating PS. 80 patients were included in the study who undergone general anesthesia for routine general orthopedic or gynecologic surgery and developed shivering within 10 minutes of admission to the recovery room where they are divided into 4 groups; each of 20 patients classified as follows: Group 1 [n = 20] placebo saline group [received i.v. saline]; Group 2 [n = 20] Doxapram group [received 1.5 mg/kg i.v.] Group 3 [n = 20] Nulbuphine group [received 0.08 mg/kg i.v.]; Group 4 [n=20] Meperdine group [received 0.4 mg/kg i.v.]. Treatment that stopped shivering was considered to have been successful. The results demonstrated that 5 min. after treatment with Doxapram, Nulbuphine and Meperidine provided rapid and potent anti-shivering effect on PS, with high response rate of 75%, 80% and 85%, respectively compared with those of placebo saline [0%] [p < 0.01]. 15 minutes after injection, the response rates of Doxapram, Nulbuphine and Meperidine were 80%, 85% and 90%, respectively compared with 15% in the saline group. 30 minutes after injection, the response rates of Doxapram, Nulbuphine and Meperidine 85%, 90% and 95%, respectively compared with 20% in the saline group. We concluded that nulbuphine and meperidine prevent PS but meperidine is superior to both Doxapram and Nulbuphine and Nulbuphine provides a similar rapid and potent shivering effect so it may be an alternative to meperidine for treating postanesthetic shivering

Comparative study between st and ard epidural and combined spinal epidural either with fentanyl or fentanyl and bupivacaine for labour analgesia

We carried out an observational study to assess maternal satisfaction with st and ard epidural and combined spinal epidural [CSE]. We selected 60 nulliparous fullterm parturients who were in active labour and requested analgesia. They were divided into 3 groups For [group 1] st and ard epidural analgesia [10 ml of 0.25%] bupivacaine was injected into the epidural space followed by top-up of 10 ml of 0.125% bupivacaine as required. [Group 2], combined spinal-epidural fentanyl [CSEF] the initial dose was 25 micro g fentanyl in 2 ml normal saline followed by top - up of 25 micro g fentanyl in 5 ml in epidural catheter as required. [Group 3] combined spinal-epidural bupivacaine and fentanyl [mixed CSE], the initial intrathecal dose was 2.5 mg bupivacaine and fentanyl 25 micro g in 2ml normal saline, followed by top-up of 20 micro g fentanyl with 0.125% bupivacaine in 10 ml in epidural space as required. We found that the overall satisfaction was geater in the combined spinal-epidural groups than the st and ard epidural group. Good analgesia was achieved in all groups, but the combined spinal-epidural bupivacaine and fentanyl had faster onset and prolonged duration followed by combined spinal-epidural fentanyl and then st and ard epidural group, The leg weakness was more in st and ard epidural group and very mild in group 3 but absent in group 2. Overall, women seem to be satisfied with low dose combined spinal-epidural fentanyl and bupivacaine perhaps because of the faster onset, less motor blockade and feelings of greater self control