clinical comparative study between extradural morphine versus buprenorphine after transurethral prostatectomy

The frist successful trial of extradural opioids injection was in Jerusalem[1]. Chronic pain was magaged extradurally at first by 2 mg morphine. Up to 10 mg morphine was used extradurally with very good analgesia but on the expense of severe respiratory depression[2]. Morphine can be detected in the cerebrospinal fluid it is injected in such a high dose[3]. Many trials was performed to use morphine in the extradural space for postoperative pain relief, with gradually decreasing dose in order to obtain pain relief with prevention of respiratory depression[4]. Extradural morphine 2 mg did not produce sufficient pain relief following caeserian section[5]. Morphine 3 mg injection in the extradural space can be effective in postoperative pain relief as previously reported[6]. Many factors may contribute to the effect of extraduraI opioids as the direct dural effect, fat deposition and systemic absorbtion. To reduce the incidence of respiratory depression it was suggested to use lipid. Isoluble drug, as buprenorphine, as this agent enter the neural tissue rather than it remains in the cerebrospinal fluid. When buprenorphine is injected in the extradural space a higher dose is required to compensate for deposition in fat and systemic absorbtion[7]. A dose of 0.1 mg buprenorphine was suggested as the optimum extradural dose for the relife of postoperative pain[8]. Because of the high lipid solubility of buprenorphine it has been suggested that its extradural dose is similar to the intravenous one[8]. Because of the high lipid solubility of buprenorphine it has been suggested that its extradural dose is similar to the intravenous one[9]. On intramuscular administration a dose of 0.09 mg of buprenorphine is equipotent to 3 mg morphine[9]. In the present study we compared 3 mg morphine with buprenorphine 0.09 mg extradurally for post operative pain relieve after transurethral prostatectomy [TUR]. A larger dose of buprenorphine [0.18 mg] was also studied

Comparison of the effects of nalbuphine, fentanyl and pethidine in rabbits pretreated wilth a monoamine oxidase inhibitor tranylcypromine [parnate]

The existence of a severe toxic interaction from the clinical use of pethidine and monoamine oxidase [MAO] inhibitors is well known. The present study evaluates the possibility of such an interaction for the opioid partial agonist Nalbuphine and the pure agonist fentanyl. Conscious rabbits [n = 6] in each group pretreated 24 hours previously with physiological saline or the MAO inhibitor tranylcypromine [Parnate] 1.5 mg/kg S.C. were subsequently given physiological saline, pethidine 5 mg/kg, fentanyl 0.02 mg/kg and effect and parnate produced only a small increase in the rabbits temperature, the combination of parnate and pethidine produced a marked hyperpyrexia [+ 4.4 +/- 0.19°C, P < 0.001], hypertension 33.9 +/- 3.1 mmHg; P < 0.01] and agitation. Two rabbits died at 40 and 50 minutes after the pethidine- parnate combination. Nalbuphine and fentanyl were without significant effects on the parameters when given after the MAO-inhibitor parnate

incidence of arterial hypoxemia in the immediate postoperative period during the transfer of surgical patients to the recovery room

The incidence rate of hypoxemia in the immediate post-operative Period Was determined using pulse oximeter for continuous minitorring of arterial oxygen satusation [sao2] in 148 ASA class I or II adult patients breathing room air during their transfer from the operating room [O.R.] to the recovery room [R.R.]. These patients were categorized according to the type of operartion into two groups, as the following 72 patients undergone abdominal procedures and 76 patients undergone pelvic and peripheral operations. Hypoxemia was defined as 90% sao2 [arterial oxygen partial pressure -pao2=58 mmhg]. Severe hypoxemia was defined as 85% sao2 [Poao2=50 mmhg]. Hypoxemia occurred in 48 [66.7%] patients of group A, and in 24 [31.58%] patients of group B. The incidence of hypoxemia was significantly higher in group A [patients undergoing abdominal procedures] than in group B [those under-going non-abdominal procedures], Also group A of Patients experienced a significantly higher incidence of severe hypoxemia [25%], than group B of patients [1 3.16%]. Thus the type of operation was a significant predictor of the immediate postoperative hypoxemia. Postoperative hypoxemia also correlates significantly with the patient age and obesity

Immediate venous sequelae of intravenous administration of midazolam versus propofol. A light and electron microscopic study

Eighteen guinea-pigs were categorized into three groups I, II, and III [6 each]. Animals of group I were injected intravenously via the external jugular veins with midazolam, group II were injected with propofol, while group Ill were received normal saline as a control model. Light microscopy revealed mild oedema in venous wall in group I and II. While electron microscopy revealed the relative innocuousness of propofol compared with midazolam in equipotent doses, probably due to the effect of the fat emmulsion solvent of propofol. In addition to the isotonicity and pH neutrality of the later