ABSTRACT
BACKGROUND: Combined spinal epidural anesthesia has become the technique of anesthesia for cesarean section because of the reliability of spinal block with the flexibility of epidural block. Buprenorphine, a new synthetic thebaine derivative is a partial agonist of the opioid micro-receptor with high receptor affinity, great lipid solubility, and slow rate of opiate receptor association and dissociation. Continous epidural infusion of opioid can possibly produced undesirable effects, such as respiratory depression, pruritus, etc. METHODS: The present study was undertaken to compare the analgesic properties and side effects of continous epidural infusion of buprenorphine and morphine combined with bupivacaine in 60 patients following elective cesarean section in combined spinal epidural anesthesia. At the clothing of peritoneum, the initial bolus doses were 3 mg morphine (M group), 0.15 mg buprenorphine (0.15B group), 0.3 mg buprenorphine (0.3B Group) combined with 0.15% bupivacaine 10 ml and subsequent continous infusion doses were 6 mg morphine plus 0.125% bupivacaine 100 ml (M Group) and 0.6 mg buprenorphine plus 0.125% bupivacaine 100 ml (0.15B, 0.3B Group) during 48 hours. The assessment of analgesic efficacy and side effects were made at arrival of recovery room,postoperative 1, 4, 8, 24, 36, and 48 hours. RESULTS: The pain score during 48 hours was significantly higher in the 0.15B group than in the M group and 0.3B group except the pain score of recovery room. (p<0.05) and the number of patients requiring additional analgesics was higher in 0.15B group than in the M group and 0.3B group but, it was not significant. The incidence of pruritus and urinary retention was significantly higher in M group than in the 0.15B and 0.3B group, and the incidence of sedation, nausea and vomiting was similar in three group. The subjective rating of satisfaction was better in the 0.3B group and M group than in the 0.15B group. CONCLUSION: The above results suggest that continous epidural infusion of 0.6 mg buprenorphine after 0.3 mg buprenorphine initial bolus dose combined with low dose bupivacaine is an advisable method of postoperative pain control in combined spinal epidural anesthesia for cesarean section.
Subject(s)
Female , Humans , Pregnancy , Analgesics , Anesthesia , Anesthesia, Epidural , Bupivacaine , Buprenorphine , Cesarean Section , Clothing , Incidence , Morphine , Nausea , Pain, Postoperative , Peritoneum , Pliability , Pruritus , Receptors, Opioid , Recovery Room , Respiratory Insufficiency , Solubility , Thebaine , Urinary Retention , VomitingABSTRACT
BACKGROUND: Combined spinal epidural anesthesia has become the technique of anesthesia for cesarean section because of the reliability of spinal block with the flexibility of epidural block. Buprenorphine, a new synthetic thebaine derivative is a partial agonist of the opioid micro-receptor with high receptor affinity, great lipid solubility, and slow rate of opiate receptor association and dissociation. Continous epidural infusion of opioid can possibly produced undesirable effects, such as respiratory depression, pruritus, etc. METHODS: The present study was undertaken to compare the analgesic properties and side effects of continous epidural infusion of buprenorphine and morphine combined with bupivacaine in 60 patients following elective cesarean section in combined spinal epidural anesthesia. At the clothing of peritoneum, the initial bolus doses were 3 mg morphine (M group), 0.15 mg buprenorphine (0.15B group), 0.3 mg buprenorphine (0.3B Group) combined with 0.15% bupivacaine 10 ml and subsequent continous infusion doses were 6 mg morphine plus 0.125% bupivacaine 100 ml (M Group) and 0.6 mg buprenorphine plus 0.125% bupivacaine 100 ml (0.15B, 0.3B Group) during 48 hours. The assessment of analgesic efficacy and side effects were made at arrival of recovery room,postoperative 1, 4, 8, 24, 36, and 48 hours. RESULTS: The pain score during 48 hours was significantly higher in the 0.15B group than in the M group and 0.3B group except the pain score of recovery room. (p<0.05) and the number of patients requiring additional analgesics was higher in 0.15B group than in the M group and 0.3B group but, it was not significant. The incidence of pruritus and urinary retention was significantly higher in M group than in the 0.15B and 0.3B group, and the incidence of sedation, nausea and vomiting was similar in three group. The subjective rating of satisfaction was better in the 0.3B group and M group than in the 0.15B group. CONCLUSION: The above results suggest that continous epidural infusion of 0.6 mg buprenorphine after 0.3 mg buprenorphine initial bolus dose combined with low dose bupivacaine is an advisable method of postoperative pain control in combined spinal epidural anesthesia for cesarean section.
Subject(s)
Female , Humans , Pregnancy , Analgesics , Anesthesia , Anesthesia, Epidural , Bupivacaine , Buprenorphine , Cesarean Section , Clothing , Incidence , Morphine , Nausea , Pain, Postoperative , Peritoneum , Pliability , Pruritus , Receptors, Opioid , Recovery Room , Respiratory Insufficiency , Solubility , Thebaine , Urinary Retention , VomitingABSTRACT
BACKGROUND: Buprenorphine is more potent and has less side effects than morphine. Therefore it can be used instead of morphine in cancer or postoperative pain contol. The aim of this study was to find an effective low dose of buprenorphine in epidural administration for pain control after obstetric-gynecologic surgery. METHODS: Epidural catheters were placed at L2-3 or L3-4 epidural space in all groups. Sixty nine patients were randomized to three epidural infusion group M, B1 and B2. Each group was 23. Group M: 3 mg morphine with 0.5% bupivacaine 10 ml as bolus, morphine 7 mg in 0.125% bupivacaine 100 ml in infusor; group B1: 0.068 mg buprenorphine with 0.5% bupivacaine 10 ml as bolus, buprenorphine 0.17 mg in 0.125% bupivacaine 100 ml in infusor; group B2: 0.11 mg buprenorphine with 0.5% bupivacaine 10ml as bolus, buprenorphine 0.24 mg in 0.125% bupivacaine 100 ml in infusor. Pain score, side effects and frequency of adjuvant analgesics were recorded at postoperative 1, 2, 6, 12, 24 and 48 hours. RESULTS: There was statistically significant difference of pain score at postoperative 1, 2 and 12 hrs in group B1 (p<0.05). Frequency of adjuvant analgesic was significantly increased in group B1. But there was no significant difference between group M and B2 in pain score. CONCLUSIONS: Our results suggest that buprenorphine 0.11 mg as bolus and 0.24 mg for 2 days are the optimal dose in continuous epidural administration for postoperative pain contol.