Comparison of Post-operative Analgesic Efficacy of Caudal Epidural Bupivacaine Versus Bupivacaine and Neostigmine Combination in Infraumbilical Surgeries in Children.

Spinal muscarinic M1 receptors are believed to be involved in the analgesic properties of spinal neostigmine. Aims were to determine the effect of adding neostigmine to bupivacaine on the duration of caudal analgesia as compared with caudal bupivacaine alone, to determine the need for rescue analgesics in the post-operative period. Material and Methods: 50 patients of ASA Grade I and II, aged between 2 to 8 years, of either sex underwent infraumbilical surgeries. Post-operative caudal epidural analgesia was activated after completion of the surgery and before recovery from anaesthesia Group-A (n=25) received caudal epidural injection of preservative free bupivacaine 0.125%. 2 mg/kg, Group-B (n=25) received both preservative free bupivacaine 0.125% and neostigmine 2μg/kg. Results and Analysis: After extubation children were evaluated for pain using the CHEOPS pain scale, shows no significant difference between the two study groups at 2 post-operative hours. Group B patients required less rescue analgesic than Group A patients in 24 hrs postoperative period. Conclusion: Addition of neostigmine to bupivacaine in caudal epidural bupivacaine prolonged the duration of caudal analgesia in the post-operative period compared to caudal bupivacaine alone.

Clinical Effects of Patient-controlled Epidural Analgesia in Children / 临床麻醉学杂志

Objective: To evaluate the feasibility and safety of postoperative patient-controlled epidural analgesia (PCEA)in children. Methods: Forty postoperative pediatric patients(5-11 years old)were divided into two groups. A and B. Both wereinstituted with postoperative PCEA with LCP model (loading dose 2.05 + 0.13ml), continuos infusion rate 0.82 + 0.15mi/h, PCA dose 0.81 + 0.16ml)by Graseby-9300 PCA pump. The PCEA solution of group A was 0.075% bupivacaine plus0.0012 % buprenorphine, that of group B was same while 0. 005% droperidol was added as an adjuvant. Results:The volumeof PCEA sdution consumption in group B was significantly less than that in group A on the first and second postoperative day (P< 0.01-0.05). Good analgesic efficiency with little side effects was obtained, as evaluated by the VASF emasay or D/D score and complications in two groups, but the analgesic effect of group B was better than that of group A. Conclusion: Thepediatric PCEA with low concentration of bupivaeaine plus buprenorphine is feasible and safe. Droperidol may enhance theanalgesic effects of PCEA.

Effects of Epidural Ketamine for Postoperative Pain Management / 대한마취과학회지

BACKGROUND: Ketamine hydrochloride, NMDA receptor antagonist is a potent analgesic and anesthetic. Other analgesics, like opioid, have been shown to effectively relieve postoperative pain when infused into epidural space, but effects of ketamine hydrochloride infused into epidrual space for postoperative pain control is still controversial, and therefore the present study was undertaken. METHODS: Ninety adult patients (ASA I or II) scheduled for upper abdominal and chest surgery were randomized into ketamine and fentanyl groups. For all patients, informed consent was obtained preoperatively. Anesthesia was induced with thiopental sodium/succinylcholine and maintained with nitrous oxide/oxygen/enflurane. Skeletal muscle relaxation was maintained with vecuronium. Epidural catheterization was done after operation. Ketamine group received epidural bolus of 0.1% bupivacaine 10 ml followed by continuous epidural infusion of 0.1% bupivacaine 100 ml containing ketamine 200 mg. Fentanyl group received epidural bolus of 0.1% bupivacaine 10 ml containing fentanyl 100 microgram followed by continuous epidural infusion of 0.1% bupivacaine 100 ml containing fentanyl 600 microgram. Continuous infusion rate was 2 ml/hr in both groups. Analgesic effects were assessed using VAS (visual analogue score), PHS (Prince Henry score) and PRS (pain relief score). Side effects and number of patients using additional analgesics were evaluated. RESULTS: Analgesic effects were significant in both group after drug administration. But fentanyl group had greater analgesic effects than ketamine group. Fentanyl group experienced side effects such as pruritus (27 cases), nausea and vomiting (9 cases). Ketamine group had side effects such as nausea and vomiting (13 cases). Number of patients using additional analgesics were seven and twenty-four in the fentanyl and ketamine groups, respectively. CONCLUSIONS: We conclued continuous epidural infusion of ketamine had fewer analgesics effect at early state of postoperative pain than fentanyl.

Analgesic Effect with Epidural Bupivacaine and Verapamil in Lower Abdominal Surgery / 대한마취과학회지

BACKGROUND: Activation of N-methyl-D-aspartic acid (NMDA) receptors leads to Ca++ entry into the cell and initiates a series of central sensitization such as wind up and longterm potentiation in the spinal cord. Therefore, it can be postulated that the central sensitization would be prevented by blocking Ca++ entry with verapamil. In this double-blind study, we administered lumbar epidural bupivacaine or bupivacaine plus verapamil to verify whether preoperative epidural anesthesia can preempt postoperative pain and to investigate the possible role of calcium channel blocker, verapamil, in the central sensitization. METHODS: Sixty patients (ASA class I-II) scheduled for lower abdominal surgery were randomly assigned to one of three groups of equal size. Group 1 (PR) is preincisional epidural bupivacaine group. Group 2 (PO) is postincisional epidural bupivacaine group. Group 3 (PRV) is preincisional epidural bupivacaine and verapamil group. Visual analogue pain and mood scores, Prince Henry Scores, sedation scores, cumulative PCA (patient controlled analgesia) morphine consumptions, and the incidence of side effects were assessed at 2, 6, 12, 24, 48 hours after operation. RESULTS: Cumulative PCA morphine consumptions in PRV group was significantly lower than in PR and PO group at 24, 48 hours after surgery. The incidence of side effects had no difference among three groups. CONCLUSIONS: Preoperative epidural anesthesia with 10ml of bupivacaine would be insufficient to preempt postoperative pain in lower abdominal surgery. However, addition of verapamil to preoperative epidural bupivacaine would decrease postoperative pain possibly by preventing the establishment of central sensitization.

The Effects of Epidural Clonidine Added to Bupivacaine , Fentanyl and Epinephrine after Total Abdominal Hysterectomy / 대한마취과학회지

Epidurally administered clonidine, a selective alpha2-adrenergic agonist, has been reported to produce postoperative analgesia. The aim of this study was to see if the addition of a small dose of clonidine to a mixture of bupivacaine, fentanyl and epinephrine prolonged the duration of analgesia and reduce the number of injections or the total bupivacaine requirement and the incidence of side effects. Forty patients presenting for TAH in ASA physical status 1 or 2, were randomly divided into two groups group 1 was given a 10 ml epidural solution of bupivacaine 12.5 mg combined with fentanyl 50 pg and epinephrine 50ug ; group 2 was given the same solution with clonidine 75 ug. Changes in the systolic and diastolic blood pressure and the pulse rate were recorded at 5, 10, 20, 30, 45, 60, 75, 90, 105 and 120 minutes after drug administration, and the analgesic effects were assessed by measuring pain score (Prince Henry Score), analgesic duration, total bupivacaine requirement for 24 hours and side effect. The results were as follows; 1) Heart rate changed little in group 1 and decreased significantly in group 2. 2) Systolic and diastolic blood pressure decreased significantly in all groups (earlier in group 2 than in group 1). 3) The mean duration of analgesia was significantly prolonged in group 2, compared with group 1 (437 min in group 2; 229 min in group 1). For 24 hours after the first injection, numbers of injections (6 in group 1; 3.15 in group 2) and total bupivacaine requirements (75.0 mg in group 1 ; 39.1 mg in group 2) were significantly reduced. 5) The side effects including hypotension, nausea and vomiting, pruritus, and respiratory depression were not significantly different from each other. These results show that epidurally administered clonidine helps to prolong analgesic duration, and decreased need for supplemental bupivacaine, after lower abdominal surgery.

Analgesic effects of continuous epidural infusion of morphine and bupivacaine after cesarean section / 대한마취과학회지

This study was undertaken to evaluate the analgesic effect of the combination of epidural morphine and bupivaeaine versus epidural morphine alone for postoperative pain. In a ran- domized study, epidural infusions of morphine combined with bupivacaine were compared with bolus epidural injection of morphine alone for postoperative analgesia at rest and dur- ing mobilization and coughing in 80 patients after elective cesarean section. Eighty patients were divided into 2 groups ; M (control) group ; bolus administration of morphine (4mg) and bolus reinjection (4mg) after 24 hours, MB (experimental) group ; bolus administration of morphine (1.5mg) and continuous administration of bupivscaine and morphine (7mg morphine in normal saline 7ml plus 100ml of 0.2% bupivacaine) with the Baxter infusor. Static and dynamic pain scores at 6, 12, 24, 36, 48 hours after operation were examined and side effects were recorded. The results were as follows ; 1) Static VAS was significantly lower in group MB compared with group M at 12, 24, and 36 hours (p< 0.05). 2) Dynamic VAS was significantly lower in group MB compared with group M throughout the study (p<0.01). 3) Pruritus was greater in group MB than in group M but statiscally not significant. 4) Nausea was greater in group M than in group MB but stetiscally not significant. 5) None of patients had respiratory depression. We concluded that continuous epidural infusion of bupivacaine and morphine is more useful than morphine alone for post operative pain management after cesarean section.

Epidural Morphine Does not Reduce Mean Inspired Concentration of Isoflurane in Humans during General Anesthesia / 대한마취과학회지

The effect of epidural morphine on the mean inspired concentration of isoflurane was inves- tigated in 34 patients undergoing hepatoma surgery, The patients were randomly assigned to the control(CTRL), epidural morphine(MORP) or epidural bupivacaine(BUPI) groups. Before induction of anesthesia, epidural catheter was inserted beween T6-10 intervertebral space in the right lateral decubitus position. MORP group(n=13) received morphine sulfate 4 mg in 4 ml normal saline and BUPI group(n=10) received 0.5% bupivacame 10 md through epidural eatheter. CTRL group(n=11) wss treated in an identical fashion except that, after placement of epidural catheter, nothing was injected. After endotracheal intubation, general anesthesia was maintained during surgery with oxygen-nitrous oxide(1:1 ratio) and isoflurane. Inspired concentration of isoflurane was adjusted to maintain blood pressure in the range of blood pressure at the ward during surgery. Mean inspired concentration of isoflurane was monitored from incision to last skin suture. Mean inspired concentration of isoflurane(+/-SD) of CTRL, MORP and BUPI group was 1.41+/-0.36, 1.52+/-0.39 and 0.37+/-0.16 vol%, respectively. There was no difference in mean inspired concentration of isoflurane between CTRL and MORP group. Under the condition of this study, epidural morphine did not reduce inspired concentration of isoflurane during surgery even though epidural morphine is effective for post operative pain control.

Continuous Epidural Infusion of Fentanyl / Bupivacaine Mixtures for Analgesia after Thoracotomy / 대한마취과학회지

Post-thoracotomy pain is so severe that may lead to postoperative complications, such as sputum retention, atelectasis, pneumonia and respiratory failure. These complications are associated with shallow breathing and inability to cough due to pain. To reduce postoperative pulmonary complications and improve respiratory mechanics, effective pain relief is essential. Among the many methods, epidural administrations of narcotics or local anesthetics have been shown to provide profound relief of postoperative pain. Forty-five patients undergoing thoracotomy were randomized into three groups based on a postoperative pain regimen as indi-cated: Group I; intermittent intramusculal injections of nalbuphine 0.2mg/kg for pain control(n= 15) Group II; intermittent epidural injections of mixtures of 0.2% bupivacaine and fentanyl 3 ug/ ml (n=15) Group III: continuous epidural infusion of mixtures of 0.2% bupivacaine and fentanyl 3 ug/ml at a rate of 4-5 ml/hr with supplementation on pain complaint. We evaluated postoperative pain score at 30 minutes, 8 hours, 16 hours, 24 hours, 32 hours, 40 hours, and 48 hours after thoracotomy. And we observed the duration of analgesia and the incidence of systemic side effects of three methods. The results were as follows; 1) The pain score was significantly decreased in group III compared to group I and II<0. 05). 2) The mean duration of analgesia was significantly longer in group III compared to group I and II(p<0.05). 3) the number of case of systemie side effects in group I was one case of nausea and vomiting, in group II, two cases of mild hypotension, and one case of nausea and vomiting, pruritus, headache, and urinary retention each respectively and in group III, one case of ruinary retention.

The Influence of Fentanyl on the Action of Epidural Bupivacaine / 대한마취과학회지

The effects of epidural fentanyl in combination with 0.5% bupivacaine were observed in randomized 60 patients undergoing lower abdominal surgery. The time of onset, segmental spread and duration of analgesia, changes in arterial blood pressure and heart rate and the incidence of side effects were observed after epidural injection of the drugs. The patients were divided into three groups; Group I: 0.9% NaCl 2 ml combined with 20ml of 0.5% bupivacaine, Group II: 0.9% NaCl 1ml and fentanyl 50ug (1 ml) combined with 20 ml of 0.5% bupivacaine, Group III: fentanyl 100 ug (2ml) combined with 20 ml of 0.5% bupivacaine. The results were as follows. 1) The time of onset was significantly short in group III (P < 0.01) 2) The level of sensory blockade 30 minutes after epidural injection in group III was 2-3 segments higher than group I. 3) The mean duration of analgesia was significantly long in group III compared to groups I and II (P<0.01). 4) The cardiovascular changes were not significantly different among the patients of the three groups.6) The side effects including mild hypotension, nausea and vomiting, voiding difficulty, itching and backache were not significantly different in the occurrence among the patients of the three groups. From the above results, it is suggested that fentanyl 100ug combined with 0.5% bupivacaine for epidural anesthesia has some benefits in its onset, spread and postoperative analgesia.

The Influence of Fentanyl on the Action of Epidural Bupivacaine / 대한마취과학회지

The effects of epidural fentanyl in combination with 0.5% bupivacaine were observed in randomized 60 patients undergoing lower abdominal surgery. The time of onset, segmental spread and duration of analgesia, changes in arterial blood pressure and heart rate and the incidence of side effects were observed after epidural injection of the drugs. The patients were divided into three groups; Group I: 0.9% NaCl 2 ml combined with 20ml of 0.5% bupivacaine, Group II: 0.9% NaCl 1ml and fentanyl 50ug (1 ml) combined with 20 ml of 0.5% bupivacaine, Group III: fentanyl 100 ug (2ml) combined with 20 ml of 0.5% bupivacaine. The results were as follows. 1) The time of onset was significantly short in group III (P < 0.01) 2) The level of sensory blockade 30 minutes after epidural injection in group III was 2-3 segments higher than group I. 3) The mean duration of analgesia was significantly long in group III compared to groups I and II (P<0.01). 4) The cardiovascular changes were not significantly different among the patients of the three groups.6) The side effects including mild hypotension, nausea and vomiting, voiding difficulty, itching and backache were not significantly different in the occurrence among the patients of the three groups. From the above results, it is suggested that fentanyl 100ug combined with 0.5% bupivacaine for epidural anesthesia has some benefits in its onset, spread and postoperative analgesia.