Comparative study of intrathecal fentanyl, tramadol, clonidine mixed with bupivacaine for peri and post operative pain relief in lower limb and lower abdominal surgery

Background: Pain relief is of paramount importance in patients undergoing surgery during perioperative and post-operative period. After effective pain relief a smoother post-operative period and early discharge from the hospital is anticipated. Intrathecal and epidural narcotics have been widely used to relieve pain and provide post-operative analgesia. Here three drugs tramadol, fentanyl, and clonidine used as adjuvant with bupivacaine in intrathecal injection for post-operative pain relief and comparative study had been done.Methods: After the study protocol was approved by the Ethical clearance committee of the DMCH, Laheriasarai, Bihar. Study design was prospective, randomized and double-blind techniques. A group of 80 patients undergoing lower abdominal and lower limb surgery were included in the study. Every patient was fully explained about the anaesthesia and surgical procedure before inclusion in the study. The patients were in the (25-65) years age group and belonged to the American Society of Anaesthesiologist (ASA) physical status class I-II and scheduled for lower abdominal and lower limbs surgery were randomly allocated to four groups with equal number: group B [Bupivacaine (35)% 3 cc + 0.4 cc normal saline], group BT [Bupivacaine (5)% 3 cc + 25 mg tramadol], BC [Bupivacaine (0.5)% 3 c.c + 30 μg clonidine], BF [Bupivacaine (0.5)% 3 c.c + 20 μg fentanyl]. All additive drugs used intrathecally were preservative free. All intrathecal punctures were performed in the lateral (Right or Left) position with a (25G) Quinke needle, using the midline approach at the L3-L4 intervertebral space.Results: The study revealed that administration of additives in group BC and group BF did prolong analgesia. In group B, duration of analgesia and mean duration of rescue analgesic requirement was (3.57±0.45) hrs. For group BC it was (9.47±0.85) hrs, for group BF (7.6±1.14) hrs, for group BT (3.72±0.42) hrs.Conclusions:Addition of adjuvants (Fentanyl, Clonidine) to intrathecal bupivacaine for perioperative pain relief does prolong postoperative analgesia and improves the intraoperative quality of analgesia than bupivacaine alone.Background: Pain relief is of paramount importance in patients undergoing surgery during perioperative and post-operative period. After effective pain relief a smoother post-operative period and early discharge from the hospital is anticipated. Intrathecal and epidural narcotics have been widely used to relieve pain and provide post-operative analgesia. Here three drugs tramadol, fentanyl, and clonidine used as adjuvant with bupivacaine in intrathecal injection for post-operative pain relief and comparative study had been done.Methods: After the study protocol was approved by the Ethical clearance committee of the DMCH, Laheriasarai, Bihar. Study design was prospective, randomized and double-blind techniques. A group of 80 patients undergoing lower abdominal and lower limb surgery were included in the study. Every patient was fully explained about the anaesthesia and surgical procedure before inclusion in the study. The patients were in the (25-65) years age group and belonged to the American Society of Anaesthesiologist (ASA) physical status class I-II and scheduled for lower abdominal and lower limbs surgery were randomly allocated to four groups with equal number: group B [Bupivacaine (35)% 3 cc + 0.4 cc normal saline], group BT [Bupivacaine (5)% 3 cc + 25 mg tramadol], BC [Bupivacaine (0.5)% 3 c.c + 30 μg clonidine], BF [Bupivacaine (0.5)% 3 c.c + 20 μg fentanyl]. All additive drugs used intrathecally were preservative free. All intrathecal punctures were performed in the lateral (Right or Left) position with a (25G) Quinke needle, using the midline approach at the L3-L4 intervertebral space.Results: The study revealed that administration of additives in group BC and group BF did prolong analgesia. In group B, duration of analgesia and mean duration of rescue analgesic requirement was (3.57±0.45) hrs. For group BC it was (9.47±0.85) hrs, for group BF (7.6±1.14) hrs, for group BT (3.72±0.42) hrs.Conclusions: Addition of adjuvants (Fentanyl, Clonidine) to intrathecal bupivacaine for perioperative pain relief does prolong postoperative analgesia and improves the intraoperative quality of analgesia than bupivacaine alone.

Comparative Study of Efficacay of Intrathecal Fentanyl and Intrathecal Tramadol Added as Adjuvant to 05% Hyperbaric Bupivacaine in Patients Undergoing Surgeries Under Spinal Anaesthesia

In view of the safety and limited duration of spinal anaesthesia, many adjuvants have been used to increase the duration of analgesia as well as quality of block. Aim: The study was undertaken to compare tramadol with the commonly used injection fentanyl when used as adjuvant to intrathecal bupivacaine on the spinal anaesthesia block characteristics. Design: Prospective, randomized, double blind study. Methods: 60 ASA grade I and II patients, undergoing infraumbilical and lower limb surgeries were randomly divided into two groups. All patients received 3 ml of 0.5% hyperbaric bupivacaine along with either 0.4ml (20mg) tramadol (group BT) or 0.4ml (20µg) fentanyl (group BF) intrathecally. The two groups had comparable results with respect to maximum sensory level achieved and the onset of sensory block. Results: The duration of block was 161.33±18.43 in group BT, while it was 267.8±556.7 in group BF (p=0.001). The duration of motor block was also prolonged (group BT: 155.83±13.96 versus group BF: 264.67±52.57; p=0.001). The side effects were comparable in both the groups. Conclusion: There was greater prolongation of both sensory and motor block when fentanyl was used as adjuvant intrathecally as compared to tramadol.

The effects of adjuvant intrathecal fentanyl on postoperative pain and rebound pain for anorectal surgery under saddle anesthesia / 대한마취과학회지

BACKGROUND: Intrathecal opioid has been known to enhance the quality and prolong the duration of spinal anesthesia, as well as to reduce postoperative pain. The purpose of this study was to evaluate postoperative analgesic characteristics of intrathecal fentanyl for the first 48 hours after anorectal surgery under saddle anesthesia. METHODS: Eighty patients were recruited in our study. Forty patients were randomly allocated to group B that received 0.5% bupivacaine 5 mg with 0.3 ml normal saline. The other 40 patients were assigned to group BF which was given 0.5% bupivacaine 5 mg with fentanyl 15 μg. The primary outcome variable was a numeric rating scale (NRS) at six hours postoperatively. Secondary outcomes included changes in the NRS score between one and 48 hours postoperatively, consumption of rescue analgesics, and the frequency of rebound pain. RESULTS: Group BF exhibited a lower mean NRS score at postoperative six hours compared to group B (P < 0.001). However, the mean NRS score was not different after postoperative six hours between the two groups. The median consumption of rescue analgesics in group BF was less than that of group B (P = 0.028) and the frequency of rebound pain decreased in group BF when compared to group B (P = 0.021). The levels of sensory block were S1 dermatome and motor block scores were 0 for both groups. There was no significant difference in adverse effects between the groups. CONCLUSIONS: Intrathecal fentanyl 15 μg for anorectal surgery under saddle anesthesia led to an improved pain score for the first six hours after surgery and decreased postoperative analgesic use. Rebound pain diminished with intrathecal fentanyl and adverse effects did not increase.

Comparison of clinical effects according to dosage of fentanyl added to 0.5% hyperbaric bupivacaine for spinal anesthesia in patients undergoing cesarean section

BACKGROUND: Spinal anesthesia for cesarean section is widely used technique for rapid induction, high success rate and excellent intraoperative and postoperative analgesia. Potentiating the effect of intrathecal local anesthetics by addition of opioid for cesarean section is well known. In this study, we compared the clinical effects when different doses of fentanyl were combined with intrathecal hyperbaric bupivacaine. METHODS: Ninety six healthy term parturients were randomly divided into four groups: Group C (control), : Group F10 (fentanyl 10 microg), : Group F15 (fentanyl 15 microg), F: Group F20 (fentanyl 20 microg). In every group, 0.5% heavy bupivacaine was added according to the adjusted dose regimen. We observed the maximal level of the sensory block and motor block, the quality of intraoperative analgesia, the duration of effective analgesia and the side effects. RESULTS: There were no significant differences between four groups in maximal level and recovery rate of sensory and motor block. Quality of intraopertive analgesia and muscle relaxation was increasing by increasing dosage of intrathecal opioids. Duration of effective analgesia was significantly prolonged in Group F15 and F20 than Group C and F10, but there were no differences between Group F15 and F20. And the frequencies of side effects such as hypotension, max sedation level were increasing by increasing dosage of intrathecal opioids. The Apgar scores were normal, and there were no differences between the four groups. CONCLUSIONS: The addition of fentanyl 15 microg for spinal anesthesia provides adequate intraoperative analgesia and good postoperative analgesia without significant adverse effects.

The effects of intrathecal fentanyl for spinal anesthesia in lower extremity surgery / 대한마취과학회지

BACKGROUND: Intrathecal opioids in combination with bupivacaine has been shown to provide adequate sensory blockade and early recovery from spinal anesthesia. This study was investigated the added effects of intrathecal fentanyl 10 microgram to bupivacaine for spinal anesthesia. METHODS: Sixty patients undergoing lower extremity surgery were into three groups. Group I received bupivacaine 10 mg (0.5%), gruop II received bupivacaine 5 mg with normal saline 1 ml, and group III received bupivacaine 5 mg with fentanyl 10 microg and normal saline 0.8 ml. RESULTS: There was no significant difference between group I and group III in the peak level and duration of sensory block. But the intensity of motor blockade was decreased in group III compared with group I and side effects of spinal anesthesia with local anesthetics was decreased in group III compared with group I. In Group II, 7 patients were complained the pain during surgery. CONCLUSIONS: Intrathecal fentanyl 10 microgram with bupivacaine 5 mg on spinal blockade provide reliable anesthesia for lower extremity surgery.

The Effect of Intrathecal Morphine Added to Continuous Femoral 3-in-1 Nerve Block for Analgesia after Total Knee Replacement / 대한마취과학회지

BACKGROUND: Most of the patients who received a 3-in-1 nerve block for analgesia after total knee replacement (TKR) complained of pain in the back of the knee. We investigated the value of an intrathecal (IT) morphine in patients receiving continuous 3-in-1 nerve block with a PCA technique for pain control after unilateral TKR. METHODS: Group 1 (n = 20) received spinal anesthesia with IT fentanyl 10microgram. Group 2 (n = 20) received spinal anesthesia with IT morphine 0.1 mg. All patients received continuous 3-in-1 nerve block performed with 20 ml of 0.25% bupivacaine with epinephrine 1 : 200000, followed by a continuous infusion of 0.125% bupivacaine at the rate of 2 ml/h plus PCA boluses of 1 ml with a lockout of 10 min. The intensity of pain at rest and on movement was assessed by the patients using a visual analog scale (VAS) for the first 2 postoperative days. RESULTS: Patients in Group 2 reported significantly lower VAS pain scores at rest than those in Group 1 for the first 1 day (P < 0.05). Cumulative PCA bolus use of 0.125% bupivacaine in Group 2 was significantly lower than those in Group 1 for the first 2 days (P < 0.05). The incidences of pruritus in Groups 1 and 2 were 0 and 50%, respectively (P < 0.01). CONCLUSIONS: We determined that the addition of IT morphine 0.1 mg to continuous femoral 3-in-1 nerve block improves postoperative analgesia after TKR.

Effect of Intrathecal Fentanyl with Hyperbaric Bupivacaine on Unilateral Spinal Anesthesia for Knee Arthroscopy / 대한마취과학회지

BACKGROUND: Unilateral spinal anesthesia prolongs sensory blockade and provides hemodynamic stability. Intrathecal opioids enhance spinal anesthesia without prolonging motor recovery or hemodynamic side effects. The author evaluated the effect of intrathecal fentanyl on unilateral spinal blockade with hyperbaric bupivacaine for knee arthroscopy. METHODS: Thirty-six healthy patients undergoing unilateral knee arthroscopy randomly received unilateral spinal anesthesia with 0.5% hyperbaric bupivacaine 4 mg (Group I) or 0.5% hyperbaric bupivacaine 4 mg combined with fentanyl 10 microgram (Group II). A lateral decubitus position was maintained for 15 minutes after intrathecal injection. The level and duration of sensory and motor blockade were recorded. RESULTS: The regression time of sensory block by two segments on dependent site was prolonged on Group II more than Group I (P < 0.05). There was no significant difference between two groups in recovery time of sensory and motor block. Unilateral sensory block was observed in 18 patients in Group I (100%) and in 2 patients in Group II (11%). Hemodynamic side effects were minimal in both groups, but pruritus was observed in 6 patients in Group II (33%). CONCLUSIONS: Small dose of intrathecal fentanyl with bupivacaine unilateral spinal anesthesia prolonged the duration of sensory block on operated site, but did not increase side effects and the duration of motor block and recovery. But intrathecal fentanyl with bupivacaine made disturbance of successful unilateral spinal block by the sensory block of nonoperated site.

The Effect of Intrathecal Fentanyl on Hypnotic Requirement of Propofol during Spinal Anesthesia / 대한마취과학회지

BACKGROUND: Intrathecal opioid, a useful adjunct to prolong analgesic effects, potentiates spinal anesthesia. The present study was designed to evaluate the effect of intrathecal fentanyl on the hypnotic requirements of propofol during spinal anesthesia. METHODS: Sixty patients scheduled for elective urologic surgery under spinal anesthesia were randomly assigned to one of four groups. In Group 1 (n =15), spinal anesthesia was performed with hyperbaric bupivacaine 10 mg, in Group 2 (n = 15) with hyperbaric bupivacaine 10 mg plus fentanyl 10microgram, in Group 3 (n = 15) with hyperbaric bupivacaine 10 mg plus fentanyl 20microgram, and in Group 4 (n = 15) with hyperbaric bupivacaine 10 mg plus fentanyl 30microgram. After performing spinal anesthesia, the target plasma concentration of propofol was set at 2.0microgram/ml. Effect site concentration (Ce) was measured when the BIS's reached 80 or 70. Ce was titrated to maintain a BIS of 70-80. Observer's sedation scoring (OAA/S), systolic and diastolic pressures, SpO2 and total infusion dose were measured every 10 minutes for 1 hour. RESULTS: Ce's at a BIS of 80 were 1.2+/-0.3microgram/ml (Group 1), 1.0+/-0.3microgram/ml (Group 2), 0.9+/-0.2microgram/ml (Group 3), and 0.8+/-0.2microgram/ml (Group 4), respectively. Ce's at a BIS of 70 were 1.6+/-0.2microgram/ml (Group 1), 1.5+/-0.4microgram/ml (Group 2), 1.2+/-0.3microgram/ml (Group 3), and 1.2+/-0.3microgram/ml (Group 4), respectively. Ce's of Group 3 and Group 4 at BISs of 70 and 80 were significantly lower than those of Group 1 (P<0.05), and the propofol requirements of Groups 3 and 4 to maintain a BIS of 70-80 were significantly less than those of Group 1 (P<0.05). CONCLUSIONS: These results indicate that adding more than 20microgram of fentanyl to hyperbaric bupivacaine for spinal anesthesia reduces the hypnotic requirement of propofol.