Dexamethasone As Adjuvant To Intratheacal Bupivacaine

Spinal Analgesia is most preferred technique of regional analgesia for surgeries below umbilical region. The most commonly used drug is Bupivacaine heavy for the procedures lasting for 90 to 120 minutes. Sometimes procedures last longer requiring supplementation of anaesthesia or sedation. Various additives have been tried for prolongation of analgesia duration like Epinepherine, clonidine and opiods. Opiods can prove risky in elderly patients. Corticosteroids have shown positive effect on quality of sensory blocks and post operative analgesia on peripheral nerves. The purpose of this study was to evaluate the effect of Dexamethasone as adjuvant to intrathecal Bupivacaine, on onset time and duration of spinal analgesia. Material and Method: Sixty patients between 18 to 65 years of age belonging to ASA group I and II were studied. Patients were divided into two groups of 30 patients each. Study group received intrathecal 15 mg (3 ml) of 0.5% hyperbaric Bupivacaine heavy and 8 mg (2.0ml) of preservative free Dexamethasone(Total 5.0 ml solution) and control group received intrathecal 15 mg (3 ml) of 0.5% hyperbaric Bupivacaine heavy with 2.0 ml normal saline (Total 5.0 ml solution). Highest level of sensory block was noted and marked. It was evaluated every 5 minutes till 4 sensory segment level regression from highest level. Onset time and duration of sensory block were noted. Patients were monitored in post operative period for any symptoms. Conclusion: Addition of Dexamethasone with Bupivacaine has shown prolongation of duration of sensory block and decreased the requirement of analgesics in postoperative management

Current Evidence for Spinal Opioid Selection in Postoperative Pain

BACKGROUND: Spinal opioid administration is an excellent option to separate the desirable analgesic effects of opioids from their expected dose-limiting side effects to improve postoperative analgesia. Therefore, physicians must better identify either specific opioids or adequate doses and routes of administration that result in a mainly spinal site of action rather than a cerebral analgesic one. METHODS: The purpose of this topical review is to describe current available clinical evidence to determine what opioids reach high enough concentrations to produce spinally selective analgesia when given by epidural or intrathecal routes and also to make recommendations regarding their rational and safety use for the best management of postoperative pain. To this end, a search of Medline/Embase was conducted to identify all articles published up to December 2013 on this topic. RESULTS: Recent advances in spinal opioid bioavailability, based on both animals and humans trials support the theory that spinal opioid bioavailability is inversely proportional to the drug lipid solubility, which is higher in hydrophilic opioids like morphine, diamorphine and hydromorphone than lipophilic ones like alfentanil, fentanyl and sufentanil. CONCLUSIONS: Results obtained from meta-analyses of RTCs is considered to be the 'highest' level and support their use. However, it's a fact that meta-analyses based on studies about treatment of postoperative pain should explore clinical surgery heterogeneity to improve patient's outcome. This observation forces physicians to use of a specific procedure surgical-based practical guideline. A vigilance protocol is also needed to achieve a good postoperative analgesia in terms of efficacy and security.

Analgésicos por via espinal / The spinal analgesia

Justificativa e objetivos: A sinapse medular é local importante para modulação da dor, com inúmeros receptores e canais iônicos onde os fármacos podem interagir reduzindo a transmissão da dor. O objetivo desta revisão foi descrever os principais medicamentos utilizados por via espinal. Conteúdo: Foram descritos os analgésicos utilizados por via espinal, as indicações, os mecanismos de ação e os efeitos colaterais. Conclusões: Vários agentes podem ser utilizados por via espinal, contudo, apesar de evidências clínicas e experimentais, todos provocam efeitos colaterais ou neurotoxicidade. É importante conhecer as indicações e contraindicações de cada substância e poder explorar o efeito sinérgico da combinação desses agentes para reduzir os efeitos colaterais e aumentar a eficácia...

Spinal Anesthesia Using 0.5% Hyperbaric Bupivacaine/Meperidine Mixture for Cesarean Section / 대한마취과학회지

BACKGROUND: Spinal anesthesia for cesarean section is regaining popularity because it can prevent pulmonary aspiration, failure of endotracheal intubation, depression of neonate by anesthetic agent in general anesthesia. Meperidine is unique in having significant local anesthetic properties that differentiate with morphine and fentanyl. Therefore, we compared the effects of adding meperidine 25 mg to intrathecal bupivacaine with fentanyl mixture. METHODS: Sixty parturients were allocated (n = 30 per group) to group 1; 0.5% hyperbaric bupivacaine 7.5 mg plus meperidine 25 mg and group 2; 0.5% hyperbaric bupivacaine 10 mg plus fentanyl 25 microgram in random order. Time to reach T4 sensory level, starting time of surgery, maximal spread of sensory block, incidence of complications, duration of motor block, perioperative analgesic effects, duration of postoperative analgesia were evaluated. We observed Apgar score and umbilical cord blood gas analysis for evaluation of the status of neonate. RESULTS: There were no significant differences in Time to reach T4 sensory level, starting time of surgery, maximal spread of sensory block, incidence of hypotension, perioperative analgesic effects, duration of motor block and neonatal status between two groups. The incidence of intraoperative nausea was greater in group 1 (60%) compared to the group 2 (20%) but the incidence of postoperative nausea and vomiting were not significantly different between two groups. Duration of postoperative analgesia was longer in group 1 (576.4 +/- 197.8 min) compared to the group 2 (192.6 +/- 75.5 min). CONCLUSIONS: Addition of meperidine 25 mg to intrathecal bupivacaine for Cesarean section improves intraoperative analgesia and also provides postoperative analgesia without significant adverse effects on the mother and neonate.

Effecet of intrathecal injection of 6-OHDA or ?_1-adrenoceptor antagonist on the spinal analgesia of ketamine / 中国药理学通报

Aim To investigate the relationship between spinal cord noradrenergic neurons ? 1 adrenoceptors and the spinal analgesia of ketamine. Methods Kunming mice were used. Analgesia tests were investigated with warm water tail flick test. The effects of intrathecal injection (ith) of ketamine (50,100,200 ?g)on tail flick latency of animals were observed. And the effect of pretreatment with intrathecal 6 hydrodoapa(6 OHDA, 6?g ) and ? 1 adrenoceptor antagonist prazosin (5, 15 ?g) or terazosin (5, 15 ?g) , respectively on the spinal analgesia of ketamine (100 ?g,ith) was studied. Results Dose dependent analgesia was observed following ith ketamine (100,200 ?g, P

Small Dose Intrathecal Morphine for Post-cesarean Analgesia / 대한마취과학회지

BACKGROUND: The aim of this study is to compare duration of analgesia and incidence of adverse effects between two doses of intrathecal morphine in patients after elective ceasrean section. METHODS: Group 1 (n = 31) received morphine 0.1 mg and group 2 (n = 28) received morphine 0.2 mg in addition to intrathecal dose of 2.0 ml of 0.5% bupivacaine in 8% dextrose and fentanyl 15ng. RESULTS: In both groups 1 and 2, excellent postoperative analgesia with long duration was obtained (19.4 +/- 10.1 and 20.5 +/- 11.3 hours, respectively). Fourteen patients (45.2%) in group 1 and 12 patients (42.9%) in group 2 developed mild pruritus that did not require treatment except one patient in group 2 who received nalbuphine 5 mg iv. Incidences of postopertaive nausea or vomiting were not significantly different between the two groups. CONCLUSIONS: Both small doses intrathecal morphine of 0.1 mg and 0.2 mg provided adequate analgesia and patient satisfaction postoperatively with same incidences of side effects.