Comparison of intravenous Lornoxicam and fentanyl combined with midazolam on analgesia during extracorporeal shock wave lithotripsy

Various sedative and analgesic medications have been used for shockwave lithotripsy [SWL]. This study compare the analgesic and side effects of intravenous lornoxicam with that of intravenous fentanyl, in combination with midazolam in ESWL. One hundred patients were randomly divided into two groups; group A [n = 50] received 16 mg lornoxicam i.v. 30 min before ESWL and group B [n = 50] received 2 microg/kg fentanyl i.v. 3 min before ESWL. All patients received 2 mg midazolam i.v. 3 min before ESWL for intraoperative sedation. Pain intensity was evaluated on a visual analog scale [VAS]. A supplemental analgesia with intravenous fentanyl 25 micro g was given when complained of pain, changed position, or grimaced in response to the shockwaves. The level of sedation was determined using the Observer's Assessment of Alertness/Sedation [OAS/S]. Oxygen supplement through a face mask was given when the SpO[2] fell below 94%. Side effects [nausea, vomiting, dizziness] and the time of discharge from post-anesthesia room [PAR] were recorded. There were no differences between two groups in the demographic data, number of shock waves, duration of ESWL procedure, and fentanyl supplement. The incidence of oxygen supplement was lower in lornoxicam group [5/50] compared with that of fentanyl group [20/50], P < 0.01. The frequency of dizziness was lower in lornoxicam group [3/50] than that in fentanyl group [15/50], P < 0.01. Five patients in fentanyl group complained of nausea, but two did in lornoxicam group. The discharge time from PAR was significantly shorter in lornoxicam group [24.4 +/- 3.23 min] than that in fentanyl group [37.14 +/- 5.82 min], P < 0.01. Intravenous lornoxicam plus midazolam could provide an adequate analgesia as good as fentanyl plus midazolam but with a lower incidence of desaturation, nausea/vomiting and dizziness and could be discharged from PAR earlier. Therefore, we suggest that a single-dose intravenous lornoxicam combined with midazolam is a safe and effective regimen for pain relief in ESWL

Effect of morphine, verapamil or morphine plus verapamil on lidocaine brachial block anaesthesia for orthopaedic surgery

Calcium channel blockers [CCBs] potentiate the analgesic properties of both local anaesthetics and opioids. We examined the analgesic effects of administering morphine, verapamil or its combination into the brachial plexus sheath with lidocaine in 64 unpremedicated patients of physical status 1 or 11, aged 20 - 55 yr and weighing 50 - 80 kg, undergoing upper extremity orthopaedic surgery. All patients received brachial plexus anaesthesia with 40 ml of 1.5% lidocaine and epinephrine 5 ug/ml. in addition, patients were randomly allocated to 1 of 4 groups; Group 1: patients received lidocaine solution, Group 2; patients received morphine 5 mg was added to lidocaine solution; Group 3; patients received verapamil 2.5 mg was added to lidocaine solution and Group 4; patients received morphine 5 mg and verapamil 2.5 mg were added to lidocaine solution. Onset of sensory block, duration of anaesthesia and analgesia were recorded. Postoperatively patients rated their pain [0 - 10] at 1, 6, 12, and 24 hr. Patients were instructed to take paracetamol tablets, every 6 hrs when pain score exceeded 3, and total postoperative analgesia requirements was recorded. Onset of sensory block was similar in the four treatment groups. Duration of anaesthesia [time of abolition of pinprick response] was significantly [p<0.001] increased in those patients receiving brachial plexus blocks with verapamil [groups 3 and 4]. Analgesic duration was significantly increased [p<0.001] in those patients receiving brachial plexus block with morphine [groups 2 and 4]. The total 24hr paracetamol use was also less in those groups [2 and 4], which was significant [p<0.05]. We conclude that, the addition of verapamil to brachial plexus block with lidocaine can prolong the duration of sensory anaesthesia, but it had no effect on analgesic duration of morphine used when both were administered with lidocaine via a brachial plexus route

Ketamine-bupivacaine mixture in spinal anesthesia for TURP, is it beneficial?

The N-methyl-D-aspartate "NMDA" subtype of glutamate receptor is blocked by ketamine and this action likely contributes to ketamine's anesthetic and analgesic properties. 60 patients underwent TURP surgery under spinal anesthesia by randomly using either 10 mg bupivacaine alone or 7.5 mg bupivacaine and ketamine 50 mg without preservatives. The following parameters observe: onset of block, duration, level of block, hemodynamic variables, postoperative analgesia: requirements and adverse side effects. The onset of block was quicker in the mixture group but not significant. Duration of block was shorter with less intravenous fluid requirements in the mixture group such as sedation, dizziness, nystagmus, nausea and vomiting. Ketamine reduces the dose and duration of bupicacaine but does not reduce the postoperative analgesia requirement, and it increases the side effects

Bupivacaine lidocaine epinephrine infiltration as local anaesthetic in middle ear surgery. arrhythmogenic and analgesic potential

Cooperation of patients undergoing middle ear surgery under local anaesthesia provides feed back stat guide, whereas integrity of facial nerve as well as hearing can be tested. Yet, infiltration of epinephrine to produce haemostasis, carries the danger to produce cardiac arrhythmia. This study was conducted to evaluate the arrhythmogenic and analgesic potential of bupivacaine - lidocaine - epinephrine infiltration as local anaesthetic in middle ear surgery. One hundred adult patients of either sex scheduled for middle ear surgery were included in this study. Local anaesthesia was achieved by injection of 5-10 ml of a mixture of bupivacaine, lidocaine epinephrine [1:50.000]. Patients were monitored as regard heart rate, systolic and diastolic blood pressures. Post operative analgesia was, also assessed. There were insignificant increase in heart rate and systolic blood pressure 5 minutes after infiltration which declined gradually near basal value. No arrhythmia was detected. Postoperative analgesia was excellent. In conclusion, bupivacaine - lidocaine epinephrine local infiltration provides excellent surgical anaesthesia, stable haemodynamics and eventual post operative course with high degree of analgesia