A comparative study of epidural 05% bupivacaine with nalbuphine and 05% bupivacaine with fentanyl in lower abdominal and lower limb surgeries

Background: Epidural opioids have unique advantages over conventional, intermittent IV/ IM administration, in that patients given epidural opioids have fewer respiratory complications and can be mobilized sooner in the postoperative period. Aim: To compare the effects of epidural 0.5%Bupivacaine with nalbuphine and 0.5% bupivacaine with fentanyl in lower abdominal and lower limb surgeries. Materials and methods: This prospective, randomized, single blind study, where in Epidural Nalbuphine (10 mg) with 0.5% bupivacaine and epidural fentanyl (50 g) with 0.5% bupivacaine in lower abdominal and lower limb surgeries. Results: There were statistically no significant difference between mean age, weight, gender, ASA grading, types of surgeries and baseline parameters in both groups. The duration of surgery and time of onset of sensory blockade, motor blockade and peak motor blockade were not statistically significant (p> 0.05). The duration of sensory blockade was highly significant (p < 0.01). Duration of motor blockade was not statistically significant (p > 0.05). Mean heart rates in both the groups were significant only at 6th, 7th, 8th, 9th and 10th hours. Mean arterial pressures in both the groups were significant only at 3rd, 6th, 7th, 8th, 9th and 10th hours. 30% of patients in group A had a pain score more than 4 during 6-12 hours of postoperative period as compared to 80% in group B. The pain scores were similar in both the groups in the first six hours of postoperative period. Number of rescue Nama Nagarjuna Chakravarthy, A Sagar, G. Venkateshwarlu. A comparative study of epidural 0.5% bupivacaine with nalbuphine and 0.5% bupivacaine with fentanyl in lower abdominal and lower limb surgeries. IAIM, 2018; 5(2): 124-134. Page 125 analgesics required in the first 24 hours of post-operative period in group B were significantly higher (p < 0.01) when compared with group A. 4 patients (13.2%) in Group B experienced respiratory depression which is significant statistically. Conclusions: Epidural Nalbuphine with 0.5%bupivacaine significantly prolongs the total duration of sensory blockade with better postoperative analgesia when compared to epidural fentanyl with 0.5%bupivacaine, with stable hemodynamics and less side effects.

Effects of Epidural Fentanyl on Speed and Quality of Block for Emergency Cesarean Section in Extending Continuous Epidural Labor Analgesia Using Ropivacaine and Fentanyl

We performed a prospective, randomized, and double-blind study comparing the top-up effects of 2% lidocaine/100 microgram fentanyl/epinephrine (n=31) and 2% lidocaine/saline/epinephrine (n=30) when extending an epidural labor analgesia using low-dose ropivacaine and fentanyl. Survival analysis for the sensory blocks to the T4 level showed no statistically significant differences in onset time to T4 between the 2 groups. Onset times (min) to T4-sensory blocks for cold and pinprick were not different between the two groups. However, median maximum sensory level in the lidocaine-fentanyl group (T1 for cold and T2 for pinprick) was significantly higher than that in the lidocaine-saline group (T3 and T4, respectively). The lidocaine-fentanyl group exhibited less visceral pain (6.5% vs. 36.7%), less supplementation of lidocaine (6.5% vs. 43.3%), and less nausea (6.5% vs. 26.7%) compared with the lidocaine-saline group during the intraoperative period. It is concluded that adding fentanyl to 2% lidocaine does not speed up the onset of the block when the onset is tested with cold or sharp pinprick but improves the quality of analgesia with fewer side effects in emergency top-up for cesarean section.

A Comparative Study on Epidural Fentanyl, Bupivacaine, Lidocaine, and Intravenous Fentanyl in Patients Undergoing Gastrectomy under General Anesthesia / 대한마취과학회지

Backgronud : Postoperative pain control became anesthesiologist's familiar yield, so many anesthesiologists are very interested in opioid and local anesthetic's characterestics and there cardiovascular effects. It's important which anesthetic has the best pain killing and the least cardiovascular effect. We used epidural opioid and local anesthetics and intravenous opioid to investigate their pain killing and cardiovascular effects. METHODS: We studied 50 patients undergoing gastrectomy. An epidural catheter was placed via the T8-9 or L1-2 interspace. Epidural fentanyl group (Ep-F) received fentanyl 2 microgram/kg in 10ml saline, epidural bupivacaine group (Ep-B), 10 ml 0.25% bupivacaine, and epidural lidocaine group (Ep-L), 10 ml 1.5% lidocaine, epidurally; intravenous fentanyl group (IV-F) received fentanyl, 2 microgram/kg. 50% of the original dose was repeated every hour until the operation ended. Control group was given nothing before general anesthesia. Cardiovascular data was compared between those before and those at 1hour after skin incision. The time interval between end of the operation and the time of first analgesic requirement and the total number of intramuscular analgesic requirements during the first 48hours postoperatively were compared. RESULTS: Urinary output during surgery was significantly larger in group Ep-F. Group Ep-L developed more frequent episodes of hypotension. Group Ep-F, group IV-F and control group required higher enflurane concentrations. CONCLUSIONS: Group Ep-F was accompanied less hypotension and postoperative analgesic requirements were reduced.

Influence of Clonidine on the Analgesic Effect of Epidural Fentanyl / 대한마취과학회지

The influence of clonidine on the analgesic effect of epidural fentanyl was investigated in 45 patients who underwent total abdominsl hysterectomy by epidural admistration of fentanyl 100 g alone, clonidine 150ug alone, or in combination of the two drugs. Changes in the mean arteral pressure and pulse rate were observed after drug administration, and the analgesic effects was assessed by measuring analgesic duration, pain score, sedation score, and side effects. Analgesic duration was prolonged with improved quality by adding 150 ug of clonidine to 100 ug of epidural fentanyl. Mean arteral pressure and pulse rate were decreased more in fentanyl plus clonidine group than each drug alone group. But these changes were restored rapidly by injection of small dose of vasopressor. The clonidine alone group showed the least analgesic effect among three groups indicatings that clonidine would not be a sole analgesic agent and would be used as an adjunct to other opiate such as fentanyl.