Naloxone added to bupivacaine or bupivacaine-fentanyl prolongs motor and sensory block during supraclavicular brachial plexus blockade: a randomized clinical trial.

BACKGROUND: In this study, the effect of naloxone on duration of supraclavicular brachial plexus block was evaluated. It was hypothesized that naloxone can increase the duration of neural blockade. METHODS: Sixty-eight patients scheduled for surgery under supraclavicular brachial plexus block were randomly assigned to receive 30 ml bupivacaine (Group C); 30 ml bupivacaine with 100 µg of fentanyl (Group F); 30 ml bupivacaine with 100 ng naloxone (Group N); or 30 ml bupivacaine with 100 µg of fentanyl and 100 ng naloxone (Group N + F). Sensory and motor blockade were recorded at 5, 15, and 30 min following the block, and every 10 min following the end of surgery. Duration of sensory and motor block was considered to be the time interval between the complete block and the first postoperative pain and complete recovery of motor functions. RESULTS: Sensory and motor onset times were the same in all groups. The duration of sensory and motor block in Group C (11.3 ± 1.7 h and 4.56 ± 1.0 h) and Group F (12.8 ± 3.3 h and 5.1 ± 2.0 h) were less than in the other groups (18.1 ± 2.2 h and 6.18 ± 1.0 h in Group N, and 15.8 ± 2.9 h and 6.53 ± 1.1 h in Group N + F, P < 0.0001). CONCLUSION: Addition of naloxone to bupivacaine in supraclavicular brachial plexus block prolonged the duration of the neural blockade.

Cost analysis and safety comparison of Cisatracurium and Atracurium in patients undergoing general anesthesia.

BACKGROUND: Non-depolarizing neuromuscular blocking agents (NMB) differ in pharmacokinetic and pharmacodynamic parameters. An anesthesiologist according to these similarities and differences is able to choose the least costly one if the same safety profile and same clinical benefit achieved with the different alternatives. AIM: The main objective of this study is to evaluate the economic and adverse drug reactions prevalence and differences between cisatracurium and atracurium the two non-depolarizing NMB drugs, which are widely used in adult patients undergoing surgery with general anesthesia in a teaching Hospital in Iran. MATERIALS AND METHODS: A cost analysis and adverse drug reactions (ADR) monitoring were performed. Only direct costs were considered and data were collected through a prospective randomized study. Regardless of the type of surgery, 100 patients were randomly divided into two equal groups to receive either cisatracurium or atracurium by anesthesiologists. ADRs prevalence and cost differences between patients receiving one of the two non-depolarizing NMB agents were evaluated by independent sample t-test and Chi-square test respectively. RESULTS: No significant difference was observed between the two groups of patients in demographic data. There was no statistical difference in the ADR prevalence in both groups. The numbers of ADR within atracurium group was higher than cisatracurium group, but this distinction was not statistically significant (p > 0.05). It was significant difference in cost between the two neuromuscular blocking drugs (p < 0.05). CONCLUSIONS: According to our study it seems that atracurium and cisatracurium had similar safety profile and atracurium had a cost benefit relative to cisatracurium in initial loading doses. In patients with instability in hemodynamic parameters the cisatracurium was the appropriate choice.  

Naloxone infusion and post-hysterectomy morphine consumption: a double-blind, placebo-controlled study.

BACKGROUND: The evidence that an infusion of a low dose of naloxone reduces post-operative pain and opioid analgesic consumption is somewhat conflicting. Thus, the aim of the present study was to investigate the effect of an ultra-low dose of naloxone on patient-controlled morphine analgesia. METHODS: Ninety patients, 35-55 years old, scheduled for total abdominal hysterectomy, were enrolled in this prospective, randomized, double-blind and placebo-controlled study. Post-operatively, they received either saline (n = 45) or naloxone (n = 45) for 24 h. A standard general anesthesia was administered in both groups. In the recovery room, patients received morphine by a patient-controlled analgesia device. An ultra-low dose of naloxone was infused intravenously at 0.25 µg/kg/h for 24 h in the intervention group. Saline was infused in the control group. Following the surgery, morphine consumption, numeric rating score for pain intensity, nausea and vomiting, pruritus, and requests for antiemetic were recorded at baseline, 30 min, 1, 4, 8,16, 20, and 24 h following their discharge from recovery. RESULTS: Naloxone reduced morphine consumption over the first 24 post-operative hours significantly compared with the controls (saline) {19.5 [standard deviation (SD) 3.4] mg vs. 27.5 [SD 5.9] mg; P < 0.001}. The incidence and severity of nausea and vomiting was significantly reduced in the naloxone group. The incidence of pruritus and the pain scores at rest and activity were not significantly different. CONCLUSION: Following hysterectomy, an ultra-low dose of naloxone infusion proved to reduce morphine consumption as well as the incidence and severity of opioid-induced nausea and vomiting.