Addition of Fentanyl or High-Dose Morphine to Bupivacaine Is Superior to Bupivacaine Alone during Single-Shot Spinal Anesthesia.

BACKGROUND: Single-shot spinal anesthesia (SSSA) with bupivacaine is a useful technique for pain control during the active phase of labor due to its simplicity and rapid onset. In this study, we evaluated the efficacy of the addition of fentanyl or high-dose morphine to bupivacaine during SSSA. METHODS: Ninety healthy consecutive multiparous parturients in the active phase of progressing labor (cervical dilatation ≥7 cm; pain score >4) requesting analgesia were included in this study. The patients were randomly allocated into 3 SSSA groups as follows: group 1 (n = 30) receiving 2.5-mg hypobaric bupivacaine alone, group 2 (n = 30) receiving a combination of 2.5-mg hypobaric bupivacaine and 10-µg fentanyl, and group 3 (n = 30) receiving a combination of 2.5-mg hypobaric bupivacaine and 0.5-mg morphine. The duration of analgesia, VAS scores, side effects, and obstetric and neonatal outcomes were compared. RESULTS: The main gestational age and cervical dilatation of the patients were 38.7 ± 1.5 months and 7.2 ± 2.2 cm (p = 0.14 and p = 0.65), respectively. The main VAS score significantly decreased in all groups at 3 h from baseline: from 8.25 to 1.75 in group 1, from 7.61 to 1.28 in group 2, and from 8.12 to 1.26 in group 3 (p < 0.001). The duration of the second phase of delivery was similar in all groups (45.5, 44, and 38 min, respectively; p = 0.67). The total analgesia duration was significantly higher in group 3 (172, 180, and 190 min for groups 1, 2, and 3, respectively; p = 0.01). The Apgar scores and fetal heart rates were similar in all groups (p = 0.95). Side effects were similar, except for pruritus in group 3 (p = 0.01). CONCLUSION: The addition of fentanyl or high-dose morphine to bupivacaine increases the efficacy and duration of SSSA in the active phase of progressing labor without increasing side effects.

Comparison of the effects of magnesium and ketamine on postoperative pain and morphine consumption. A double-blind randomized controlled clinical study.

PURPOSE: To compare the effects of magnesium sulfate and ketamine on postoperative pain and total morphine consumption in a placebo-controlled design. METHODS: One hundred and twenty women scheduled for total abdominal hysterectomy were included in this prospective, randomized, double-blind study. Postoperatively, when the Numeric Pain Rating Scale (NPRS) was four or more, IV-PCA morphine was applied to all patients. The patients were randomized into three groups: Group K ketamine, Group M magnesium, and Group C saline received as infusion. Total morphine consumption for 48h, pain scores, adverse effects, and patients' satisfaction were evaluated. RESULTS: Total morphine consumption was significantly lower in Group K (32.6±9.2 mg) than in Group M (58.9±6.5 mg) and in Group C (65.7±8.2 mg). The satisfaction level of patients in Group K was higher than the other two groups (p<0.05). Pruritus and nausea were observed more frequently in Group C. CONCLUSION: The addition of ketamine to IV-PCA morphine reduces the total consumption of morphine without psychotic effects; however, magnesium did not influence morphine consumption.

Comparison of the effects of magnesium and ketamine on postoperative pain and morphine consumption. A double-blind randomized controlled clinical study

PURPOSE: To compare the effects of magnesium sulfate and ketamine on postoperative pain and total morphine consumption in a placebo-controlled design. METHODS: One hundred and twenty women scheduled for total abdominal hysterectomy were included in this prospective, randomized, double-blind study. Postoperatively, when the Numeric Pain Rating Scale (NPRS) was four or more, IV-PCA morphine was applied to all patients. The patients were randomized into three groups: Group K ketamine, Group M magnesium, and Group C saline received as infusion. Total morphine consumption for 48h, pain scores, adverse effects, and patients' satisfaction were evaluated. RESULTS: Total morphine consumption was significantly lower in Group K (32.6±9.2 mg) than in Group M (58.9±6.5 mg) and in Group C (65.7±8.2 mg). The satisfaction level of patients in Group K was higher than the other two groups (p<0.05). Pruritus and nausea were observed more frequently in Group C. CONCLUSİON: The addition of ketamine to IV-PCA morphine reduces the total consumption of morphine without psychotic effects; however, magnesium did not influence morphine consumption.

[Comparison of the effects of lidocaine, lidocaine plus tramadol and lidocaine plus morphine for intravenous regional anesthesia]. / Intravenöz rejyonal anestezide kullanilan lidokain, lidokain-tramadol ve lidokain-morfinin etkinliklerinin karsilastirilmasi.

OBJECTIVES: The aim of this study was to compare the effects of lidocaine alone and those of morphine or tramadol when added to lidocaine for intravenous regional anesthesia (IVRA) on tourniquet pain, the onset and regression time of motor and sensory block, the level and duration of analgesia, and analgesic consumption. METHODS: After institutional approval and informed consent, 90 patients scheduled for forearm or hand surgery were enrolled and randomly assigned to one of three groups for administration of either 0.5% lidocaine (Group L), 0.5% lidocaine with 1.5 mg.kg(-1) tramadol (Group LT), or 0.5% lidocaine with 0.1 mg.kg(-1) morphine (Group LM) in a volume of 40 ml. The onset and duration of sensory and motor blocks, duration of analgesia and proximal and distal tourniquet, time to first pain medication, visual analog scale (VAS) scores, analgesic requirements in 24 hours, vital signs, and side effects were recorded. RESULTS: Sensory block onset time was significantly shorter in Group LM compared with the other groups and also in Group LT compared to Group L. In addition, sensory block regression time was significantly shorter in Group L than in Group LM (p<0.05). There was a significant increase in VAS scores at the postoperative 4th and 5th hr in Group L (p<0.05). Mean arterial blood pressure was significantly reduced in Group LM at the time of tourniquet deflation (p<0.05). CONCLUSION: IVRA with lidocaine and morphine or tramadol improves postoperative analgesia and sensory block. However, these combinations provide no advantage on tourniquet pain, motor block quality, analgesia duration or analgesic consumption.