Search

Background: The present study was conducted to assess the efficacy of epidural fentanyl with a combination of epidural fentanyl and magnesium in lower extremity surgery. Subjects and Methods : This study was conducted on 100 ASA I/II patients scheduled to undergo elective lower limb orthopedic surgeries. Group I patients received epidural fentanyl 50 µg (1cc) diluted and made up to 6cc with normal saline. Group II patients received epidural fentanyl 50 µg (1cc)+ Magnesium sulphate 50mg (4 units in insulin syringe of 50% solution) diluted and made up to 6cc with normal saline. Patient data such as indication for surgery, the anesthetic details, intraoperative monitoring, post-operative follow-up, etc was recorded. Results: Each group had 36 males and 14 females. Time is taken for the highest sensory level in group I was 13.92 4.50 minutes and 12.24 3.43 minutes in groups I and II respectively. The mean duration of surgery was 99.00 13.31 minutes in group I and 92.20 15.21 in group II. Time for Regression to L1 was 118.80 13.41 and 119.60 17.85 minutes in group I and II respectively. The duration of analgesia (min) was 107.00 25.82 and 143.40 39.57 minutes in group I and II respectively. Common adverse events were nausea/ vomiting seen 2 in group I and 4 in group II and urinary retention seen 0 in group I and 2 in group II. The difference was non- significant (P> 0.05). Conclusion: Authors found that the addition of magnesium sulfate to epidural fentanyl for elective lower limb orthopedic surgeries has prolonged the duration of fentanyl analgesia without any significant side effects.

Background Skin-to-skin contact after birth between mother and baby has immediate and long-term advantages. Widstrom's 9 Stages of Newborn Behavior offer an opportunity to evaluate a baby in the natural, expected and optimal habitat. Intrapartum drugs, including fentanyl administered via epidural and synthetic oxytocin (synOT), have been studied in relation to neonatal outcomes with conflicting results. Aims Determine the effects of common intrapartum medications on the instinctive behavior of healthy newborns during the first hour after birth through a prospective cohort study. Study design Video record newly-born term infants during the first hour after birth while in skin-to-skin contact with mother. Code and analyze videos using Widstrom's 9 Stages; compare with the labor medications mothers received. Subjects Convenience sample of sixty-three low-income mothers self-selected to labor with or without intrapartum analgesia. Outcome measures Duration of time infants spend in each of Widstrom's 9 Stages for four cohorts: 1) exposed to no synOT or epidural fentanyl during labor, 2) exposed to fentanyl (but not synOT), 3) exposed synOT (but not fentanyl), 4) exposed to both fentanyl and synOT. Results A strong inverse correlation was found between intrapartum exposure to fentanyl and synOT and the normal behavior of an infant, as measured by time in each Stage. Conclusions Intrapartum exposure to the drugs fentanyl and synOT is associated with altered newborn infant behavior, including suckling, while in skin-to-skin contact with mother during the first hour after birth. Widstrom's 9 Stages offer an opportunity to analyze newborn behavior whilst in the optimal habitat of the infant.

BACKGROUND Combined Spinal Epidural Anaesthesia (CSEA) is frequently used for its rapid onset of analgesia and good patient satisfaction. In this group, various types of intrathecal intervention are possible. The aim of the present study has been designed to evaluate the quality of analgesia when intrathecal fentanyl 25 mcg was given along with epidural 0.0625% bupivacaine 10 cc with fentanyl 2 mcg/mL in one group in companion with another group who has been given intrathecal fentanyl 25 mcg given long with epidural 10 cc bupivacaine 0.1% with fentanyl 2 mcg/mL. MATERIALS AND METHODS The parturients who fulfilling selection criteria were randomised and divided into two groups, group A and group B each having 30 patients. Group A were given intrathecal fentanyl 25 mcg with epidural 0.0625 mg bupivacaine 10 mL plus fentanyl 2 mcg/mL. Group B here received intrathecal fentanyl 25 mcg with epidural 0.1% bupivacaine 10 mL plus 2 mcg/mL fentanyl. A long with routine preparation of normal delivery, parturient baseline HR, RR and BP was recorded. RESULTS Parameters total dose of bupivacaine required in group A was 30.46 mg, and in group B, it was 20.62 mg, which was not significant statistically. Total dose of fentanyl was 60.86 mcg in group A and 59.42 mcg in group B, which not significant. Mean of total number of top-up required in group A and group B was 4.02 and 3.96, respectively. Total volume of epidural drugs required was 30.9 mL in group A and 29.46 mL in group B. Height of dermatome reached up to T8 in 18 patients in group A; in 6 patients, it reached up to T9; and in 6 patients, it reached up to T10. Similarly, height of dermatome reached in group B up to T8 in 16 patients, up to T9 in 7 patients and up to T10 in 6 patients. CONCLUSION We would like to conclude that both dose of bupivacaine is associated with quality of labour analgesia, but dose requirement for 0.1% bupivacaine was less. Both are associated with no motor blocked and duration of labour was decreased and also not associated with any vital parameter abnormality.

Background: Fentanyl as an epidural additive act on spinal opioid receptors, while dexmedetomidine has selective alpha-2 receptor agonist action enhancing analgesic effects. Aims: We aimed to compare the postoperative analgesic efficacy of single doses of dexmedetomidine against fentanyl as epidural adjuvant to 0.125% bupivacaine. Settings and Design: A prospective, randomized, controlled, double-blind trial was conducted in a tertiary care teaching institute. Patients and Methods: Forty-six patients undergoing abdominal surgery under general anesthesia with epidural analgesia were allocated into two groups to receive postoperative analgesia with single doses of 10 mL 0.125% bupivacaine with the addition of dexmedetomidine 0.5 μg.kg-1 (Group D) or fentanyl 0.5 μg.kg-1 (Group F). The primary outcome was the duration of postoperative analgesia between the two groups. The secondary outcomes were hemodynamic variations, vasopressor need, and motor blockade. Statistical Analysis: Chi-square test for static parameters and Student's t-test or Mann–Whitney test for continuous variables were used for analysis. Results: The duration of analgesia was longer in Group D (5.0 ± 2.0 h) versus Group F (2.9 ± 1.4 h), Sixteen patients in Group D versus seven patients in Group F needed vasopressors after the bolus to maintain the blood pressure (BP) within 20% of prebolus value (P = 0.018). Heart rate and mean and systolic BP were lower in Group D at various time points following bolus administration. Conclusion: A single dose of dexmedetomidine as an additive to epidural local anesthetic postoperatively prolongs the duration of analgesia in comparison to fentanyl but is associated with changes in hemodynamics, including the need for the administration of vasoactive drugs.

BACKGROUND Epidural fentanyl is commonly used for initiation of early labor analgesia. The aim of this prospective study is to test the hypothesis that duration of epidural fentanyl analgesia differs in nulliparous women requesting epidural analgesia in early labor who are variant allele carriers of the OPRM1 SNVs 118A>G rs1799971, IVS2+31G>A rs9479757, and IVS2+691G>C rs2075572. METHODS Two hundred and twenty parturients who received epidural analgesia with fentanyl were included in the 118A>G analysis, and a 196 sub-cohort was included in the IVS2+31G>A and IVS2+691G>C exploratory analysis. Peripheral blood DNA was genotyped using Taqman allele discrimination assays. RESULTS One hundred and seventy-four subjects (79%; 95% CI: 74-84) were homozygous for the wild type OPRM1 118A>G SNV (AA), and forty-six subjects (21%; 95% CI: 16-26) were heterozygous AG (N.=40) or homozygous GG (N.=6) for the variant allele. The minor allele frequency (MAF) was hence 12%. The MAFs for the IVS2+31G>A and IVS2+691G>C SNVs in the sub-cohort of 196 participants were 5% and 59% respectively. There was no significant difference in duration of epidural fentanyl analgesia for the three SNVs (161±68 and 143±51 min for wild type and allele carriers of the 118A>G SNV respectively [P=0.08]). Similarly, no significant differences were shown with the visual analog scale scores, side effects, and satisfaction for each of the three SNVs. CONCLUSIONS OPRM1 SNVs did not affect the duration of epidural fentanyl administered for early labor analgesia in nulliparous women. These results should be confirmed in patients receiving epidural opioids in other clinical settings.

AIMS AND OBJECTIVES Magnesium has antinociceptive effects in animal and human models of pain. It is found that the addition of Magnesium sulphate to postoperative Epidural infusion of Fentanyl may decrease the need for Fentanyl. We undertook a study to compare the duration of postoperative analgesia after Epidural Fentanyl and Epidural Fentanyl plus Magnesium sulphate administered postoperatively, along with side effects. MATERIALS AND METHODS 50 patients undergoing elective lower limb and abdominal surgeries were randomized into one of the two groups with 25 patients in each group. Combined Spinal Epidural Anaesthesia was used for all patients. Spinal anaesthesia with 2.5 cc of 0.5% Hyperbaric Bupivacaine was given. When sensory blockade regressed to L1, patients were given either 50 µg of Fentanyl (diluted to 6cc with normal saline, Group F) or 50 µg of Fentanyl plus 50 mg Magnesium sulphate (diluted to 6cc with normal saline, Group FM). Parameters like blood pressure, pulse rate, respiratory rate and oxygen saturation were monitored, and other side effects were noted. Data were analysed by using Student t test and Chi-square/ Fisher Exact tests. RESULTS There was significant difference in duration of analgesia between Group F (107 min) and Group FM (143 min). Hemodynamic parameters were stable in both the groups with minimal side effects. CONCLUSION Co-administration of Magnesium sulphate with Fentanyl for postoperative Epidural analgesia results in prolongation of Fentanyl analgesia without significant side-effects.

Local anesthetics combined with opioids are commonly used in labor epidural analgesic schemes. This study investigated if the addition of fentanyl to epidural ropivacaine can affect cervical dilation and progress of vaginal delivery.Sixty-two nulliparous parturients were randomized to receive epidurally 8 ml ropivacaine 0.2% combined with fentanyl 20 μg (F/R-group, n = 31) or with normal saline 0.4 ml (R-group, n = 31), every hour. Rescue doses of 5 ml ropivacaine 0.2% were also administered. Measurements were performed every 60 min until full cervical dilation. The primary end-point was the time to reach 10-cm cervical dilation. Secondary outcomes were Bishop scores, mode of delivery, total ropivacaine dose, pain, and satisfaction scores (numerical scale, 0-10).Data from 60 parturients (29 in the F/R and 31 in the R-group) were analyzed. The F/R-group had 26 vaginal deliveries (four instrumentally assisted), and three cesarean deliveries. The R-group had 27 vaginal deliveries (six instrumentally assisted) and 4 cesarean deliveries. Time to 10-cm cervical dilation did not differ between the groups (4 ± 2.4 h in the F/R-group vs 4.4 ± 2.1 h in the R-group, p = .341). The number of women remaining in the study every hour until full cervical dilation and Bishop scores for a 4-h period did not differ between the groups (p = .617). Total ropivacaine dose was comparable between the groups, but the F/R-group reported significantly lower pain (p = .01) and higher satisfaction scores (p = .001).The addition of fentanyl to ropivacaine 0.2% solution did not affect cervical dilation and progress of the first stage of labor, but improved both analgesia and satisfaction.

Background:Breastfeeding is an important public health concern. High cumulative doses of epidural fentanyl administered for labor analgesia have been reported to be associated with early termination of breastfeeding. We tested the hypothesis that breastfeeding success is adversely influenced by the

We performed a prospective, randomized, and double-blind study comparing the top-up effects of 2% lidocaine/100 microg 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.

Summary We studied whether delivering postoperative analgesia, using a patient-controlled epidural analgesia (PCEA) device was effective and safe in elderly patients. We enrolled 40 patients aged > 65 years (elderly group) and 40 patients aged 20–64 years (young group) scheduled for elective major abdominal surgery. PCEA infusion was started following completion of surgery. Mean (SD) fentanyl consumption (10.7 (3.7) compared with 10.5 (2.7) lg.kg )1 ,p = 0.76) and number of times patients pressed the bolus switch (32 (36) compared with 44 (38), p = 0.16) during the first 24 h postoperatively were similar in the two groups. Pain scores, which were similar in both groups at rest, were significantly lower in the elderly on coughing (at 24 h, p < 0.05). In addition, average pain scores were similar at the time of PCEA bolus demands in the two groups. Elderly and young adult patients therefore required similar amounts of patient-controlled epidural fentanyl to produce satisfactory pain relief.

BACKGROUND: In this study, we compared rates of postoperative nausea and vomiting (PONV) and pruritus after using different protocols for administering epidural droperidol. METHODS: Using the same dose of droperidol, we evaluated the effectiveness of three different methods of administration (single, continuous, and combined) on the frequency of PONV and pruritus induced by continuous infusion of epidural fentanyl for 48 h postoperatively. One hundred sixty ASA physical status I and II patients who underwent surgical resection for colorectal cancer under general anesthesia combined with epidural anesthesia were randomly allocated into four groups: (a) control group (no droperidol), (b) single injection group (droperidol 2.5 mg), (c) continuous group (droperidol 1.25 mg/day) and (d) combined single (droperidol 1.25 mg) and continuous (droperidol 0.625 mg/day) group. RESULTS: Pruritus and PONV were significantly less frequent in all droperidol groups, when compared with the control group (P < 0.05). The incidence and the incidence over time of PONV were similar among all groups who received epidural droperidol. CONCLUSION: Epidural droperidol is effective for reducing pruritus and PONV, regardless of the method of administration.

OBJECTIVES The aim of the study was to evaluate pharmacokinetics of fentanyl administered as continuous epidural infusion with 0.2% ropivacaine for postoperative pain relief in infants and toddlers, and older children undergoing major abdominal and urological procedures. METHODS Thirteen infants and toddlers (median age 14 [range 3-36] months, 11 [5-17] kg, Group I) and 11 children (68 [45-131] months, 21 [16-52] kg, Group II) participated in the study. Epidural catheter was placed under general anesthesia in the L1-L2, L2-L3, or L3-L4 epidural space and threaded up to 4 cm into the epidural space. Bolus dose of 0.2% ropivacaine, 0.5 ml·kg(-1) and fentanyl, 2 μg·kg(-1) was given, then followed by continuous infusion of 0.2% ropivacaine, 0.15 ml·kg(-1) ·h(-1) with fentanyl 1.12 μg·kg(-1) ·h(-1) . In the postoperative period, fentanyl dose was reduced to 0.375 μg·kg(-1) ·h(-1) . RESULTS With this dosing regimen, fentanyl concentration in plasma was within the range of analgesic concentrations, and did not exceed 1.0 ng·ml(-1) . After discontinuation of epidural infusion, pharmacokinetics of fentanyl was complicated by a slight increase in plasma concentration during the elimination phase. Both elimination half-life of fentanyl (t1/2, MRT ) and mean residence time (MRT) were much longer than those observed after single IV bolus dose, and longer in Group I than in Group II (t1/2 MRT 15.9 [3.6-31.5] h vs 8.0 [7.1-13.3] h, P

Summary Background Ketamine is a NMDA receptor blocker, which has been used to reduce central sensitisation. This study is aimed to evaluate the preemptive effect of IV S(+)-ketamine (0.5 mg/kg) for hysterectomy. Methods Thirty patients aged 18–60 years, Physical State (ASA) I or II, were randomly distributed into two groups: G1 patients received IV 0.5 mg/kg of S(+)-ketamine 20 min (min) before surgical incision and saline 20 min after surgical incision. G2 received saline 20 min before surgical incision and IV S(+)-ketamine (0.5 mg/kg) after surgical incision. The patients had general anaesthesia. In the postoperative period, analgesia was maintained with epidural fentanyl. Pain was assessed by numerical scale at T0 (arousal), and T6, T12, T18, T24 later. The time interval for the first request of additional analgesia and the total amount of analgesic consumption were reported. Results There was a statistical difference between the groups in the median values of pain intensity in T0 on the numerical scale (G1 = 3.00; G2 = 9.00). The time interval to require the first analgesic supplement was longer in the G1 than G2 (45.33 min versus 9.66 min; p = 0.04; Mann–Whitney's test). There was a statistical difference between G1 and G2 in the total dose of epidural fentanyl required for supplementation (G1: 103 μg; G2: 203 μg; p Conclusion In this study, pre-incisional S(+)-ketamine (0.5 mg/kg) had a preemptive effect in hysterectomy.

Objectives To compare the effectiveness of two different methods for epidural analgesia in the second stage of labour—fentanyl alone versus the usual mixture of bupivicaine and fentanyl. Design A double-blind, randomised, controlled trial. Setting An English maternity hospital. Sample Eighty nulliparous women in the second stage of labour. Methods After successful institution of epidural analgesia with a continuous infusion of bupivicaine/fentanyl mixture in the first stage of labour, the patients were randomised at full dilatation to receive either continuation of the same solution or a change to a fentanyl-only solution given at the same rate. Main outcome measures Mode of delivery, duration of the second stage and quality of analgesia. Results There was no difference in the number of instrumental deliveries (30%vs 27.5%) or the duration of the second stage (141 vs 147 minutes) between the bupivicaine/fentanyl and fentanyl groups, respectively. The bupivicaine/fentanyl group demonstrated a lower need for rescue epidural analgesia (1 vs 6, RR 0.2, 95% CI 0.02–1.3) and significantly fewer high pain scores (11 vs 20, RR 0.6, 95% CI 0.3–1.0). Conclusion Second stage epidural analgesia with fentanyl did not alter delivery outcomes or labour duration but resulted in poorer analgesia.

Spinal fentanyl can improve analgesia during Caesarean section. However, there is evidence that, following its relatively short-lived analgesic effect, there is a more prolonged spinal opioid tolerance effect. The effectiveness of postoperative epidural fentanyl analgesia may therefore be reduced following the use of spinal fentanyl at operation. This randomised, double-blind study was designed to assess whether patient-controlled epidural fentanyl could produce effective analgesia following 25 microg of spinal fentanyl at operation. Patients undergoing elective Caesarean section received spinal bupivacaine combined with either fentanyl 25 microg (fentanyl group; n = 18) or normal saline (saline group; n = 18). Patient-controlled epidural fentanyl was used for postoperative analgesia. The fentanyl group used a mean of 23.4 (SD 14.5) microg x h(-1) of fentanyl, compared with 27.0 (10.8) microg x h(-1) for the saline group (p =0.41). Using a 0-100 mm visual analogue score for pain, the maximum pain score recorded at rest for the fentanyl group was median 24 [IQR 15-35] mm, compared with 15 [13-45] mm for the saline group (p = 0.41). The maximum pain score recorded on coughing for the fentanyl group was 29 [24-46] mm, compared with 27 [19-47] mm for the saline group (p = 0.44). Nine of the fentanyl group rated postoperative analgesia as excellent and nine as good, compared with 10 of the saline group who rated it as excellent and eight as good (p = 0.74). Epidural fentanyl can produce effective analgesia following the use of 25 microg spinal fentanyl at Caesarean section.

Epidural opioids have been recently used for postoperative pain relief. The present study was conducted for comparing the efficacy of analgesia produced by epidural pentazocine and fentanyl for lower limb surgeries. In this prospective double-blind study, 60 patients of either sex belonging to ASA grade I and II, aged 20-60 years were equally divided into two groups to receive either 50μg fentanyl + 20 mL of 0.5% bupivacaine (Group I) or 30 mg pentazocine + 20 mL of 0.5% bupivacaine (Group II) epidurally for the lower limb orthopedic surgeries. Patients were observed for onset, duration, and potency of analgesia with both the drugs besides side effects. Both the drugs produced significant analgesia (assessed by Magill's classification of degree of pain). Onset of analgesia was similar for both the drugs, but pentazocine showed significant longer duration of action than fentanyl. The incidence of side effects was also similar for both the drugs. Epidural pentazocine provides longer duration of analgesia than epidural fentanyl with similar side effects.

上腹部手術時の硬膜外大量フェンタニル(F) (0.01mg/kg)麻酔にモルヒネ(M) (0.06mg/kg)を混合投与した際の,循環動態に及ぼす影響と術後鎮痛効果を検討した.対象を7名ずつ硬膜外F+M投与(FM)群,硬膜外リドカイン+M投与(LM)群および硬膜外F単独投与(F)群の3群に分けた.いずれの群も笑気とセボフルランによる全身麻酔を併用した.LM群では他の2群と比べ術中の昇圧薬と輸液の投与量が有意に多かった.F群はFM群より高いセボフルラン濃度を必要とした.また,FM群は他群と比べ術後の鎮痛薬使用頻度が有意に少なかった.各群とも重篤な副作用は認められなかった.麻酔開始時の硬膜外腔へのフェンタニルとモルヒネの混合投与は,術中・術後管理のうえで有用と考えられた.