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Wolla CD, Epperson TI, Woltz EM, Wolf BJ, Bolin ED. Prolongation of spinal duration by escalating doses of intrathecal epinephrine in lower limb arthroplasty. Pain Manag 2023; 13:647-654. [PMID: 37965771 DOI: 10.2217/pmt-2023-0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023] Open
Abstract
Aim: The optimal dose of low-dose intrathecal epinephrine in the absence of intrathecal opioids is unknown. Materials & methods: Prospective, randomized, double blind clinical trial of patients undergoing lower limb arthroplasties. The primary end point was spinal block duration measured via motor and sensory block duration. Results: 30 patients undergoing lower limb arthroplasty were randomized into one of six groups with varying intrathecal epinephrine doses 0-100 mcg. There was a direct linear effect between motor block duration and intrathecal epinephrine dose with higher doses being associated with longer block duration (p = 0.011). Mean motor block duration was 3.74 ± 1.13, 3.36 ± 0.47, 3.39 ± 0.60, 4.06 ± 0.98 and 5.20 ± 1.41 h for the EPI0, EPI25, EPI50, EPI75 and EPI100 groups respectively. Conclusion: This study reveals that low-dose intrathecal epinephrine (75-100 mcg) in the absence of intrathecal opioids can be reliably used to prolong motor block duration in lower limb arthroplasty. Clinical Trial Registration: NCT02619409 (ClinicalTrials.gov).
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Affiliation(s)
- Christopher D Wolla
- Department of Anesthesiology & Perioperative Medicine, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Tom I Epperson
- Department of Anesthesiology & Perioperative Medicine, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Erick M Woltz
- Department of Family Medicine, Prisma Health, Greenville, SC 29605, USA
| | - Bethany J Wolf
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Eric D Bolin
- Department of Anesthesiology & Perioperative Medicine, Medical University of South Carolina, Charleston, SC 29425, USA
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Chiu CC, Liu KS, Wang JJ, Chen YW, Hung CH. Intrathecal dopamine and serotonin enhance motor and nociceptive blockades of lidocaine in rats. Neurosci Lett 2023; 814:137473. [PMID: 37689343 DOI: 10.1016/j.neulet.2023.137473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 09/04/2023] [Accepted: 09/06/2023] [Indexed: 09/11/2023]
Abstract
The study examined the effect of intrathecal injection of dopamine (serotonin) and/or lidocaine. Intrathecal injections of dopamine (serotonin or epinephrine), lidocaine, or their combination were carried out in male Sprague Dawley rats. Neurobehavioral examinations (motor and nociceptive reactions) were performed before and after spinal injection. Intrathecal serotonin (1.5 μmol), dopamine (2.5 μmol), epinephrine (1:40000), and lidocaine (0.75 μmol) produced 29%, 33%, 29%, and 54% nociceptive blockade, whereas serotonin (1.5 μmol), dopamine (2.5 μmol), or epinephrine (1:40000) produced a longer duration of nociceptive blockade than lidocaine (0.75 μmol) (P < 0.05). Serotonin (1.5 μmol), dopamine (1.25 and 2.5 μmol), or epinephrine (1:40000 and 1:80000) prolonged the duration and increased the potency of spinal motor and nociceptive blockades of lidocaine (50% effective dose, ED50) (P < 0.05). The motor and nociceptive blockades caused by lidocaine (ED50) plus dopamine (2.5 μmol) or lidocaine (ED50) plus epinephrine (1:40000) were more outstanding than lidocaine (ED50) plus serotonin (0.75 μmol) (P < 0.05). Our study provides evidence that intrathecal dopamine or serotonin produces spinal nociceptive blockade dose-dependently. Dopamine and serotonin are less potent than lidocaine in inducing spinal nociceptive blockade. When mixed with lidocaine solution, dopamine or serotonin improves spinal motor and nociceptive blockades. The motor and nociceptive blockade caused by lidocaine (ED50) plus dopamine (2.5 μmol) is similar to that caused by lidocaine (ED50) plus epinephrine (1:40000).
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Affiliation(s)
- Chong-Chi Chiu
- Department of General Surgery, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan; Department of Medical Education and Research, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan; School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Kuo-Sheng Liu
- Department of Pharmacy, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Jhi-Joung Wang
- Department of Anesthesiology, Tri-Service General Hospital & National Defense Medical Center, Taipei, Taiwan; Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Yu-Wen Chen
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan; Department of Physical Therapy, College of Health Care, China Medical University, Taichung, Taiwan
| | - Ching-Hsia Hung
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Rambhia MT, DeLeon AM, Bauchat J, Kenny E, Cuppini C, Lopez C, Samworth AG, Farrer J, McCarthy RJ. Effects of Adding Intrathecal Epinephrine to Spinal Anesthesia on Anesthesia-Related Cesarean Delivery Outcomes: Should We Reconsider Its Use? Cureus 2023; 15:e45147. [PMID: 37711273 PMCID: PMC10498415 DOI: 10.7759/cureus.45147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Intrathecal epinephrine is used to increase the duration of spinal anesthesia for amenable surgical procedures anticipated to require additional time; however, in the ambulatory setting, it is associated with a prolonged time to post-anesthesia care unit (PACU) discharge. The current study's authors hypothesized that adding intrathecal epinephrine to spinal anesthesia for cesarean delivery would be associated with a dose-dependent prolonged post-anesthesia unit length of stay. METHODS A single-center, retrospective study of patients undergoing repeat cesarean delivery under spinal anesthesia from 2011 to 2015 was conducted. Patients received spinal bupivacaine 12 mg, morphine 150 mcg, and fentanyl 15 mcg with no-epinephrine, 100 mcg, or 200 mcg of epinephrine. The primary outcome was recovery room length of stay. Secondary outcomes were surgical duration, intraoperative vasopressor use, perioperative opioids, and antiemetic use. RESULTS Data were analyzed for 1,362 patients. Median recovery room stay was 123 min (interquartile range, 100 to 150) and was not different among groups. More women receiving epinephrine 200 mcg had ≥2 prior cesarean deliveries compared with no-epinephrine or 100 mcg. No significant differences in surgical duration or intraoperative opioids were identified among the groups. Median intraoperative vasopressor use was increased by 225 mcg of phenylephrine equivalents (99% CI, 25 mcg to 430 mcg) in the 100 mcg group and 250 mcg of phenylephrine equivalents in the 200 mcg group (99% CI, 75 mcg to 500 mcg) compared to no-epinephrine (P<0.001). Recovery room antiemetic and opioid analgesic administration were not different among groups. CONCLUSIONS Based on the results of this study, the addition of intrathecal epinephrine for women undergoing cesarean delivery increases intraoperative vasopressor use but does not prolong PACU length of stay, reduce intraoperative opioids, or increase antiemetic requirements postoperatively. The current study also demonstrated that surgical duration times were not different among the no-epinephrine, 100 mcg, and 200 mcg epinephrine groups.
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Affiliation(s)
- Milly T Rambhia
- Anesthesiology, Kaiser Permanente Mid-Atlantic Permanente Medical Group, Rockville, USA
| | - Alexander M DeLeon
- Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Jeanette Bauchat
- Anesthesiology, Vanderbilt University Medical Center, Nashville, USA
| | - Eleanor Kenny
- Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Candice Cuppini
- Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Carmen Lopez
- Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Alexander G Samworth
- Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Jason Farrer
- Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, USA
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Ko WH, Cho YH, Jang W, Kim SH, Lee HS, Ko HC, Kwon JH. Hemodynamic protective effects of epinephrine containing saline irrigation in biportal endoscopic lumbar surgery. Medicine (Baltimore) 2022; 101:e29311. [PMID: 35905267 PMCID: PMC9333511 DOI: 10.1097/md.0000000000029311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
During endoscopic orthopedic surgery, epinephrine mixed with irrigation saline is frequently used to improve visualization. By monitoring hemodynamic parameters throughout the procedure, we intended to discover the hemodynamic effect of epinephrine between the normal saline irrigation fluid without epinephrine group (NS) and normal saline irrigation fluid with epinephrine group (EPI). Patients who underwent 1-level lumbar decompression or discectomy surgery without fusion between August 2019 and July 2020 were reviewed retrospectively. The hemodynamic parameters were compared between the NS group and EPI group. As a second endpoint, the incidence of hypotension and hypertension events, expected blood loss, postoperative nausea and vomiting and postoperative epidural hematoma were compared between the 2 groups. The 2 groups were homogeneous in terms of age, sex, weight, height, body mass index (BMI), ASA physical status (ASA PS), and diagnosis. The incidence of hypotension events (67.2 % in the NS group, 45.7 % in the EPI group, P =.015) and severe hypotension events (51.7 % in the NS group, 28.6 % in the EPI group, P = .015) were less frequent in the EPI group. Only epinephrine had a significant protective effect through a multivariable analysis (P = .027, OR = 2.361) and in severe hypotension events, only epinephrine had a significant protective effect through a multivariable analysis (P = .011, OR = 2.818), and EBL was the risk factor through a multivariable analysis (P = .016, OR = 1.002) We believe that the addition of epinephrine to irrigation saline has hemodynamic protective effects in patients who underwent endoscopic lumbar surgery.
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Affiliation(s)
- Woo-Hyeong Ko
- Department of Anesthesiology and Pain Medicine, Seoul Sungsim General Hospital, Seoul, Korea
- *Correspondence: Woo-Hyeong Ko, Department of Anesthesiology and Pain Medicine, Seoul Sungsim General Hospital, 259 Wangsan-ro, Dongdaemun-gu, Seoul 02488, Korea (e-mail: )
| | - Yong-Hyun Cho
- Department of Anesthesiology and Pain Medicine, Seoul Sungsim General Hospital, Seoul, Korea
| | - Won Jang
- Department of Anesthesiology and Pain Medicine, Seoul Sungsim General Hospital, Seoul, Korea
| | - Sun-Hee Kim
- Department of Anesthesiology and Pain Medicine, Seoul Sungsim General Hospital, Seoul, Korea
| | - Hyun-Seok Lee
- Department of Anesthesiology and Pain Medicine, Seoul Sungsim General Hospital, Seoul, Korea
| | - Hyun-Cheol Ko
- Department of Anesthesiology and Pain Medicine, Seoul Sungsim General Hospital, Seoul, Korea
| | - Jae-Hyun Kwon
- Department of Anesthesiology and Pain Medicine, Seoul Sungsim General Hospital, Seoul, Korea
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Abstract
Neuraxial drug administration, i.e., the injection of drugs into the epidural or intrathecal space to produce anesthesia or analgesia, is a technique developed more than 120 years ago. Today, it still is widely used in daily practice in anesthesiology and in acute and chronic pain therapy. A multitude of different drugs have been introduced for neuraxial injection, only a part of which have obtained official approval for that indication. A broad understanding of the pharmacology of those agents is essential to the clinician to utilize them in a safe and efficient manner. In the present narrative review, we summarize current knowledge on neuraxial anatomy relevant to clinical practice, including pediatric anatomy. Then, we delineate the general pharmacology of neuraxial drug administration, with particular attention to specific aspects of epidural and intrathecal pharmacokinetics and pharmacodynamics. Furthermore, we describe the most common clinical indications for neuraxial drug administration, including the perioperative setting, obstetrics, and chronic pain. Then, we discuss possible neurotoxic effects of neuraxial drugs, and moreover, we detail the specific properties of the most commonly used neuraxial drugs that are relevant to clinicians who employ epidural or intrathecal drug administration, in order to ensure adequate treatment and patient safety in these techniques. Finally, we give a brief overview on new developments in neuraxial drug therapy.
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Freundlich A, Gozal E, Grisaru-Granovsky S, Grass A, Bar-Gil Shitrit A, Ioscovich A. Peripartum anesthetic management of patients with inflammatory bowel disease, a retrospective case-control study. Taiwan J Obstet Gynecol 2021; 60:70-77. [PMID: 33495012 DOI: 10.1016/j.tjog.2020.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2020] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE Inflammatory bowel diseases (IBD) are a group of pathologies associated with an increased rate of abortions, premature deliveries, cesarean sections and other morbidity during the peripartum period. The objective of this retrospective study was to investigate the anesthetic management for delivery of women with IBD. MATERIAL AND METHODS The records of patients with IBD, who delivered at our Center, were obtained for data which included anesthetic and obstetric management as well as neonatal outcome. Five subgroups were defined based on mode of delivery, presence or absence of epidural in normal vaginal delivery (NVD) and urgency of cesarean section, each of which was compared with control groups of healthy parturients in the same period. Additionally, the rate of cesarean sections and the use of epidural analgesia for NVD were compared with the general obstetric population of our center in the same period. RESULTS 107 patients with IBD who delivered at our center were studied. The rates of cesarean sections and emergency cesarean sections were significantly higher compared to the general population. However, the rate of instrumental delivery and of epidural analgesia use for NVD were similar. Among those who underwent cesarean sections, no significant differences were found in anesthesia type, surgery duration, number of complications, type of monitoring or postoperative management compared to the control group. CONCLUSION Peripartum anesthetic management of patients with IBD does not differ significantly from that of parturients without it. Anesthesiologists can plan their anesthesia in a similar way as they do in healthy parturients.
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Affiliation(s)
- Andres Freundlich
- Department of Anesthesia, Shaare Zedek Medical Center, Jerusalem, Israel.
| | - Eytan Gozal
- Medical School, Hebrew University of Jerusalem, Israel
| | | | - Ariel Grass
- Department of Anesthesia, Shaare Zedek Medical Center, Jerusalem, Israel
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Kamhawy G, El-Lilly A, Yakout M. Dexmedetomidine as an adjuvant to bupivacaine on combined posterior lumbar plexus and sciatic nerve blocks, is it effective? EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1080/11101849.2019.1609717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Ghada Kamhawy
- Anesthesia Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Ahmed El-Lilly
- Anesthesia Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Mahmoud Yakout
- Anesthesia Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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Tschopp C, Tramèr MR, Schneider A, Zaarour M, Elia N. Benefit and Harm of Adding Epinephrine to a Local Anesthetic for Neuraxial and Locoregional Anesthesia. Anesth Analg 2018; 127:228-239. [DOI: 10.1213/ane.0000000000003417] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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9
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Katz D, Hamburger J, Gutman D, Wang R, Lin HM, Marotta M, Zahn J, Beilin Y. The Effect of Adding Subarachnoid Epinephrine to Hyperbaric Bupivacaine and Morphine for Repeat Cesarean Delivery. Anesth Analg 2018; 127:171-178. [DOI: 10.1213/ane.0000000000002542] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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10
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Das A, Halder S, Chattopadhyay S, Mandal P, Chhaule S, Banu R. Effect of Two Different Doses of Dexmedetomidine as Adjuvant in Bupivacaine Induced Subarachnoid Block for Elective Abdominal Hysterectomy Operations: A Prospective, Double-blind, Randomized Controlled Study. Oman Med J 2015; 30:257-63. [PMID: 26366259 DOI: 10.5001/omj.2015.52] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Improvements in perioperative pain management for lower abdominal operations has been shown to reduce morbidity, induce early ambulation, and improve patients' long-term outcomes. Dexmedetomidine, a selective alpha-2 agonist, has recently been used intrathecally as adjuvant to spinal anesthesia to prolong its efficacy. We compared two different doses of dexmedetomidine added to hyperbaric bupivacaine for spinal anesthesia. The primary endpoints were the onset and duration of sensory and motor block, and duration of analgesia. . METHODS A total of 100 patients, aged 35-60 years old, assigned to have elective abdominal hysterectomy under spinal anesthesia were divided into two equally sized groups (D5 and D10) in a randomized, double-blind fashion. The D5 group was intrathecally administered 3ml 0.5% hyperbaric bupivacaine with 5µg dexmedetomidine in 0.5ml of normal saline and the D10 group 3ml 0.5% bupivacaine with 10µg dexmedetomidine in 0.5ml of normal saline. For each patient, sensory and motor block onset times, block durations, time to first analgesic use, total analgesic need, postoperative visual analogue scale (VAS) scores, hemodynamics, and side effects were recorded. . RESULTS Although both groups had a similar demographic profile, sensory and motor block in the D10 group (p<0.050) was earlier than the D5 group. Sensory and motor block duration and time to first analgesic use were significantly longer and the need for rescue analgesics was lower in the D10 group than the D5 group. The 24-hour VAS score was significantly lower in the D10 group (p<0.050). Intergroup hemodynamics were comparable (p>0.050) without any appreciable side effects. . CONCLUSION Spinal dexmedetomidine increases the sensory and motor block duration and time to first analgesic use, and decreases analgesic consumption in a dose-dependent manner.
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Affiliation(s)
- Anjan Das
- Department of Anesthesiology, College of Medicine and Sagore Dutta Hospital, Kolkata, India
| | - Susanta Halder
- Department. of Anesthesiology, Radha Gobinda Kar Medical College and Hospital, Kolkata, India
| | - Surajit Chattopadhyay
- Department of Anesthesiology, College of Medicine and Sagore Dutta Hospital, Kolkata, India
| | - Parthajit Mandal
- Department of Gynecology and Obstetrics, College of Medicine & Sagore Dutta Hospital, Kolkata, India
| | - Subinay Chhaule
- Department of Anesthesiology, College of Medicine and Sagore Dutta Hospital, Kolkata, India
| | - Rezina Banu
- Department of Gynecology and Obstetrics, Murshidabad Medical College, Berhampur, India
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Single-dose systemic acetaminophen to prevent postoperative pain: a meta-analysis of randomized controlled trials. Clin J Pain 2015; 31:86-93. [PMID: 25485955 DOI: 10.1097/ajp.0000000000000081] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The effect of a single-dose systemic acetaminophen to treat postoperative pain has been previously quantified, but the effect of systemic acetaminophen to prevent postoperative pain is currently not well defined. The preventive analgesic effect of acetaminophen has yet to be quantified in a meta-analysis. The objective of the current investigation was to evaluate the effect of a single preventive dose of systemic acetaminophen on postoperative pain outcomes. MATERIALS AND METHODS A wide search was performed to identify randomized controlled trials that evaluated the effects of a single dose of systemic acetaminophen on pain outcomes in a large variety of surgical procedures. Meta-analysis was performed using a random-effect model. RESULTS Eleven randomized clinical trials evaluating 740 patients were included in the analysis. The weighted mean difference (95% confidence interval [CI]) of the combined effects favored acetaminophen over control for early pain at rest (≤4 h, -1.1 (-2.0 to -0.2)) and early pain at movement (24 h, -1.9 (-2.8 to -1.0)) Postoperative opioid consumption was decreased in the systemic acetaminophen group compared with control. Weighted mean difference (95% CI) of -9.7 (-13.0 to -6.4) mg morphine intravenous equivalents systemic acetaminophen also reduced postoperative nausea and vomiting compared with control, odds ratio (95% CI) of 0.25 (0.13 to 0.47), numbers needed to treat (95% CI)=3.3 (2.3 to 5.9). DISCUSSION Systemic acetaminophen, when used as a single-dose preventive regimen, is an effective intervention to reduce postoperative pain. It also reduces postoperative nausea and/or vomiting. Doses >1 g were not associated with greater reduction in pain outcomes.
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Halder S, Das A, Mandal D, Chandra M, Ray S, Biswas MR, Mandal P, Das T. Effect of different doses of dexmedetomidine as adjuvant in bupivacaine -induced subarachnoid block for traumatized lower limb orthopaedic surgery: a prospective, double-blinded and randomized controlled study. J Clin Diagn Res 2014; 8:GC01-6. [PMID: 25584237 DOI: 10.7860/jcdr/2014/9670.5118] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 09/04/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND AIMS Improved pain management for blunt trauma to the lower extremity has shown to reduce morbidity, induce early ambulation and improve long-term outcomes. Dexmedetomidine; a selective α-2 agonist; has recently been used intrathecally in different doses to prolong spinal anaesthesia. We evaluated the effect of adding two different doses of dexmedetomidine to hyperbaric bupivacaine for spinal anaesthesia. The primary endpoints were the onset and duration of sensory, motor block and duration of analgesia. MATERIALS AND METHODS Eighty patients, (20-60yrs) posted for elective lower limb orthopedic surgery of traumatic origin under spinal anaesthesia were divided into 2 equal groups (Group D5&D10) in a randomized, double-blind fashion. In this prospective parallel group study, group D5(n=40) 3ml 0.5% hyperbaric bupivacaine+5μg dexmedetomidine in 0.5 ml of normal saline and group D10 (n=40) 3ml 0.5% bupivacaine+10μg dexmedetomidine in 0.5 ml of normal saline were administered intrathecally. Sensory and motor block onset times and block durations, time to first analgesic use, total analgesic need, postoperative VAS, hemodynamics and side effects were recorded for each patient. RESULTS Though with similar demographic profile in both groups, sensory and motor block in group D10(p<0.05) was earlier than group D5. Sensory, motor block duration and time to first analgesic use were significantly longer and the need for rescue analgesics was lower in group D10(p<0.05) than D5. 24 h VAS score was significantly lower in group D10(p<0.05). Intergroup hemodynamics was comparable (p>0.05) without any appreciable side effects. CONCLUSION Spinal dexmedetomidine increases the sensory, motor block duration and time to first analgesic use, and decreases analgesic consumption in a dose-dependent manner.
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Affiliation(s)
- Susanta Halder
- Senior Resident, Department of Anaesthesiology, R.G Kar Medical College , Kolkata, India
| | - Anjan Das
- Assistant Professor, Department of Anaesthesiology, College of Medicine & Sagore Dutta Hospital , Kolkata, India
| | - Debabrata Mandal
- Assistant Professor, Department of Oral & Maxillofacial Surgery, R Ahmed Dental College , Kolkata, India
| | - Mainak Chandra
- R.M.O Cum CT, Department of Orthopedics, R.G Kar Medical college , Kolkata, India
| | - Souradeep Ray
- R.M.O Cum CT, Department of ENT, College of Medicine & Sagore Dutta Hospital , Kolkata, India
| | - Madhuri Ranjana Biswas
- Associate Professor, Department of Anaesthesiology, College of Medicine & Sagore Dutta Hospital , Kolkata, India
| | - Parthojit Mandal
- Assistant Professor, Department of Gyanecology and Obstetrics, College of Medicine & Sagore Dutta Hospital , Kolkata, India
| | - Tanuka Das
- R.M.O Cum CT, Department of Gyanecology and Obstetrics, College of Medicine & Sagore Dutta Hospital , Kolkata, India
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Perineural dexamethasone to improve postoperative analgesia with peripheral nerve blocks: a meta-analysis of randomized controlled trials. PAIN RESEARCH AND TREATMENT 2014; 2014:179029. [PMID: 25485150 PMCID: PMC4251083 DOI: 10.1155/2014/179029] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 10/09/2014] [Indexed: 12/13/2022]
Abstract
Background. The overall effect of perineural dexamethasone on postoperative analgesia outcomes has yet to be quantified. The main objective of this quantitative review was to evaluate the effect of perineural dexamethasone as a nerve block adjunct on postoperative analgesia outcomes. Methods. A systematic search was performed to identify randomized controlled trials that evaluated the effects of perineural dexamethasone as a block adjunct on postoperative pain outcomes in patients receiving regional anesthesia. Meta-analysis was performed using a random-effect model. Results. Nine randomized trials with 760 subjects were included. The weighted mean difference (99% CI) of the combined effects favored perineural dexamethasone over control for analgesia duration, 473 (264 to 682) minutes, and motor block duration, 500 (154 to 846) minutes. Postoperative opioid consumption was also reduced in the perineural dexamethasone group compared to control, -8.5 (-12.3 to -4.6) mg of IV morphine equivalents. No significant neurological symptoms could have been attributed to the use of perineural dexamethasone. Conclusions. Perineural dexamethasone improves postoperative pain outcomes when given as an adjunct to brachial plexus blocks. There were no reports of persistent nerve injury attributed to perineural administration of the drug.
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Rahangdale R, Kendall MC, McCarthy RJ, Tureanu L, Doty R, Weingart A, De Oliveira GS. The effects of perineural versus intravenous dexamethasone on sciatic nerve blockade outcomes: a randomized, double-blind, placebo-controlled study. Anesth Analg 2014; 118:1113-9. [PMID: 24686045 DOI: 10.1213/ane.0000000000000137] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Perineural dexamethasone has been investigated as an adjuvant for brachial plexus nerve blocks, but it is not known whether the beneficial effect of perineural dexamethasone on analgesia duration leads to a better quality of surgical recovery. We hypothesized that patients receiving dexamethasone would have a better quality of recovery than patients not receiving dexamethasone. We also sought to compare the effect of perineural with that of IV dexamethasone on block characteristics. METHODS Patients undergoing elective ankle and foot surgery were recruited over a 9-month period. Patients received ultrasound-guided sciatic nerve blocks by using 0.5% bupivacaine with epinephrine 1:300,000 (0.45 mL/kg) and were randomized into 3 groups: group 1 = perineural dexamethasone 8 mg/2 mL with 50 mL IV normal saline, group 2 = perineural saline/2 mL with IV 8 mg dexamethasone in 50 mL normal saline, and group 3 = perineural saline/2 mL with 50 mL normal saline. The primary outcome was the global score in the quality of recovery (QoR-40). The secondary outcomes included analgesia duration, opioid consumption, patient satisfaction, numeric pain rating scores, and postoperative neurologic symptoms. RESULTS Eighty patients were randomized, and 78 patients completed the study protocol. There was no improvement in the global QoR-40 score at 24 hours between the perineural dexamethasone and saline, median (97.5% CI) difference of -3 (-7 to 3); IV dexamethasone and saline, median difference of -1 (-8 to 5); or perineural dexamethasone and IV dexamethasone median difference of -2 (-6 to 5). Analgesia duration (P < 0.001) and time to first toe movement (P < 0.001) were prolonged by perineural dexamethasone compared with saline. IV dexamethasone prolonged time to first toe movement compared with saline (P = 0.008) but not analgesia duration (P = 0.18). There was no significant difference in the time to first toe movement or analgesia duration between the perineural and IV dexamethasone groups. Postoperative opioid consumption was not different among study groups. Self-reported neurologic symptoms at 24 hours were not different among perineural dexamethasone (17, 63%), IV dexamethasone (10, 42%), or normal saline (8, 30%) (P = 0.31). All postoperative neurologic sequelae were resolved by 8 weeks. CONCLUSIONS Preoperative administration of IV and perineural dexamethasone compared with saline did not improve overall QoR-40 or decrease opioid consumption but did prolong analgesic duration in patients undergoing elective foot and ankle surgery and receiving sciatic nerve block. Given the lack of clinical benefit and the concern of dexamethasone neurotoxicity as demonstrated in animal studies, the practice of perineural dexamethasone administration needs to be further evaluated.
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Affiliation(s)
- Rohit Rahangdale
- From the Department of Anesthesiology, Northwestern University, Chicago, Illinois
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Current World Literature. Curr Opin Anaesthesiol 2013; 26:98-104. [DOI: 10.1097/aco.0b013e32835cb4f0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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