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Thapa D, Ahuja V, Kosaraju CC, Gill K, Meena A. Incomplete supraclavicular brachial plexus block in an opioid-dependent patient: A case report. J Anaesthesiol Clin Pharmacol 2022; 38:487-488. [PMID: 36505209 PMCID: PMC9728447 DOI: 10.4103/joacp.joacp_212_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/07/2021] [Indexed: 11/06/2022] Open
Affiliation(s)
- Deepak Thapa
- Anaesthesia and Intensive Care, Government Medical College and Hospital, Sector 32, Chandigarh, India
| | - Vanita Ahuja
- Anaesthesia and Intensive Care, Government Medical College and Hospital, Sector 32, Chandigarh, India,Address for correspondence: Dr. Vanita Ahuja, Anaesthesia and Intensive Care, Government Medical College and Hospital, Sector 32, Chandigarh, India. E-mail:
| | - Charmila C. Kosaraju
- Anaesthesia and Intensive Care, Government Medical College and Hospital, Sector 32, Chandigarh, India
| | - Karnjot Gill
- Anaesthesia and Intensive Care, Government Medical College and Hospital, Sector 32, Chandigarh, India
| | - Ankita Meena
- Anaesthesia and Intensive Care, Government Medical College and Hospital, Sector 32, Chandigarh, India
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Moran MC, Heaton LJ, Leroux BG, Flake NM. Local Anesthetic Efficacy in Marijuana Users and Nonusers: A Pilot Study. Anesth Prog 2022; 69:15-21. [PMID: 36534774 PMCID: PMC9773404 DOI: 10.2344/anpr-69-02-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 03/07/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Despite the common clinical impression that patients with a history of drug use are challenging to anesthetize with local anesthesia, literature on this clinical phenomenon is sparse. The objective of this pilot study was to assess if differences in local anesthetic efficacy for dental treatment exist between marijuana users and nonusers. METHODS Subjects were healthy adult males and females who qualified as either chronic marijuana users or nonusers. All subjects had an asymptomatic, vital maxillary lateral incisor that responded to an electric pulp test (EPT). A standard maxillary infiltration injection technique was employed using 1.7 mL 2% lidocaine with 1:100,000 epinephrine over the test tooth, and the tooth was tested with an EPT at 3-minute intervals. RESULTS A total of 88% of nonusers (15/17) and 61% of users (11/18) were successfully anesthetized, defined as anesthesia onset within 10 minutes and lasting at least 15 minutes. The difference in the proportion of anesthetized subjects was not statistically significant (P = .073). For subjects with successful anesthesia, there was no significant difference between nonusers and users in the onset or duration of anesthesia. CONCLUSION No significant differences in local anesthetic efficacy with respect to local anesthetic success, onset, or duration of action were found between chronic marijuana users and nonusers. However, larger studies are likely needed to provide more definitive evidence.
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Affiliation(s)
- Michael C. Moran
- Department of Endodontics, University of Washington School of Dentistry
| | - Lisa J. Heaton
- Department of Oral Health Sciences, University of Washington School of Dentistry
| | - Brian G. Leroux
- Department of Oral Health Sciences, University of Washington School of Dentistry
| | - Natasha M. Flake
- Department of Endodontics, University of Washington School of Dentistry
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Derakhshan P, Imani F, Seyed-Siamdoust SA, Garousi S, Nouri N. Cerebrospinal Fluid and Spinal Anesthesia Parameters in Healthy Individuals versus Opium-addict Patients during Lower Limb Surgery. ADDICTION & HEALTH 2020; 12:11-17. [PMID: 32582410 PMCID: PMC7291896 DOI: 10.22122/ahj.v12i1.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Studies have reported lower pain threshold, spinal anesthesia duration, and level of sensory block in addicts compared to non-addict patients undergoing spinal anesthesia for surgery. Moreover, blood gas and cerebrospinal fluid (CSF) were likely to be affected as well. The aim in the present study is to evaluate CSF and spinal parameters in addict versus non-addict patients during lower limb surgery. Methods In this case-control study, 22 opium addicts and 22 sex- and age- matched non-addicts undergoing lower limb surgery under spinal anesthesia were included. The CSF parameters, venous blood gas (VBG), and sensory and motor block findings were compared between the groups. Findings The addict and non-addict patients were similar regarding CSF and blood gas parameters except higher pH in VBG (7.39 ± 0.06 vs. 7.33 ± 0.11, P = 0.030) and CSF (7.39 ± 0.06 vs. 7.33 ± 0.11, P = 0.030) for addict patients. The addict patients had significantly later onset of sensory block (5.72 ± 1.57 vs. 3.16 ± 0.93 minutes, P < 0.001) and shorter motor block duration (137.72 ± 11.51 vs. 149.09 ± 14.44 minutes, P = 0.006), with no significant difference in the sensory block duration and motor block onset. Conclusion Addict patients have delayed onset of sensory block with shorter duration of motor block and lower sensory block level. Among the blood gas and CSF markers, only pH was significantly higher in addict patients, needing further evaluations; however, it seems that addiction has no significant effect on these parameters.
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Affiliation(s)
- Pooya Derakhshan
- Pain Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Farnad Imani
- Pain Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Sorour Garousi
- Pain Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Nasrin Nouri
- Pain Research Center, Iran University of Medical Sciences, Tehran, Iran
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Abstract
BACKGROUND Previous evidence suggests that opioid-tolerant patients are less responsive to local anesthetics (LAs) for postoperative pain management. METHODS To determine whether this apparent loss of LA potency is due to an intrinsic change in the peripheral nerve, the effect of systemic morphine was assessed on the potency of lidocaine-induced block of the compound action potential in isolated rat sciatic nerves. Analgesic efficacy was assessed with the heat withdrawal assay. RESULTS While acute administration of 10 mg/kg morphine had no detectable influence on lidocaine potency, seven daily subcutaneous injections of morphine produced a three-fold decrease in potency (EC50 for block A and C waves for naive rats were [mean ± SD] 186 ± 32 μM [n = 6] and 201 ± 31 μM [n = 6], respectively, vs. 608 ± 53 μM [n = 6] and 613 ± 42 μM [n = 6], respectively [P < 0.001], in nerves from rats that had received seven daily injections of morphine [10 mg/kg]). This loss in potency was both dose-dependent and injection number dependent, such that the magnitude of the loss of lidocaine potency was significantly (n = 6; P < 0.01) correlated (r = 0.93) with the development of morphine tolerance. Interestingly, despite the complete recovery of analgesic efficacy within days after cessation of morphine administration, the morphine-induced decrease in lidocaine potency was fully manifest even 35 days after the last morphine injection. Coadministration of naloxone (1 mg/kg, intraperitoneally), but not of naloxone methiodide (1 mg/kg, subcutaneously), with each of seven daily injections of morphine blocked the decrease in lidocaine potency. CONCLUSIONS These preclinical data suggest that the morphine-induced decrease in LA potency is due, at least in part, to the intrinsic changes in the peripheral nerve. Identification of the underlying mechanisms may suggest strategies for more effective postoperative pain management in the growing population of opioid-tolerant patients.
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Yousefshahi F, Predescu O, Francisco Asenjo J. The Efficacy of Systemic Lidocaine in the Management of Chronic Pain: A Literature Review. Anesth Pain Med 2017; 7:e44732. [PMID: 28856112 PMCID: PMC5561441 DOI: 10.5812/aapm.44732] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 02/05/2017] [Accepted: 03/11/2017] [Indexed: 12/23/2022] Open
Abstract
Context Despite recent advances in the understanding of the chronic pain concept, its diagnosis and management remains a daily challenge for clinicians and patients. Based on the published literature, this review discusses and tries to organize the current knowledge and the up-to-date clinical experience about the efficacy and safety of the use of intravenous lidocaine in treatment and prevention of chronic pain. Evidence Acquisition To prepare this narrative review, we performed an in depth literature review using the PubMed searching engine. We extracted all relevant articles published in English, up to April 2016. Results Lidocaine, administered as transdermal patch or intravenous lidocaine, is a safe and effective modality in the treatment of post-herpetic neuralgia (PHN), complex regional pain syndrome, as well and for prevention of chronic pain. It may be effective in the management of neuropathic pain syndromes, chronic pain, post-operative pain, and refractory cancer pain. Conclusions Intravenous lidocaine and lidocaine patch are effective and safe for the treatment of several chronic or neuropathic pain syndromes. The use of lidocaine during surgery could prevent the development of some chronic post-surgical pain syndromes.
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Affiliation(s)
- Fardin Yousefshahi
- Department of Anesthesiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Oana Predescu
- Assistant Professor, Department of Anesthesia, McGill University Health Centre, Montreal, QC, Canada
| | - Juan Francisco Asenjo
- Professor, Department of Anesthesia, McGill University Health Centre, Montreal, QC, Canada
- Corresponding author: Juan Francisco Asenjo, Montreal General Hospital, 1650 Cedar Avenue, D10-144, Montreal, QC, Canada. E-mail:
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Are Opioid-tolerant Patients Resistant to Local Anesthetic Nerve Blockade?: We Need More Information. Anesthesiology 2016; 125:625-6. [PMID: 27428824 DOI: 10.1097/aln.0000000000001240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Sadeghi M, Yekta RA, Azimaraghi O, Barzin G, Movafegh A. [Evaluation of spinal anesthesia blockade time with 0.5% hyperbaric bupivacaine, with or without sufentanil, in chronic opioid users: a randomized clinical trial]. Rev Bras Anestesiol 2016; 66:346-50. [PMID: 27155781 DOI: 10.1016/j.bjan.2016.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The primary outcome of this study was to evaluate the effect of adding sufentanil to hyperbaric bupivacaine on duration of sensory blockade of spinal anesthesia in chronic opioid users in comparison with non-addicts. METHODS Sixty patients scheduled for orthopedic surgery under spinal anesthesia were allocated into four groups: group 1 (no history of opium use who received intrathecal hyperbaric bupivacaine along with 1mL saline as placebo); group 2 (no history of opium use who received intrathecal bupivacaine along with 1mL sufentanil [5μg]); group 3 (positive history of opium use who received intrathecal bupivacaine along with 1mL saline as placebo) and group 4 (positive history of opium use who received intrathecal bupivacaine along with 1mL sufentanil [5μg]). The onset time and duration of sensory and motor blockade were measured. RESULTS The duration of sensory blockade in group 3 was 120±23.1min which was significantly less than other groups (G1=148±28.7, G2=144±26.4, G4=139±24.7, p=0.007). The duration of motor blockade in group 3 was 145±30.0min which was significantly less than other groups (G1=164±36.0, G2=174±26.8, G4=174±24.9, p=0.03). CONCLUSIONS Addition of 5μg intrathecal sufentanil to hyperbaric bupivacaine in chronic opioid users lengthened the sensory and motor duration of blockade to be equivalent to blockade measured in non-addicts.
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Affiliation(s)
- Mostafa Sadeghi
- Departamento de Anestesiologia, Dor e Cuidados Intensivos, Dr. Ali Shariati Hospital, Tehran University of Medical Sciences, Teerã, Irã
| | - Reza Atef Yekta
- Departamento de Anestesiologia, Dor e Cuidados Intensivos, Dr. Ali Shariati Hospital, Tehran University of Medical Sciences, Teerã, Irã
| | - Omid Azimaraghi
- Departamento de Anestesiologia, Dor e Cuidados Intensivos, Dr. Ali Shariati Hospital, Tehran University of Medical Sciences, Teerã, Irã
| | - Gilda Barzin
- Departamento de Anestesiologia, Dor e Cuidados Intensivos, Dr. Ali Shariati Hospital, Tehran University of Medical Sciences, Teerã, Irã
| | - Ali Movafegh
- Departamento de Anestesiologia, Dor e Cuidados Intensivos, Dr. Ali Shariati Hospital, Tehran University of Medical Sciences, Teerã, Irã.
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Sadeghi M, Yekta RA, Azimaraghi O, Barzin G, Movafegh A. Evaluation of spinal anesthesia blockade time with 0.5% hyperbaric bupivacaine, with or without sufentanil, in chronic opioid users: a randomized clinical trial. Braz J Anesthesiol 2015; 66:346-50. [PMID: 27343782 DOI: 10.1016/j.bjane.2014.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 11/11/2014] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The primary outcome of this study was to evaluate the effect of adding sufentanil to hyperbaric bupivacaine on duration of sensory blockade of spinal anesthesia in chronic opioid users in comparison with non-addicts. METHODS Sixty patients scheduled for orthopedic surgery under spinal anesthesia were allocated into four groups: group 1 (no history of opium use who received intrathecal hyperbaric bupivacaine along with 1mL saline as placebo); group 2 (no history of opium use who received intrathecal bupivacaine along with 1mL sufentanil [5μg]); group 3 (positive history of opium use who received intrathecal bupivacaine along with 1mL saline as placebo) and group 4 (positive history of opium use who received intrathecal bupivacaine along with 1mL sufentanil [5μg]). The onset time and duration of sensory and motor blockade were measured. RESULTS The duration of sensory blockade in group 3 was 120±23.1min which was significantly less than other groups (G1=148±28.7, G2=144±26.4, G4=139±24.7, p=0.007). The duration of motor blockade in group 3 was 145±30.0min which was significantly less than other groups (G1=164±36.0, G2=174±26.8, G4=174±24.9, p=0.03). CONCLUSIONS Addition of 5μg intrathecal sufentanil to hyperbaric bupivacaine in chronic opioid users lengthened the sensory and motor duration of blockade to be equivalent to blockade measured in non-addicts.
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Affiliation(s)
- Mostafa Sadeghi
- Department of Anesthesiology, Pain and Critical Care, Dr. Ali Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Atef Yekta
- Department of Anesthesiology, Pain and Critical Care, Dr. Ali Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Omid Azimaraghi
- Department of Anesthesiology, Pain and Critical Care, Dr. Ali Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Gilda Barzin
- Department of Anesthesiology, Pain and Critical Care, Dr. Ali Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Movafegh
- Department of Anesthesiology, Pain and Critical Care, Dr. Ali Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Azimaraghi O, Marashi SM, Khazaei N, Pourhassan S, Movafegh A. The Effect of Adding Sufentanil to 0.5% Hyperbaric Bupivacaine on Duration of Brachial Plexus Blockade in Chronic Opium Abusers: a Randomized Clinical Trial. Anesth Pain Med 2015; 5:e21960. [PMID: 26161314 PMCID: PMC4493736 DOI: 10.5812/aapm.21960v2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Revised: 10/04/2014] [Accepted: 11/11/2014] [Indexed: 01/19/2023] Open
Abstract
Background: Anesthesia induction in patients with current substance abuse can be a challenge for anesthesiologists. Objectives: This study aimed to evaluate the effect of adding Sufentanil to Bupivacaine on duration of brachial plexus nerve block. Patients and Methods: One hundred and twenty patients with (Groups C and D) and without (Groups A and B) a history of opium abuse (60 in each group) scheduled for elective upper extremity procedures were randomly assigned to either receive 30 mL bupivacaine alone (Groups A and C) or in combination with additional 10 µg sufentanil (Groups B and D). An ultrasound-guided technique was applied to perform upper extremity brachial plexus blockade. The onset and duration of sensory and motor blocks were recorded and compared between the four groups. Results: The duration of sensory and motor block were significantly less in Group C (537.0 ± 40.1 minutes, 479.0 ± 34.8 minutes) and the longest duration of sensory and motor block was observed in group B (705.0 ± 43.8 minutes, 640.0 ± 32.5 minutes). The duration of sensory and motor block in Group B (705.0 ± 43.8 minutes, 640.0 ± 32.5 minutes) was longer and statistically higher than group A (619.5 ± 48.0 minutes, 573.2 ± 31.5 minutes), the same trend was observed in group D (598.6 ± 53.2 minutes, 569.3 ± 39.9 minutes) over group C (537.0 ± 40.1 minutes, 479.0 ± 34.8 minutes) (P < 0.001, one-way ANOVA). Conclusions: The length of sensory and motor blockade is shorter in chronic opioid abusers. Adding 10 µg sufentanil to hyperbaric bupivacaine in opium abusers lengthened the sensory and motor block duration.
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Affiliation(s)
- Omid Azimaraghi
- Department of Anesthesiology, Pain and Critical Care, Dr. Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Mojtaba Marashi
- Department of Anesthesiology, Pain and Critical Care, Dr. Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Noushin Khazaei
- Department of Anesthesiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sarah Pourhassan
- Department of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Movafegh
- Department of Anesthesiology, Pain and Critical Care, Dr. Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Corresponding author: Ali Movafegh, Department of Anesthesiology, Pain and Critical Care, Dr. Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Tel: +98-9123021389, Fax: +98-88220032, E-mail:
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Hashemian AM, Omraninava A, Kakhki AD, Sharifi MD, Ahmadi K, Masoumi B, Mehrpour O. Effectiveness of local anesthesia with lidocaine in chronic opium abusers. J Emerg Trauma Shock 2014; 7:301-4. [PMID: 25400392 PMCID: PMC4231267 DOI: 10.4103/0974-2700.142765] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 03/13/2014] [Indexed: 11/04/2022] Open
Abstract
CONTEXT It had been demonstrated that chronic opium abusers have lower pain thresholds compared with than non-abusers. AIMS This study aimed to compare the required dose of lidocaine, a common local anesthetic drug, with regard to the onset of anesthesia in opium abusers with that in non-abusers undergoing similar suturing of minor hand lacerations. MATERIALS AND METHODS In this study, 109 opium abusers and 91 non-abusers underwent similar suturing for hand lacerations known as digital block. We explained the patients that their case records would remain confidential and admitting to any history of opioid abuse could assist in alleviating any pain associated with the procedure. RESULTS There was no statistically significant difference between the two groups with regard to age, gender, and cause of injury (P > 0.05). We found a significantly longer duration of onset of analgesia in nonopioid abusers (5.42 ± 1.93 min) than that in abusers (10.30 ± 1.79 min) (P < 0.001). In addition, the lidocaine dose administered to abusers (6.67 ± 1.21 ml) was higher (4.07 ± 1.26) as well as statistically significant (P < 0.001) than that in non-abusers. CONCLUSION The findings from this study suggest a longer duration of onset of anesthesia and requirement of a higher lidocaine dose in opium abusers compared with nonopioid abuser. Moreover, chronic opium abusers (4-5 years) experienced significantly higher time of onset of anesthesia compared with nonchronic abusers. This outcome may be useful in selecting a more suitable local anesthetic protocol in such patients.
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Affiliation(s)
- Amir Masoud Hashemian
- Department of Emergency, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Omraninava
- Department of Emergency, Aja University of Medical Sciences, Tehran, Iran
| | - Ali Darvishpoor Kakhki
- Department of Medical Surgery Nursing, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Davood Sharifi
- Department of Emergency, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Koorosh Ahmadi
- Department of Emergency, Alborz University of Medical Sciences, Karaj, Iran
| | - Babak Masoumi
- Department of Emergency, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Omid Mehrpour
- Department of Clinical Toxicology, Atherosclerosis and Coronary Artery Research Center, Birjand University of Medical Science, Birjand, Iran
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Gupta S, Dev K, Katyal S, Kathuria S. Intrathecal fentanyl with 0.5% bupivacaine heavy in chronic opium abusers. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2014. [DOI: 10.1080/22201173.2012.10872833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- S Gupta
- Department of Anaesthesia, Dayanand Medical College and Hospital, Ludhiana. 141 001, Punjab, India
| | - K Dev
- Department of Anaesthesia, Dayanand Medical College and Hospital, Ludhiana. 141 001, Punjab, India
| | - S Katyal
- Department of Anaesthesia, Dayanand Medical College and Hospital, Ludhiana. 141 001, Punjab, India
| | - S Kathuria
- Department of Anaesthesia, Dayanand Medical College and Hospital, Ludhiana. 141 001, Punjab, India
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Dahi-Taleghani M, Fazli B, Ghasemi M, Vosoughian M, Dabbagh A. Effect of intravenous patient controlled ketamine analgesiaon postoperative pain in opium abusers. Anesth Pain Med 2014; 4:e14129. [PMID: 24701419 PMCID: PMC3961031 DOI: 10.5812/aapm.14129] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Revised: 11/22/2013] [Accepted: 12/01/2013] [Indexed: 12/29/2022] Open
Abstract
Background: Acutepostoperative pain is among the worst experience that patient scan undergo, and many analgesics have been used to suppress it; especially in chronic opium abusers. Ketamine is an N-methyl-D-aspartate antagonist analgesic, having both anesthetic and analgesic properties, which are not affected to the same extent in chronic opium abusers. Objectives: In this study, we assessed the analgesic effects of ketamine added to morphine as a patient-controlled analgesia method for acute pain management, compared with a placebo, inchronic maleopium abusers. Patients and Methods: After institutional review board approval for ethical considerations, a randomized double-blinded placebo controlled clinical trial was conducted. A total of 140 male patients aged 18-65 years, undergoing orthopedic surgery, were entered into the study after matching inclusion and exclusion criteria. All patients received the same anesthesia method; while the first group received ketamine (1mg/mL) and morphine (0.5 mg/mL) as a patient-controlled analgesia (70 patients), the second group received morphine (0.5 mg/mL) plus normal saline (70 patients). P value less than 0.05 was considered statistically significant. Results: The ketamine and morphine group of patients experienced less postoperative pain and required less postoperative rescue analgesia. However, the unwanted postoperative side effects were nearly the same; although increased levels of postoperative nausea and vomiting were observed in the ketamine and morphine group Conclusions: This study demonstrated improved analgesic effects after using intravenous patient controlled analgesia with ketamine on postoperative pain in opium abusers.
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Affiliation(s)
- Mastane Dahi-Taleghani
- Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Benjamin Fazli
- Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahshid Ghasemi
- Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Vosoughian
- Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Dabbagh
- Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Corresponding author: Ali Dabbagh, Anesthesiology Research Center, ShahidBeheshti University of Medical Sciences, Tehran, Iran. Tel: +98-989121972368, Fax: +98-982122432572, E-mail: ,
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Safari F, Dabbagh A, Sharifnia M. The effect of adjuvant midazolam compared with fentanyl on the duration of spinal anesthesia with 0.5% bupivacaine in opium abusers. Korean J Anesthesiol 2012; 63:521-6. [PMID: 23277813 PMCID: PMC3531531 DOI: 10.4097/kjae.2012.63.6.521] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 08/29/2012] [Accepted: 08/30/2012] [Indexed: 11/22/2022] Open
Abstract
Background There are a number of adjuvants to be used for local anesthetics in spinal block. The aim of this study was to demonstrate the possible effect of intrathecal midazolam compared with bupivacaine as adjuvants in spinal anesthesia with bupivacaine in chronic opium abuses. Methods In a double blind, randomized clinical trial, 90 opium abuser patients undergoing lower limb orthopedic surgery were selected and randomly assigned into 3 groups (30 cases each). The patients received 15 mg plain bupivacaine, or 15 mg bupivacaine plus 25 mcg fentanyl or 15 mg bupivacaine plus 1 mg midazolam, intrathecally. Results The duration of anesthesia was much longer in the bupivacaine-midazolam group than the bupivacaine-fentanyl group; both were longer than the plain bupivacaine group (P < 0.05). Conclusions Subarachnoid injection of adjuvant midazolam or fentanyl with plain 0.5% bupivacaine in opium abusers in lower limb orthopedic surgery increases the duration of sensory block. Therefore midazolam is more effective than fentanyl in such cases.
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Affiliation(s)
- Farhad Safari
- Department of Anesthesiology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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