Intrathecal buprenorphine versus fentanyl as adjuvant to 0.75% ropivacaine in lower limb surgeries

Effect of different doses of buprenorphine in combination with bupivacaine in the management of postoperative analgesia: A comparative study

Background:

Longer duration of analgesia, ceiling effect on respiratory depression, and the antihyperalgesia property make buprenorphine a good adjuvant for managing moderate-to-severe postoperative pain.

Aims:

The aim of this study is to evaluate the onset and duration of postoperative analgesia of three different doses of buprenorphine of 60, 100, and 150 μg given intrathecally along with hyperbaric bupivacaine in patients undergoing lower limb surgeries.

Setting and Design:

This prospective observational study was carried out in the anesthesia department of a tertiary care hospital.

Materials and Methods:

The study included 90 patients of either sex, aged 18–60 years, scheduled for elective lower limb surgery under subarachnoid block. Patients were randomly allocated into three groups (30 each) receiving different doses of buprenorphine. In addition, all patients received 3 mL of 0.5% hyperbaric bupivacaine.

Statistical Analysis Used:

The Chi-square test or Fisher's exact test was used to find out the association between the categorical variables. The association of quantitative variables between the groups was assessed by Kruskal–Wallis test while within the groups was assessed by repeated-measures analysis of variance test.

Results:

Baseline characteristics such as age, gender, and American Society of Anesthesiologist physical status classification were comparable among the three groups. Sensory block, motor block, and total duration of analgesia were significantly higher with higher doses of buprenorphine. The mean difference in the duration of analgesia was comparable in patients receiving 100 μg (720 min) and 150 μg (825 min) of buprenorphine. Bradycardia as a side effect was only in patients receiving 150 μg of buprenorphine.

Conclusion:

Risk–benefit of different doses of buprenorphine suggests that 100 μg may be the ideal dose for a better quality of spinal block and maintaining hemodynamic stability.

Comparative evaluation of intrathecal bupivacaine 0.5% with intrathecal bupivacaine 0.5% and 60-μg buprenorphine for postoperative analgesia in elective cesarean section patients

Introduction:

The analgesia after the C-section is a very challenging condition to the anesthetist. Various combinations of the agents have been proposed for a successful analgesia. Hence, in our study, we aimed to compare the intrathecal bupivacaine 0.5% with intrathecal bupivacaine 0.5% and 60-microgram buprenorphine for postoperative analgesia in elective C-section patients.

Materials and Methods:

We piloted a prospective study among 40 subjects grouped equally as Group I – bupivacaine 0.5%, and Group II – bupivacaine 0.5% and 60-μg buprenorphine. We compared the clinical parameters for the pain relief by visual analog scale (VAS), the duration of the analgesia, and the side effects for the two groups. The values obtained were compared using the ANOVA test deliberating P < 0.05 as significant.

Results:

Significant longer duration and faster onset of the analgesia were seen for the Group II than the Group I. The VAS score was higher for the Group I than Group II. Greater side effects were seen in the buprenorphine group.

Conclusion:

Within the limits of this study, beneficial effect of the bupivacaine was identified when added to the routine bupivacaine for the analgesia in the C-section.

Comparison of Intrathecal Fentanyl and Buprenorphine as an Adjuvant to 0.5% Hyperbaric Bupivacaine for Spinal Anesthesia

Purpose:

This study was designed to evaluate and compare three groups, that is, (1) normal saline 0.5 mL with 15 mg of 0.5% hyperbaric bupivacaine normal (BN), (2) intrathecal fentanyl 25 μg (0.5 mL) as an adjuvant to 15 mg of 0.5% hyperbaric bupivacaine fentanyl (BF), and (3), 150 μg buprenorphine with 15 mg of 0.5% hyperbaric bupivacaine buprenorphine (BB) with respect to the onset and duration of sensory and motor spinal block, level of anesthesia, effects on hemodynamic parameters, requirement of postoperative analgesia, and side effects in patients aged 16–60 years undergoing surgical and orthopedic procedures requiring spinal anesthesia.

Methods:

A prospective, observational study was performed at a single center with 90 consecutive patients enrolled as per the inclusion criteria. Patients were divided into three groups of 30 each based on drugs administered, BN, BF, and BB groups, and outcome measures were recorded. The three groups were compared with the analysis of variance test for the continuous variables, with P < 0.05 considered statistically significant.

Results:

The groups were similarly matched with respect to age. The earliest onset of sensory block was in the BF group (2.87 min), P < 0.05. Similarly, the mean time to achieve the highest sensory level was least in the BF group (9.63 min), P < 0.05. The onset of motor blockade was earliest in the BB group (7.65 min), P < 0.05. The mean time for two segment regression was maximum in the BB group (126.03 min), P < 0.05. The mean time for regression to L1 was the longest in the BB group (200.83 min), P < 0.05. Maximum duration of analgesia after spinal drug administration was the highest in the BB group (412.17 min), P < 0.05.

Conclusion:

The addition of both buprenorphine 150 μg and fentanyl 25 μg to 0.5% hyperbaric bupivacaine 15 mg enhances the quality and duration of sensory block for spinal anesthesia providing better postoperative analgesia, while decreasing the incidence of complications associated with each drug alone.

Tailored Surgery in Inguinal Hernia Repair. The Role of Subarachnoid Anesthesia: A Retrospective Study

Safety and effectiveness evaluation of subarachnoid anesthesia implemented with hyperbaric Prilocaine in reduced dose (30mg) in combination with Fentanyl (20mcg), for the purpose of ensuring an optimal analgesia in open inguinal hernia repair. Although the local anesthesia is the first line treatment for open inguinal hernia repair, a minority of patients is not eligible because of obesity or big groin hernia, requiring a high dose of local anesthetic. Subarachnoid anesthesia implemented with hyperbaric Prilocaine in reduced dose in combination with Fentanyl may be a good alternative. Thirty patients were treated with intrathecal association of Prilocaine 30 mg and Fentanyl 20 mcg (group PF); they were compared to a group of fifty three ones, previously treated with a classic procedure with intrathecal Prilocaine 60 mg (group P). The sensitive blockage remained within an higher limit at T12 level in the patients of PF group, and a lower limit at S1 level 50 minutes after the anesthesia, while in the P group the anesthetic tended to migrate (p<0.0001). In PF group 70 minutes after the anesthesia 21 patients had a Bromage score equal to 0 and 9 patients equal to 9 (in P group, 19 patients had a score equal to 3, 8 to 2 and 3 to 1, p<0.0001). Subarachnoid anesthesia using Prilocaine 30 mg + Fentanyl 20 mcg could be stated as a viable alternative to local anesthesia in selected patients.

Comparative evaluation of anaesthetic efficacy and haemodynamic effects of a combination of isobaric bupivacaine with buprenorphine vs. isobaric levobupivacaine with buprenorphine for spinal anaesthesia - A double blinded randomised clinical trial

Background and Aims

Bupivacaine is the most frequently used local anaesthetic for spinal anaesthesia, however, use of levobupivacaine in clinical practice has advanced recently. This study aimed to compare the anaesthetic potency and haemodynamic effects of intrathecal bupivacaine with buprenorphine versus levobupivacaine with buprenorphine in infraumbilical surgeries.

Methods

This prospective randomised double blind study was conducted in seventy patients aged 18-65 years, American Society of Anesthesiologists grade I-II, scheduled for lower abdominal and lower limb surgery under spinal anaesthesia. The patients either received 0.5% isobaric racemic bupivacaine 3 ml with 2 μg/kg of buprenorphine (Group B) or 0.5% isobaric levobupivacaine 3 ml with 2 μg/kg of buprenorphine (Group L). The time for onset of sensory block between the two groups was the priomary end-point. Other measurements included haemodynamic variables, sensory and motor blockade characteristics, postoperative analgesia, and complications in the first 24 h.

Results

There was no significant difference in the onset of sensory block between the two groups. Sensory and motor blockade characteristics were similar between the two groups. However, there was significant fall in the heart rate at 5 min in Group B compared to Group L. There was statistically significant fall in systolic blood pressure in group B compared to Group L from 5 min up to 60 min and fall in diastolic blood pressure from 10 min to 45 min.

Conclusion

Our study showed that onset of sensory block is similar between isobaric levobupivacaine with buprenorphine 37 38 and isobaric bupivacaine with buprenorphine.

A prospective randomized study on the impact of low-dose dexamethasone on perioperative blood glucose concentrations in diabetics and nondiabetics

Background:

Dexamethasone is a potent corticosteroid when administered alone or in combination alone has proven efficacious in preventing nausea and vomiting (PONV) perioperatively. However, the administration of even a single dose has been associated with hyperglycemia. This is the first study that evaluates the effect of two low-doses of dexamethasone (4 and 8 mg) on blood glucose concentrations among diabetics and nondiabetics in patients who have received spinal anesthesia.

Materials and Methods:

After obtaining ethical clearance and patient consent, 180 American Society of Anesthesiologists 1–3 patients undergoing the elective infraumbilical surgeries under spinal anesthesia aged between 18 and 70 years were included in this study. Ninety diabetic patients were allotted to the diabetic group (DM), and ninety nondiabetic patients were allotted to the nondiabetic group (ND). Group DM was divided into three subgroups DM0, DM4, and DM8. Group ND was divided into three subgroups ND0, ND4, and ND8. The patients in groups DM0 and ND0 served as controls. The patients in groups DM4 and ND4 received 4 mg dexamethasone. The patients in groups DM8 and ND8 received 8 mg dexamethasone. The blood glucose concentrations were monitored at 0 (baseline), 1, 2, 3, 4, 5, 6, and 8 h after giving the drug.

Results:

The baseline blood glucose values were higher in diabetics compared to nondiabetics (128.57 ± 22.26 vs 94.99 ± 12.82 mg/dL). There was a statistically significant increase in blood glucose concentrations in both diabetics and nondiabetics who received dexamethasone. The rise of blood glucose from baseline was similar in both diabetics and nondiabetics.

Conclusion:

The maximum rise in blood glucose was in the range of 40–45 mg/dl in the patients who received dexamethasone. The clinician should use his clinical judgment before administering dexamethasone for PONV prophylaxis/treatment.

Intrathecal Hyperbaric Bupivacaine with Varying Doses of Buprenorphine for Postoperative Analgesia after Cesarean Section: A Comparative Study

Background:

Postoperative analgesia after cesarean section poses unique clinical challenges to anesthesiologist. Intrathecal buprenorphine is a promising drug for postoperative analgesia.

Aim:

The aim of this study was to compare the efficacy of two doses of buprenorphine (45 μg and 60 μg) as an adjuvant to hyperbaric bupivacaine for postoperative analgesia in cesarean section.

Setting and Design:

Prospective randomized double-blind controlled study involving ninety parturients posted for elective cesarean section under subarachnoid block.

Materials and Methods:

Group A (n = 30) received 1.8 ml of 0.5% hyperbaric bupivacaine with 45 μg buprenorphine, Group B (n = 30) received 1.8 ml 0.5% hyperbaric bupivacaine with 60 μg buprenorphine, Group C (n = 30) received 1.8 ml of 0.5% hyperbaric bupivacaine with 0.2 ml normal saline, respectively. Following parameters were observed: onset and duration of sensory block, postoperative pain scores based on visual analog scale (VAS), rescue analgesic requirement, and maternal and neonatal side effects if any.

Statistical Analysis:

Unpaired t-test and Chi-square test were used.

Results:

Duration of postoperative analgesia was significantly prolonged in Groups A and B in comparison to Group C and it was longest in Group B. Rescue analgesic requirement and VAS score were significantly lower in the buprenorphine groups. No major side effects were observed.

Conclusion:

Addition of buprenorphine to intrathecal bupivacaine prolonged the duration and quality of postoperative analgesia after cesarean section. Increasing the dose of buprenorphine from 45 μg to 60 μg provided longer duration of analgesia without increase in adverse effects.