Evaluation of the Addition of Bupivacaine to Intrathecal Morphine and Fentanyl for Postoperative Pain Management in Laparascopic Liver Resection

Nguyen, Micheline; Vandenbroucke, Franck; Roy, Jean‐Philippe; Beaulieu, Danielle; Seal, Robert F.; Lapointe, Réal; Dagenais, Michel; Roy, André; Massicotte, Luc

doi:10.1097/aap.0b013e3181de12e4

Cited by 13 publications

(14 citation statements)

References 33 publications

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“…However, this procedure causes a great deal of pain and suffering for the patients and their relatives. Furthermore, it often fails or causes injury, with delays in treatment of cerebral leukemia or multiple attempts in one procedure with difficult puncture in late chemotherapy or fear of puncture with a low success rate in treating leukemia (Barbi et al, 2005;Nagel et al, 2008;Nguyen et al, 2010). Therefore, it is necessary to develop an easily applicable method to relieve the patients' pain.…”

Section: Introductionmentioning

confidence: 99%

Rapid sedation induced by fentanyl combined with propofol via an intrathecal chemotherapy injection for leukemia in children

et al. 2015

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ABSTRACT. This study explored the sedative and analgesic effects of fentanyl combined with propofol via an intrathecal chemotherapy injection for acute leukemia (acute lymphocytic leukemia or acute myelocytic leukemia) among children, to relieve pain and difficulty during intrathecal injection, improve treatment compliance, increase the success rate of single puncture, and reduce procedure failure, with the aim of developing a painless procedure for children with acute leukemia. Fifty person-times received fentanyl combined with propofol via an intrathecal chemotherapy injection among the hospitalized children with leukemia. The patients' cooperation with the procedure, response to the medication, dosages of fentanyl and propofol, reaction to the procedures, wake-up time, and changes in oxygen saturation (SpO 2 ), heart rate (HR), respiration, and blood pressure (BP) before, during, and after the procedures were observed. The doctors who performed the procedures assessed the quality of sedation and analgesia. In the treatment group, the patients were quiet during the lumbar puncture and intrathecal injection, showing good sedation and analgesia. HR and respiration decreased slightly. There were no changes in SpO 2 and BP. No obvious respiratory depression occurred with proper dosages. Only a few patients showed stertorous respiration, which stopped soon after the procedures. In the control group, the patients were agitated, crying, and not cooperative before and during the procedures, which made the procedures very difficult. During intrathecal injection, pain obviously reduced and the success rate of single lumbar puncture increased. It is safe and effective to apply fentanyl combined with propofol for sedation and analgesia.

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Section: Introductionmentioning

confidence: 99%

Rapid sedation induced by fentanyl combined with propofol via an intrathecal chemotherapy injection for leukemia in children

et al. 2015

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“…Specifically, the reported incidences of nausea/vomiting and pruritus after surgery were approximately 60–80% and 30–100%, respectively [ 36 – 38 ]. Nguyen et al [ 39 ] suggested that the addition of bupivacaine (15 mg) to intrathecal morphine (0.4 mg) improved pain relief and reduced the incidence of adverse events (such as hypotension) in patients undergoing laparoscopic liver resection. Girgin et al [ 40 ] found that the incidence of pruritus increased as the dose of intrathecal morphine rose from 0.1 to 0.4 mg; however, when morphine was combined with low-dose bupivacaine (7.5 mg), the complication rate was reduced while analgesia remained stable in women undergoing cesarean sections.…”

Section: Discussionmentioning

confidence: 99%

Comparison of analgesic efficacy between rectus sheath blockade, intrathecal morphine with bupivacaine, and intravenous patient-controlled analgesia in patients undergoing robot-assisted laparoscopic prostatectomy: a prospective, observational clinical study

et al. 2020

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Background We explored the analgesic outcomes on postoperative day (POD) 1 in patients undergoing robot-assisted laparoscopic prostatectomy (RALP) who received intravenous patient-controlled analgesia (IV-PCA), rectus sheath bupivacaine block (RSB), or intrathecal morphine with bupivacaine block (ITMB). Methods This was a prospective, observational clinical trial. Patients were divided into three groups: IV-PCA (n = 30), RSB (n = 30), and ITMB (n = 30). Peak pain scores at rest and with coughing, cumulative IV-PCA drug consumption, the need for IV rescue opioids, and Quality of Recovery-15 (QoR-15) questionnaire scores collected on POD 1 were compared among the groups. Results The preoperative and intraoperative findings were comparable among the groups; the ITMB group required the least remifentanil of all groups. During POD 1, the ITMB group reported lower levels of pain at rest and with coughing, compared with the other two groups. During POD 1, incidences of severe pain at rest (10.0% vs. 23.3% vs. 40.0%) and with coughing (16.7% vs. 36.7% vs. 66.7%) were the lowest in the ITMB group compared with the RSB and IV-PCA groups, respectively. After adjustment for age, body mass index, diabetes mellitus, hypertension, and intraoperative remifentanil infusion, severe pain at rest was 0.167-fold less common in the ITMB group than in the IV-PCA group, while pain with coughing was 0.1-fold lower in the ITMB group and 0.306-fold lower in the RSB group, compared with the IV-PCA group. The ITMB group required lower cumulative IV-PCA drug infusions and less IV rescue opioids, while exhibiting a better QoR-15 global score, compared with the other two groups. Complications (nausea and pruritus) were significantly more common in the ITMB group than in the other two groups; however, we noted no ITMB- or RSB-related anesthetic complications (respiratory depression, post-dural headache, nerve injury, or puncture site hematoma or infection), and all patients were assessed as Clavien-Dindo grade I or II during the hospital stay. Conclusion Although ITMB induced complications of nausea and pruritus, this analgesic technique provided appropriate pain relief that enhanced patient perception related to early postoperative recovery. Trial registration Clinical Research Information Service, Republic of Korea, (approval number: KCT0005040) on May 20, 2020

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“…Speci cally, the reported incidences of nausea/vomiting and pruritus after surgery were approximately 60-80% and 30-100%, respectively [36][37][38]. Nguyen et al [39] suggested that the addition of bupivacaine (15 mg) to intrathecal morphine (0.4 mg) improved pain relief and reduced the incidence of adverse events (such as hypotension) in patients undergoing laparoscopic liver resection. Girgin et al [40] found that the incidence of pruritus increased as the dose of intrathecal morphine rose from 0.1 to 0.4 mg; however, when morphine was combined with low-dose bupivacaine (7.5 mg), the complication rate was reduced while analgesia remained stable in women undergoing cesarean sections.…”

Section: Discussionmentioning

confidence: 99%

Comparison of analgesic efficacy between rectus sheath blockade, intrathecal morphine with bupivacaine, and intravenous patient-controlled analgesia in patients undergoing robot-assisted laparoscopic prostatectomy: a prospective, observational clinical study

Shim

Cho

Kim

et al. 2020

Preprint

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Background: We explored the analgesic outcomes on postoperative day (POD) 1 in patients undergoing robot-assisted laparoscopic prostatectomy (RALP) who received intravenous patient-controlled analgesia (IV-PCA), rectus sheath bupivacaine block (RSB), or intrathecal morphine with bupivacaine block (ITMB). Methods: This was a prospective, observational clinical trial. Patients were divided into three groups: IV-PCA (n = 30), RSB (n = 30), and ITMB (n = 30). Peak pain scores at rest and with coughing, cumulative IV-PCA drug consumption, the need for IV rescue opioids, and Quality of Recovery-15 (QoR-15) questionnaire scores collected on POD 1 were compared among the groups.Results: The preoperative and intraoperative findings were comparable among the groups; the ITMB group required the least remifentanil of all groups. During POD 1, the ITMB group reported lower levels of pain at rest and with coughing, compared with the other two groups. During POD 1, incidences of severe pain at rest (10.0% vs. 23.3% vs. 40.0%) and with coughing (16.7% vs. 36.7% vs. 66.7%) were the lowest in the ITMB group compared with the RSB and IV-PCA groups, respectively. After adjustment for age, body mass index, diabetes mellitus, hypertension, and intraoperative remifentanil infusion, severe pain at rest was 0.167-fold less common in the ITMB group than in the IV-PCA group, while pain with coughing was 0.1-fold lower in the ITMB group and 0.306-fold lower in the RSB group, compared with the IV-PCA group. The ITMB group required lower cumulative IV-PCA drug infusions and less IV rescue opioids, while exhibiting a better QoR-15 global score, compared with the other two groups. Complications (nausea and pruritus) were significantly more common in the ITMB group than in the other two groups; however, we noted no ITMB- or RSB-related anesthetic complications (respiratory depression, post-dural headache, nerve injury, or puncture site hematoma or infection), and all patients were assessed as Clavien-Dindo grade I or II during the hospital stay.Conclusion: Although ITMB induced complications of nausea and pruritus, this analgesic technique provided appropriate pain relief that enhanced patient perception related to early postoperative recovery.Trial registration: Clinical Research Information Service, Republic of Korea, (approval number: KCT0005040) on May 20, 2020https://cris.nih.go.kr/cris/search/search_result_st01_kren.jsp?seq=15943&sLeft=2&ltype=my&rtype=my

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Evaluation of the Addition of Bupivacaine to Intrathecal Morphine and Fentanyl for Postoperative Pain Management in Laparascopic Liver Resection

Abstract: The addition of bupivacaine to intrathecal morphine and fentanyl significantly reduced intravenous morphine consumption after laparoscopic liver resection.

Cited by 13 publications

References 33 publications

Rapid sedation induced by fentanyl combined with propofol via an intrathecal chemotherapy injection for leukemia in children

Rapid sedation induced by fentanyl combined with propofol via an intrathecal chemotherapy injection for leukemia in children

Comparison of analgesic efficacy between rectus sheath blockade, intrathecal morphine with bupivacaine, and intravenous patient-controlled analgesia in patients undergoing robot-assisted laparoscopic prostatectomy: a prospective, observational clinical study

Comparison of analgesic efficacy between rectus sheath blockade, intrathecal morphine with bupivacaine, and intravenous patient-controlled analgesia in patients undergoing robot-assisted laparoscopic prostatectomy: a prospective, observational clinical study

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