Intrathecal hyperbaric bupivacaine with varying doses of buprenorphine for postoperative analgesia after cesarean section: A comparative study

Ravindran, Rashmi; Sajid, Binu; Ramadas, Konnanath Thekkethil; Susheela, Indu

doi:10.4103/aer.aer_82_17

Cited by 10 publications

(14 citation statements)

References 15 publications

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“…However, when morphine is also added to the intrathecal mixture, fentanyl might induce acute opioid tolerance and result in greater opioid consumption [59]. Intrathecal buprenorphine [60] and epidural hydromorphone [61] resulted in improved postoperative analgesia and reduced opioid consumption compared with intrathecal bupivacaine or ropivacaine alone.…”

Section: Resultsmentioning

confidence: 99%

PROSPECT guideline for elective caesarean section: updated systematic review and procedure‐specific postoperative pain management recommendations

et al. 2020

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Caesarean section is associated with moderate-to-severe postoperative pain, which can influence postoperative recovery and patient satisfaction as well as breastfeeding success and mother-child bonding. The aim of this systematic review was to update the available literature and develop recommendations for optimal pain management after elective caesarean section under neuraxial anaesthesia. A systematic review utilising procedure-specific postoperative pain management (PROSPECT) methodology was undertaken. Randomised controlled trials published in the English language between 1 May 2014 and 22 October 2020 evaluating the effects of analgesic, anaesthetic and surgical interventions were retrieved from MEDLINE, Embase and Cochrane databases. Studies evaluating pain management for emergency or unplanned operative deliveries or caesarean section performed under general anaesthesia were excluded. A total of 145 studies met the inclusion criteria. For patients undergoing elective caesarean section performed under neuraxial anaesthesia, recommendations include intrathecal morphine 50-100 µg or diamorphine 300 µg administered pre-operatively; paracetamol; non-steroidal anti-inflammatory drugs; and intravenous dexamethasone administered after delivery. If intrathecal opioid was not administered, single-injection local anaesthetic wound infiltration; continuous wound local anaesthetic infusion; and/or fascial plane blocks such as transversus abdominis plane or quadratus lumborum blocks are recommended. The postoperative regimen should include regular paracetamol and non-steroidal anti-inflammatory drugs with opioids used for rescue. The surgical technique should include a Joel-Cohen incision; non-closure of the peritoneum; and abdominal binders. Transcutaneous electrical nerve stimulation could be used as analgesic adjunct. Some of the interventions, although effective, carry risks, and consequentially were omitted from the recommendations. Some interventions were not recommended due to insufficient, inconsistent or lack of evidence. Of note, these recommendations may not be applicable to unplanned deliveries or caesarean section performed under general anaesthesia.

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Section: Resultsmentioning

confidence: 99%

PROSPECT guideline for elective caesarean section: updated systematic review and procedure‐specific postoperative pain management recommendations

et al. 2020

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“…Opioids are still currently being used as adjuvants to intrathecal blocks as side effects are minimal, and they can be safely used in the elderly as well as pregnant patients and ease of availability makes them a practical choice. [ 17 18 19 20 21 22 23 24 25 26 27 ] Previous systematic reviews have evaluated the safety and efficacy of intrathecal opioids (Fentanyl) as adjuvants for spinal anesthesia. [ 17 18 19 ] A study conducted by Wang and et al on the effects of intrathecal bupivacaine and bupivacaine plus fentanyl in elderly patients undergoing total hip arthroplasty showed that although the quality of anesthesia was the same, the fentanyl group showed less use of ephedrine for stable hemodynamics and a longer duration for postoperative analgesic use.…”

Section: Discussionmentioning

confidence: 99%

Comparison of intrathecal fentanyl and buprenorphine as an adjuvant to 0.5% hyperbaric bupivacaine for spinal anesthesia

Dhawale

Sivashankar

2021

Anesth Essays Res

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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.

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“…Its high lipid solubility, higher affinity for opioid receptors, and long duration of action make it a better choice as postoperative analgesic. [2] Dexmedetomidine is a highly selective α 2 adrenoceptor agonist that binds eight times more avidly to α 2 receptors than clonidine having sympatholytic, sedative-hypnotic, anxiolytic, and analgesic property. [3]…”

Section: Introductionmentioning

confidence: 99%

Efficacy of intra-articular dexmedetomidine versus buprenorphine for postoperative analgesia following knee arthroscopy: A comparative study

Das

Samal

2019

Anesth Essays Res

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Background: Arthroscopic knee surgery is most commonly performed minimally invasive surgical procedure in orthopaedics. Postoperative pain relief is must for early mobilisation that reduces patient's morbidity and improves postoperative recovery. Aims and Objectives: We sought to compare analgesic efficacy of intraarticular buprenorphine with dexmedetomidine following arthroscopic surgery of knee. Settings and Design: A prospective , randomized controlled double blinded study was conducted involving 60 patients undergoing arthroscopic knee surgery. Materials and Methods: Patients were allocated into group B ( n = 30) and group D ( n = 30) receiving 100 μg of intraarticular buprenorphine and 100 μg of intraarticular dexmedetomidine respectively. Parameters observed were the time to first rescue analgesia , the number of patients requiring rescue analgesia with in next 24 hours, Visual analogue scale (VAS) at rest and on mobilization at 1 st , 2 nd , 4 th , 8 th , 12 th and 24 th hour. Statistical Analysis: Quantitative data were analyzed by unpaired student's t test and categorical data by Fisher's exact test. A P < 0.05 was considered to be significant. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS 19.0, SPSS Inc., Chicago, IL, USA). Results: Time to first rescue analgesia was significantly longer in patients receiving in group B. VAS scores at rest were comparable between the groups at 1 st , 2 nd , 4 th and 8 th hour but significantly low with intraarticular buprenorphine than intraarticular dexmedetomidine at 12 th and 24 th hour. VAS scores on ambulation were comparable at 1 st , 2 nd and 4 th hour but significantly higher in dexmedetomidine group as compared to buprenorphine at 8 th , 12 th and 24 th hour. Conclusion: Intraarticular buprenorphine 100 μg provides longer duration of analgesia with decreased postoperative rescue analgesic requirement as compared to 100 μg intraarticular dexmedetomidine.

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Intrathecal hyperbaric bupivacaine with varying doses of buprenorphine for postoperative analgesia after cesarean section: A comparative study

Cited by 10 publications

References 15 publications

PROSPECT guideline for elective caesarean section: updated systematic review and procedure‐specific postoperative pain management recommendations

PROSPECT guideline for elective caesarean section: updated systematic review and procedure‐specific postoperative pain management recommendations

Comparison of intrathecal fentanyl and buprenorphine as an adjuvant to 0.5% hyperbaric bupivacaine for spinal anesthesia

Efficacy of intra-articular dexmedetomidine versus buprenorphine for postoperative analgesia following knee arthroscopy: A comparative study

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