Local Analgesia without Anesthesia Using Peripheral Perineural Morphine Injections

Mays, Kit S.; Lipman, Jonathan J.; Schnapp, Moacir

doi:10.1213/00000539-198705000-00008

Cited by 89 publications

(35 citation statements)

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“…Post operative analgesia was prolonged in buprenorphine group, our study and other studies 11,13 came to similar conclusions. With addition of buprenorphine to LA agents the onset and duration of motor blockade are comparable, this finding corroborated with another such studies 8,10 .Many studies suggest the action of opioids on peripheral nerves 14,15 and the unique mechanism of buprenorphine along with portable local anesthetics effects 16 .This suggests the usefulness of peripheral perineuronal route of opiate like buprenorphine administration 17 .The easily availability and lack of significant side effects like respiratory depression and sedation makes buprenorphine an attractive choice as an adjuvant for brachial plexus block.…”

Section: Discussionsupporting

confidence: 74%

Buprenorphine as an adjuvant in supraclavicular brachial plexus block.

Singam

Chaudhari

Nagrale

2012

Int J of Biomed & Adv Res

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Background & Aims: Brachial plexus block is a useful alternative to general anaesthesia. Postoperative analgesia is an added advantage. Buprenorphine, an agonist antagonist opioid has been used by various routes to prolong analgesia. The present study was undertaken to assess the analgesic efficacy of Buprenorphine with Bupivacaine in brachial plexus block. Methods: A prospective, randomized, double blind study was done on 60 adult patients of American Society of Anesthesiologists 1 and 2, aged between 18-50 years and scheduled for various upper limb surgeries. Patients were divided into two groups of 30 each. Group C (control group) received 38ml of inj. bupivacaine 0.25% +2ml normal saline and group B (Buprenorphine group) received 38ml of inj. bupivacaine 0.25% +2ml inj. Buprenorphine (preservative free) (0.3 mg). Patients were observed for onset and duration of motor block, onset and duration of sensory block, duration of pain relief and occurrence of any complications. Results: Post operative analgesia was significantly longer (901.33±60.04 min) in group B, as compared to group C (343.00±33.02 min) with p value <0.001. Duration of sensory block in group C was 322.16±31.80 min and in group B 647.83±55.70 min. with p value <0.001. Pain score was significantly low in group B (mean 1.44), compared to group C (mean 5.60) at 12 hours postoperatively. Conclusion: Addition of Buprenorphine 0.3 mg to 38ml of bupivacaine 0.25% for supraclavicular brachial plexus block prolonged sensory blockade and post-operative analgesia without increasing the risk of adverse effects.

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Section: Discussionsupporting

confidence: 74%

Buprenorphine as an adjuvant in supraclavicular brachial plexus block.

Singam

Chaudhari

Nagrale

2012

Int J of Biomed & Adv Res

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“…Opioid medications added to local anesthetic solutions have also been shown capable of prolonging the duration of peripheral nerve blocks. 19,20 There are several limitations associated with the PNB technique and study design. First, despite improved precision of nerve blocks achieved with nerve-stimulation guidance, conversion to GA was required in 7.5% of patients.…”

Section: Discussionmentioning

confidence: 99%

Nerve stimulator guided pudendal nerve blockversus general anesthesia for hemorrhoidectomy

Naja

El-Rajab

Al-Tannir

et al. 2006

Can J Anesth/J Can Anesth

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Purpose: A randomized clinical trial was undertaken to test the hypothesis that patients receiving a nerve stimulator guided pudendal nerve block for hemorrhoidectomy would experience more effective and prolonged postoperative analgesia and shorter hospital stay compared to patients receiving general anesthesia. Methods:This was a prospective randomized observer-blinded study. Following Ethics Committee approval and informed consent, 80 patients scheduled for hemorrhoidectomy were randomized to two groups of 40 patients each: general anesthesia alone, or nerve stimulator guided pudendal nerve block. Postoperative pain, the primary outcome variable of the study, was assessed by visual analogue scale scores at pre-determined intervals during the postoperative period. Analgesic consumption, time to return to normal activities, patients' and surgeons' satisfaction, and duration of hospital stay were recorded. Results:The guided pudendal nerve block group failed in three patients, requiring their conversion to general anesthesia. Otherwise, patients in the pudendal nerve block group experienced better postoperative pain relief at rest (P < 0.0001), on walking, sitting, and defecation (P < 0.001), reduced need for opioids (11/35 vs 32/37; P < 0.0001), a more rapid return to normal activities (7.2 vs 13.8 days; P < 0.0001) and also a shorter hospital stay (25/35 vs 3/37 outpatient cases; P < 0.0001) compared to the general anesthesia group. Pudendal nerve block was also associated with overall higher patient satisfaction compared to general anesthesia (30/35 vs 9/37; P < 0.0001). Conclusion:Nerve stimulator guided pudendal nerve block is associated with reduced postoperative pain, shortened hospital stay, and earlier return to normal activity compared to general anesthesia for hemorrhoidectomy.

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“…Other clinical studies, which have evaluated the peripheral antinociceptive actions of morphine and other opioids have produced equivocal findings. This particularly applies to the perineural injection of morphine, with one study reporting positive results [13] whilst others report poor efficacy [14,15]. By contrast an intra-articular injection of morphine provided significant analgesia after arthroscopic knee surgery [16].…”

Section: Discussionmentioning

confidence: 99%

The efficacy of locally applied morphine in post‐operative pain after bilateral third molar surgery.

Moore

Seymour

Gilroy

et al. 1994

Brit J Clinical Pharma

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1. Recent evidence has hinted at a peripheral site of action of morphine analgesic efficacy. 2. Previous studies by the same authors have developed a model for testing local analgesic efficacy by placing drugs into tooth sockets after third molar surgery. 3. The present studies test the hypothesis of local morphine activity at two dosage concentrations, 100 ng ml‐1 and 100 micrograms ml‐1 after third molar surgery. 4. No significant analgesic efficacy was found at either dose when compared with placebo.

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Local Analgesia without Anesthesia Using Peripheral Perineural Morphine Injections

Cited by 89 publications

References 0 publications

Buprenorphine as an adjuvant in supraclavicular brachial plexus block.

Buprenorphine as an adjuvant in supraclavicular brachial plexus block.

Nerve stimulator guided pudendal nerve blockversus general anesthesia for hemorrhoidectomy

The efficacy of locally applied morphine in post‐operative pain after bilateral third molar surgery.

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