Low‐dose bupivacaine with sufentanil prevents hypotension after spinal anesthesia for hip repair in elderly patients

Olofsson, Christina; Eb, Nygårds; Ab, Bjersten; Hessling, Alexander von

doi:10.1111/j.1399-6576.2004.00504.x

Cited by 77 publications

(91 citation statements)

References 21 publications

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“…These findings are consistent with the results of Asehnoune et al 13 No significant difference (P>0.05) between the mean respiratory rate in both the groups throughout the observation period. There was no respiratory depression in any of the patients of either group that was similar to studies of Olofsson et al 8 Nausea and vomiting was seen only in patients of group B. No clinically significant sedation occurred in any of the patients of either group.…”

Section: Discussionsupporting

confidence: 71%

“…These findings of the present study are similar to results of Ben David et al Olofsson et al also found that there was statistically significant decrease in degree and duration of motor block when 7.5 mg of bupivacaine with 5 mg sufentanil was compared with 15 mg of bupivacaine. 8 From the studies of Sundnes et al and Axelsson et al we can conclude that by reducing the dose of local anesthetic, the cephalad spread, degree of motor block and duration of motor block can be decreased. 9,10 The addition of sufentanil enhances the somatic analgesia thus achieving similar peak sensory levels with smaller dose of local anaesthetic thus induction to baby delivery time can be reduced.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of intrathecal sufentanil and hyperbaric bupivacaine with intrathecal hyperbaric bupivacaine for caesarean section

2016

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INTRODUCTIONNeuraxial block for lower segment cesarean section (LSCS) has become increasingly popular amongst parturients, as most of them prefer being awake during birth of the baby.1 Many practitioners prefer spinal anaesthesia to epidural block because of simplicity of technique, rapidity in onset of action and reliability in producing uniform sensory and motor blockade as also avoiding the much dreaded complication of aspiration due to delayed gastric emptying as seen with general anaesthesia. 2-4The disadvantages however are limited duration of action, lack of long lasting post-partum analgesia and visceral pain during manipulation of uterus or at the time of peritoneal closure associated with intra-operative nausea and vomiting. To overcome these problems, ABSTRACTBackground: Sufentanil added to intrathecal bupivacaine for cesarean section has shown to improve intraoperative and postoperative analgesia without any adverse effects to the mother and neonate. In the present study we compare the effects of intrathecal sufentanil 5 µg and 8 mg of 0.5% hyperbaric bupivacaine with intrathecal 10 mg of 0.5% hyperbaric bupivacaine for caesarean section. Methods: This study was performed in a 60 pregnant patients undergoing elective LSCS under spinal anaesthesia in a randomized, prospective double blind comparative method in Lokmanya Tilak Municipal General Hospital after taking approval from hospital ethics committee. After fulfilling requirements of inclusion criteria patients were randomly divided into 2 groups of 30 each. Study group (BS) received intrathecal sufentanil 5 µg with 8 mg of 0.5% hyperbaric bupivacaine and the control group (B) received intrathecal 0.5% hyperbaric bupivacaine 10 mg. Pre, intra and postoperative investigations were made accordingly. Results: No significant differences were observed among demographic parameters like age, weight, height and duration of surgery (p>0.05). The results were statistically significant (p<0.05) when the two groups were compared for the sensory blockade and motor blockade and the time to first analgesic requirement was significantly (p<0.05) prolonged in group BS as compared to group B. Both the groups showed decrease in pulse rate as compared to the baseline in the intra-operative and postoperative period. A significant (p<0.05) fall in the systolic blood pressure in B group was observed compared to BS group from 4 min to 75. None of the patients in either group developed respiratory rate <10 per minute and fall in oxygen saturation throughout the observation period. The sedation scores of the both groups were comparable and are statistically significant (p<0.05) with each other. Conclusions: A reduced dose of 0.5% hyperbaric bupivacaine (8 mg) in combination with sufentanil (5 µg) provides reliable spinal anesthesia for cesarean section with better hemodynamic stability and low incidence of minor side effects as compared to 10 mg hyperbaric bupivacaine.

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Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Comparison of intrathecal sufentanil and hyperbaric bupivacaine with intrathecal hyperbaric bupivacaine for caesarean section

2016

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“…precipitate heart failure. To minimize such risks, and to decrease the incidence of hemodynamic instability in high risk surgical populations (the elderly, patients with ischemic heart disease and/or a history of heart failure), it has been suggested that the dose of LAAs be reduced by combining LAAs with adjuvant drugs such as sufentanil 40 or to administer LAAs continuously via spinal anesthesia. 41 The following points must be considered in the assessment of the clinical relevance of our results.…”

Section: +mentioning

confidence: 99%

Effects of bupivacaine, levobupivacaine and ropivacaine on myocardial relaxation

David

Ferreti

Amour

et al. 2007

Can J Anesth/J Can Anesth

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CAN J ANESTH 54: 3 www.cja-jca.org March, 2007 Purpose: Ropivacaine and levobupivacaine were developed to reduce the risk of occasional toxicity reported with bupivacaine. While the effects of long-acting local anesthetics (LAAs) on myocardial contractility (inotropy) are well described, their effects on relaxation (lusitropy) remain largely unknown. The present study aimed to compare the effects of LAAs on rat myocardium. Methods:Left ventricular papillary muscles of male Wistar rats were used to compare the inotropic and lusitropic responses of increasing concentrations of LAAs (10 -8 to 10 -3 M) under isometric and isotonic conditions. Data are mean % (SD) of baseline value.Results: Long-acting local anesthetics induced a significant impairment of relaxation in isotonic and isometric conditions. As compared to ropivacaine, bupivacaine and levobupivacaine induced greater negative lusitropic effects in isotony [at 10 -3 M, maximum unloaded shortening velocity ( max Vr) = 27 ± 11 vs 13 ± 6 and 8 ± 5%] and isometry (at 10 -3 M, time-to-halfrelaxation: 106 ± 10 vs 127 ± 17 and 133 ± 17%). When the comparison was made with equipotent concentrations, the negative lusitropic effects induced with levobupivacaine were significantly greater than those of bupivacaine and ropivacaine in isometric and isotonic conditions (at 10 -3 M, max Vr = 7 ± 4 vs 13 ± 6 and 17 ± 4 %). As previously described, LAAs also induced concentration-dependent negative inotropic effects that were greater for levobupivacaine compared to equivalent or equipotent concentrations of bupivacaine and ropivacaine.Conclusions: Long-acting local anesthetics induce marked negative inotropic and lusitropic effects. Among LAAs, levobupivacaine exerts the greater depressant effects. Impairment of calcium handling and sarcoplasmic reticulum could explain the differential responses to local anesthetics. Objectif : La ropivacaïne et la lévobupivacaïne ont été dévelop-pées pour réduire le risque d'accidents sévères observés avec la bupivacaïne. Si les effets des anesthésiques locaux (LAAs) sur la contractilité myocardique (inotropie) sont bien décrits, les effets sur la relaxation (lusitropie) restent peu explorés. Cette étude a eu pour objectif de comparer les effets des LAAs chez le rat. Méthode : Les effets de concentrations croissantes de LAAs (10 -8 à 10 -3 M) sur les réponses inotropes et lusitropes ont été comparés à l'aide d'un modèle de muscles papillaires. Les valeurs sont exprimées en % de la valeur de base (moyenne ± ET). Résultats

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“…This include lignocaine, bupivacaine, alfentanyl, sufentanyl, butorphanol, fentanyl etc. [6][7][8] It was observed that in our hospital we use lignocaine for spinal anesthesia since many years without any major complications. We found that studies mentioned in literature comparing use of local anesthetic for spinal anesthesia have small sample size of patients.…”

Section: Introductionmentioning

confidence: 99%

Low dose lignocaine + butorphanol vs. low dose bupivacaine for spinal anaesthesia in day care urological surgeries: a prospective randomized control trial

Khant¹,

Chaudhari²,

Kore³

et al. 2017

Turkish Journal of Urology

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Objective: A local anaesthetic with fast onset, short and reliable duration of anaesthesia may be preferable for day care urological surgeries. Low dose lignocaine is believed to act faster and to have a shorter duration of action than low dose bupivacaine. Use of lignocaine for spinal anesthesia is discouraged now a days because of rare reports of transient neurological symptoms. The purpose of this study was to compare effectiveness and safety of low dose of lignocaine + butorphanol against low dose of bupivacaine for day care urological surgeries. Material and methods:A prospective randomized control trial was conducted between December 2012 to November 2015. After taking ethical committe approval and patient consent, total 990 patients were randomized in two groups. Group A received 0.5 mL of 5% lignocaine (25 mg) + 0.3 mL butorphanol (0.3 mg) and group B received 1 mL of 0.5% bupivacaine (5 mg) for spinal anesthesia. Spinal anesthesia was given at the L3-L4 interspace with the patient in the sitting or lateral position. The criteria for evaluation were time till onset of sensory and motor block, duration of sensory and motor block, time till ambulation, time till fit for discharge and any complications. Results:Both the groups were comparable in terms of age, male to female ratio, American Society of Anesthesiologists (ASA) grade and duration surgery. Group A and Group B were statistically different in terms of mean time till onset of sensory block (120±22 sec and 274±36 sec), onset of motor block (228±34 sec and 372±41 sec), duration of sensory block (100±21 min and 230±28 min), duration of motor block (60±15 min and 152±23 min), time till ambulation (138±24 min and 292±48 min), time till fit for discharge (256±35 min and 428±46 min) respectively (<0.0001). Nausea, vomitings, hypotension, bradycarida and pruritis were less in group A compared to group B (<0.01). None of patient in any group had temporary or permanent neurological defecit. Conclusion:Spinal anaesthesia is an effective as well as a safe modality to anaesthetize the patient for day care urological procedures. This study shows lignocaine + butorphanol is preferable over bupivacaine for spinal anesthesia for day care urological procedures. It also favours day care surgery at remote areas with lesser medical facilities. It helps to minimize requirement of medical and paramedical staff, thus further extending scope of day care urological surgeries.

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Low‐dose bupivacaine with sufentanil prevents hypotension after spinal anesthesia for hip repair in elderly patients

Abstract: A reduced dose of hyperbaric bupivacaine (7.5 mg) in combination with sufentanil (5 microg) provides reliable spinal anesthesia for the repair of hip fracture in aged patients with few events of hypotension and little need for vasopressor support of blood pressure.

Cited by 77 publications

References 21 publications

Comparison of intrathecal sufentanil and hyperbaric bupivacaine with intrathecal hyperbaric bupivacaine for caesarean section

Comparison of intrathecal sufentanil and hyperbaric bupivacaine with intrathecal hyperbaric bupivacaine for caesarean section

Effects of bupivacaine, levobupivacaine and ropivacaine on myocardial relaxation

Low dose lignocaine + butorphanol vs. low dose bupivacaine for spinal anaesthesia in day care urological surgeries: a prospective randomized control trial

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