Lumbar epidural fentanyl infusions for post-thoracotomy patients: Analgesic, respiratory, and pharmacokinetic effects

Badner, Neal H.; Sandler, Alan N.; Koren, Gideon; Lawson, Scott; Klein, Julia; Einarson, Thomas R.

doi:10.1016/0888-6296(90)90402-2

Cited by 34 publications

(6 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This is the first study to assess the analgesic effect of dextrose injected in the caudal epidural space. Onset of analgesia compares well with reported onset with epidural morphine and fentanyl and may be of longer duration ( 32 , 33 ). It did not alter sensation, although the analgesia was longer than that reported for single epidural injection of bupivacaine in one study ( 34 ).…”

Section: Discussionsupporting

confidence: 70%

Short Term Analgesic Effects of 5% Dextrose Epidural Injections for Chronic Low Back Pain: A Randomized Controlled Trial

Maniquis-Smigel¹,

Reeves

Rosen³

et al. 2016

Anesth Pain Med

View full text Add to dashboard Cite

BackgroundHypertonic dextrose injection (prolotherapy) is reported to reduce pain including non-surgical chronic low back pain (CLBP), and subcutaneous injection of 5% dextrose is reported to reduce neurogenic pain, hyperalgesia and allodynia. The mechanism in both cases is unclear, though a direct effect of dextrose on neurogenic pain has been proposed. This study assessed the short-term analgesic effects of epidural 5% dextrose injection compared with saline for non-surgical CLBP.MethodsRandomized double-blind (injector, participant) controlled trial. Adults with moderate-to-severe non-surgical low back pain with radiation to gluteal or leg areas for at least 6 months received a single epidurogram-confirmed epidural injection of 10 mL of 5% dextrose or 0.9% saline using a published vertical caudal injection technique. The primary outcome was change in a numerical rating scale (NRS, 0 - 10 points) pain score between baseline and 15 minutes; and 2, 4, and 48 hours and 2 weeks post-injection. The secondary outcome was percentage of participants achieving 50% or more pain improvement at 4 hours.Results and ConclusionsNo baseline differences existed between groups; 35 participants (54 ± 10.7 years old; 11 female) with moderate-to-severe CLBP (6.7 ± 1.3 points) for 10.6 ± 10.5 years. Dextrose participants reported greater NRS pain score change at 15 minutes (4.4 ± 1.7 vs 2.4 ± 2.8 points; P = 0.015), 2 hours (4.6 ± 1.9 vs 1.8 ± 2.8 points; P = 0.001), 4 hours (4.6 ± 2.0 vs 1.4 ± 2.3 points; P < 0.001), and 48 hours (3.0 ± 2.3 vs 1.0 ± 2.1 points; P = 0.012), but not at 2 weeks (2.1 ± 2.9 vs 1.2 ± 2.4 points; P = 0.217). Eighty four percent (16/19) of dextrose recipients and 19% (3/16) of saline recipients reported ≥ 50% pain reduction at 4 hours (P < 0.001). These findings suggest a neurogenic effect of 5% dextrose on pain at the dorsal root level; waning pain control at 2 weeks suggests the need to assess the effect of serial dextrose epidural injections in a long-term study with robust outcome assessment.

show abstract

Section: Discussionsupporting

confidence: 70%

Short Term Analgesic Effects of 5% Dextrose Epidural Injections for Chronic Low Back Pain: A Randomized Controlled Trial

Maniquis-Smigel¹,

Reeves

Rosen³

et al. 2016

Anesth Pain Med

View full text Add to dashboard Cite

show abstract

“…Pruritus is the most common side effect whereas nausea and vomiting are rare. 3 Magnesium is an N-methyl D-Aspartate (NMDA) receptor antagonist. Magnesium not only has its individual analgesic property but also has the analgesic property of opioids.…”

mentioning

confidence: 99%

Comparative study of ropivacaine with ropivacaine-fentanyl and ropivacaine-fentanyl- magnesium sulfate in epidural anesthesia for lower limb surgeries

Gupta¹,

Tiwari

Kapoor

et al. 2018

Int Surg J

View full text Add to dashboard Cite

Background: Epidural anesthesia is currently one of the most used technique for patients undergoing lower limb surgery. Dose sparing action of one adjuvant for another in epidural anesthesia with local anesthetic drugs for providing quality care to the patient remains controversial. Aims of the present study was to compare and study the properties 0.75% Ropivacaine alone (R) with 0.75% Ropivacaine-Fentanyl (RF) and 0.75% Ropivacaine-Fentanyl-Magnesium sulfate (RFM) in epidural anesthesia for lower limb surgeries. Study design was prospective randomized double blind study.Methods: Patients between 18-60 years of age of ASA physical status class I and II undergoing lower limb surgeries were randomly allocated into 3 groups of 20 each. Total volume in epidural space given was 17ml in all 3 groups. Group R (n=20) received 15ml of 0.75% Ropivacaine with 2ml of normal saline, Group RF (n=20) received 15ml of 0.75% Ropivacaine with 50mg of fentanyl (1ml) and 1ml normal saline and Group RFM (n=20) received 15ml of 0.75% Ropivacaine with 50mg of fentanyl (1ml) and 100mg MgSO4 (1ml). Patients were then studied for hemodynamic profile, various block characteristics and side effects. Statistical analysis used was ANOVA, paired t-test, Chi-square and post hoc test were used. P <0.05 was considered significant.Results: All three groups had stable hemodynamic parameters with Group RFM showing better block characteristics (p <0.001) in terms of time for achieving onset of analgesia, time for achieving T10 sensory blockade, time for requirement of first epidural top up, time for achieving motor Blockade, time for complete recovery of motor blockade with no significant differences in the side effect profile.Conclusions: Epidural anesthesia for lower limb surgeries may have better block characteristic parameters if a combination of Ropivacaine-fentanyl-magnesium sulphate is used in comparison with ropivacaine-fentanyl or ropivacaine alone.

show abstract

“…One could also use patient-controlled analgesic or similar techniques, as our group and many others do, to optimize fentanyl dosage (4,6,7). One could also use patient-controlled analgesic or similar techniques, as our group and many others do, to optimize fentanyl dosage (4,6,7).…”

Section: Addition Of Low-dose Bupivacaine To Epidural Fentanyl Infusionmentioning

confidence: 96%

Addition of Low-Dose Bupivacaine to Epidural Fentanyl Infusion

Prados¹

1991

Anesthesia & Analgesia

View full text Add to dashboard Cite

Reference 1. Badner NH, Reimer EJ, Komar WE, Moote CA. Low-dose bupivacaine does not improve postoperative epidural fentanyl analgesia in orthopedic patients. Anesth Analg 1991;72:33741.In Response:We thank Drs. Maves and Gebhart for their interest in our paper comparing the use of epidural fentanyl with epidural fentanyl and 0.1% bupivacaine (1). Our study was designed only to compare the concentrations used and not to determine if synergy does or does not occur between epidural opioids and local anesthetics. Our conclusions were therefore intended to convey the fact that the addition of 0.1% bupivacaine per se does not improve the efficacy of epidural fentanyl in a concentration of 10 pg/mL. We chose these concentrations as they are used routinely and have been reported by others to be superior to this concentration of epidural fentanyl alone ( 2 4 ) . We cannot argue with Drs. Maves and Gebhart's findings, as well as the findings of others (5), that the addition of local anesthetics to intruthecul opioids improves analgesia in rats. Our study simply showed that 0.1% bupivacaine is not the appropriate concentration for epidural fentanyl in a lO-pg/mL concentration in patients after total knee joint replacement. Although we suggested that morbidity was increased with the addition of 0.1% bupivacaine, the one case of respiratory depression was most likely due to the epidural fentanyl and not to an additive effect of the combination. In fact, as we suggested in the discussion, a higher concentration of bupivacaine may be necessary to allow a decrease in epidural fentanyl requirements and thereby show a synergistic effect. We are presently investigating this possibility in an ongoing study.

show abstract

Lumbar epidural fentanyl infusions for post-thoracotomy patients: Analgesic, respiratory, and pharmacokinetic effects

Cited by 34 publications

References 31 publications

Short Term Analgesic Effects of 5% Dextrose Epidural Injections for Chronic Low Back Pain: A Randomized Controlled Trial

Short Term Analgesic Effects of 5% Dextrose Epidural Injections for Chronic Low Back Pain: A Randomized Controlled Trial

Comparative study of ropivacaine with ropivacaine-fentanyl and ropivacaine-fentanyl- magnesium sulfate in epidural anesthesia for lower limb surgeries

Addition of Low-Dose Bupivacaine to Epidural Fentanyl Infusion

Contact Info

Product

Resources

About