Spinal, Epidural, and Caudal Anesthesia

Brown, David L.

doi:10.1016/b978-0-443-06959-8.00051-0

Cited by 119 publications

(120 citation statements)

References 171 publications

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“…ketamine, neostigmine, midazolam but none of them have been accepted in clinical practice due to their side effect or non-availability. 3 Clonidine, is an α-2 adrenergic agonist that produces analgesia in humans mediated by α-2 adrenoreceptors, located postsynaptic ally in the dorsal horn of spinal cord. Administered intrathecally, it has shown good results, as it prolongs the duration of intrathecally administered local anaesthetics and has potent antinociceptive properties.…”

Section: Discussionmentioning

confidence: 99%

“…opioids like morphine, buprenorphine, pethidine, hydromorphone, fentanyl, sufentany and tramadol. 1,3 Other classes of drugs such as epinephrine, midazolam, neostigmine, ketamine, magnesium and clonidine have been added to the intrathecal local anaesthetics to prolong the analgesic effect and to reduce the incidence of adverse events. [4][5][6][7] These opioids produce satisfactory analgesia for 24hours postoperatively, but are frequently associated with side effects like respiratory depression, itching, nausea, vomiting and urinary retention.…”

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confidence: 99%

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Comparison of effect of intrathecal dexmedetomidine and clonidine as an adjuvant to hyperbaric bupivacaine in patients undergoing surgery for fracture femur and tibia

Chandra¹,

Krishna

Singh

2017

Int Surg J

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Background: Spinal anaesthesia with bupivacaine is administered routinely for lower abdominal and lower limb surgeries. The ensuing nerve block is sufficient to ensure patient’s wellbeing, while motor block facilitates the surgeon’s work. Post-operative pain relief can be achieved by various methods namely systemic opioid and non-opioid peripheral nerve blocks and local wound infiltration, each with their own merits and demerits. the present study was undertaken to compare the effect of intrathecal dexmedetomidine and clonidine as an adjuvant to hyperbaric bupivacaine in patients undergoing surgery for fracture femur and tibia.Methods: 80 patients between 20-60 years, undergoing elective surgery for closed fracture shaft of femur and tibia with ASA physical status of 1 and 2 were included in the study. All the subjects were randomly allocated to one of the two groups (Group C and Group D) by a computer-generated randomization chart. Group C received 2.5ml of 0.5% hyperbaric bupivacaine with 50mcg clonidine and group D received 2.5ml of 0.5% hyperbaric bupivacaine with 5mcg dexmedetomidine.Results: 30 of the 40 patients in group C were of ASA I and 10 were ASA II, while in group D, 25 were ASA I and 15 were ASA II. A significant difference was found in the onset time for sensory and motor block, receding time for sensory and motor block and the need of the first rescue analgesia between the two groups, showing that Dexmedetomidine was more potent than clonidine.Conclusions: Dexmedetomidine is a potent, highly selective and specific α2-adrenoreceptor agonist that has both sedative and analgesic effects and is also a valuable adjuvant when regional anaesthesia is incorporated.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Comparison of effect of intrathecal dexmedetomidine and clonidine as an adjuvant to hyperbaric bupivacaine in patients undergoing surgery for fracture femur and tibia

Chandra¹,

Krishna

Singh

2017

Int Surg J

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“…It has been showed that chronic opium abusers have lower thresholds for pain. Factors affecting the block duration in spinal anesthesia among others include: type of the local anesthetic agent as well as the drug dosage and drug adjuvant such as opioids and epinephrine (1). Despite the fact that opioids are the primary medication for moderate to severe pain, their overuse is connected with the advancement of tolerance therefore higher dose is needed for pain relieving; however its mechanism has not completely cleared yet (2)(3)(4).…”

Section: Introductionmentioning

confidence: 99%

Effect of Fentanyl in Spinal Anesthesia With Bupivacaine in Opium Abusers

Zirak¹,

Soltani²,

Javdani³

et al. 2014

Razavi Int J Med

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Background: Spinal anesthesia is a common procedure in the anesthesia. In some studies it has been shown that chronic use of opioids is associated with shorter duration of spinal anesthesia when local anesthetics are applied. Objectives: This trial was conducted in order to determine effect of fentanyl on the duration of spinal block by bupivacaine in chronic opium abusers who undergo spinal anesthesia and have lower thresholds for pain. Patients and Methods:This study was a randomized clinical trial in which 50 opium abusers (25 patients in each group) undergoing lower extremity orthopedic surgeries with spinal anesthesia were selected. The patients were randomly divided into two groups. The study group received 15 mg hyperbaric bupivacaine 0.5% plus 25 µg fentanyl, while the control group received 15mg hyperbaric bupivacaine 0.5% plus 0.25 mL normal saline. Results: All randomly selected cases were male (44.7 ± 13.6 year). The mean duration of sensory block was much longer in the study group (87.8 ± 7.22 minutes) in comparison with the control group (70.47 ± 5.45 minutes) (P < 0.001). There was no statistically significant difference between the two groups regarding their age and duration of surgery. Conclusions: Bupivacaine administration in spinal anesthesia for spinal block has a shortened duration in comparison to the combination of bupivacaine and fentanyl in chronic opium abusers.

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“…Rejyonel anestezi tekniğinin kullanılması; spontan solunumun devam etmesi, erken mobilizasyon ve hastanede kalış süresinde azalma gibi pek çok avantajlara sahiptir 1 . Ancak operasyon boyunca hastanın uyanık kalması anksiyete sebebi olabilmektedir.…”

Section: Introductionunclassified

İntravenöz Deksmedetomidinin Spinal Blok ve Sedasyon Üzerine Etkisi

Ekici¹,

Türktan²,

Güler³

2015

Cukurova Medical Journal

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ÖZETAmaç: Spinal anestezi ürolojik girişimlerde sık tercih edilen bir anestezi yöntemidir. Bazı hastalar spinal anestezi sırasında sedasyona ihtiyaç duyabilir. Çalışmamızda, levobupivakain ile yapılan spinal anestezi altında uygulanan intravenöz deksmedetomidinin motor ve duyusal blok ve sedasyon üzerine etkilerini araştırmayı amaçladık. Materyal ve Metod: Randomize ve çift kör çalışmamız ASA I-III, 18-75 yaş arası, transüretral cerrahi planlanan 50 hasta üzerinde yapıldı. Hastalar iki gruba ayrıldı ve tüm hastalara 12.5 mg % 0.5 levobupivakain ile spinal anestezi uygulandı. Grup D (n=25)'ye 1 µg/kg yükleme dozunu takiben 0.5 µg/kg/saat deksmedetomidin infüzyonu, Grup S(n=25)'ye ise aynı volüm ve hızda salin infüzyonu uygulandı. Hastaların sistolik, diyastolik ve ortalama arter basıncı, kalp hızı, periferik oksijen satürasyon değerleri, ağrı ve sedasyon skorları, motor ve duyusal blok süreleri, derlenme ve hasta konfor skorları ve yan etkiler kaydedildi. Bulgular: Maksimum blok düzeyine ulaşma süresi ve spinal anestezi süresi Grup D'de Grup S'e göre istatistiksel olarak anlamlı daha uzun bulundu. Ramsey Sedasyon Skoru değerleri intraoperatif 1. dakika haricinde ve postoperatif 10. ve 15. dakikalarda Grup D'de Grup S'e göre istatistiksel olarak anlamlı yüksek bulundu. Yan etki sıklığı, derlenme ve hasta konforu değerleri gruplar arasında benzer bulundu. Sonuç: Spinal anestezi altında transüretral girişim yapılan hastalarda deksmedetomidin infüzyonunun motor blok süresini uzattığı, yan etki sıklığını arttırmadan etkin ve güvenli bir sedasyon sağladığı sonucuna varıldı. Anahtar kelimeler: Spinal anestezi, transüretral girişim, deksmedetomidin, sedasyon ABSTRACT Purpose: Spinal anesthesia is often preferred anesthesia technique in urological surgery. Some patients may require sedation during spinal anesthesia. In our study, we aimed to investigate the effect of intravenous dexmedetomidine on sedation, motor and sensory blockade under spinal anesthesia with levobupivacaine. Material and Methods: Our randomised, double-blind study was applied to ASA I-III, 18-75 years old 50 patients scheduled for transurethral surgery. The patients were divided into two groups and spinal anesthesia with 5% levobupivacaine 12.5 mg was administered to all patients. Intravenous dexmedetomidine was received 1 µg/kg for loading dose before 0.5 µg/kg/hour infusion to Group D (n=25). Saline infusion was given to Group S (n=25) as the same volume and infusion rate of dexmedetomidine. Systolic, diastolic and mean arterial pressure, heart rate, peripheral oxygen saturation values, pain and sedation score, the level and duration of motor and sensorial block, recovery and patient comfort score and side effects were recorded. Results: Time to reach maximum block level and duration of spinal anesthesia were longer in Group D than Group S. Sedation scores were significantly higher in Group D than Group S intraoperatively (except 1 th minute) and Araştırma Makalesi / Research Article 55

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Spinal, Epidural, and Caudal Anesthesia

Cited by 119 publications

References 171 publications

Comparison of effect of intrathecal dexmedetomidine and clonidine as an adjuvant to hyperbaric bupivacaine in patients undergoing surgery for fracture femur and tibia

Comparison of effect of intrathecal dexmedetomidine and clonidine as an adjuvant to hyperbaric bupivacaine in patients undergoing surgery for fracture femur and tibia

Effect of Fentanyl in Spinal Anesthesia With Bupivacaine in Opium Abusers

İntravenöz Deksmedetomidinin Spinal Blok ve Sedasyon Üzerine Etkisi

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