A comparative study on the effect of addition of intrathecal buprenorphine to 2-chloroprocaine spinal anesthesia in short duration surgeries

Background: Orthopedic surgery typically results in moderate to severe pain in a majority of patients. Opioids were traditionally the primary medication to target mechanisms of pain transmission. Multimodal analgesia has become a preferred method of pain management in orthopedic practice. Utilizing more than one mode to address post-surgical pain by recruiting multiple receptors through different medications accelerates the recovery process and decreases the need for opioids. By implementing effective analgesic techniques and interventions, this practice, in turn, decreases the usage of perioperative opioids, and in the long term, prevents addiction to pain medications and risk of opioid overdose. In orthopedic surgeries, previous studies have found that multimodal analgesia has reduced early opioid usage in the postoperative course. Pain is the result of direct injury to the nervous system, with a wide variety of chemicals directly stimulating or sensitizing the peripheral nociceptors. The pathophysiology behind the mechanism of post-surgical pain, along with the importance of preoperative, perioperative, and postoperative pain regimens are emphasized. A brief overview of pain medications and their properties is provided. These medications are further categorized, with information on special considerations and typical dosage requirements. Pain management should address both neuropathic and subjective types of pain. Effective pain control requires constant reassessment with individualized strategies. Conclusion: By focusing on multimodal analgesia, anesthesiologists can now utilize newer techniques for postoperative pain relief from orthopedic surgery, with better short-term and long-term outcomes for the patient.

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A Prospective Comparative Study of Fentanyl and Buprenorphine as an Adjuvant to Intrathecal Chloroprocaine for Perianal Surgeries

Gnanasekaran

Annamalai

Sathappan

et al. 2022

Bali Journal of Anesthesiology

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Introduction: Chloroprocaine is a local anesthetic with faster onset of action and short half-life, which results in short duration of analgesia limiting its use in surgeries. Researches proved that synergy with other drugs prolongs the duration of action and also the postoperative analgesia of chloroprocaine. Thus the present study was designed to compare the effectiveness of adding buprenorphine and fentanyl to intrathecal 1% 2-chloroprocaine for perianal surgeries. Materials and Methods: This prospective comparative study included 100 American Society of Anaesthesiologists physical class 1 and 2 patients of age 18–60 years, body mass index <35, scheduled for short duration perianal surgeries under spinal anesthesia. Patients were randomized into two groups: 30 mg 1% chloroprocaine was given along with 25 µg fentanyl in group F and 75 µg buprenorphine in group B. The time of onset, duration of sensory and motor block, two-segment and complete regression of spinal anesthesia, and duration of postoperative analgesia were studied. Results: Time for two-segment regression was 41.40 ± 7.82 and 44.80 ± 6.14 min in groups F and B, respectively, with P=0.43. In groups F and B, time to reach the modified Bromage score of 3 was 4.41 ± 0.48 and 4.17 ± 0.57 min, respectively. The time to void was insignificantly longer in group B than that in F of 300.96 ± 35.41 and155.86 ± 46.67 min without requirement of urinary catheterization. The time of first postoperative analgesic requirement was significantly longer in group B than that of group F of 715.82 ± 127.09 178.07 ± 453.13 min, respectively. Conclusion: The addition of intrathecal buprenorphine to chloroprocaine for spinal anesthesia significantly prolonged the postoperative analgesia compared with addition of fentanyl.

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A comparative study on the effect of addition of intrathecal buprenorphine to 2-chloroprocaine spinal anesthesia in short duration surgeries

Cited by 4 publications

References 27 publications

Review of Neuraxial Agents Producing Analgesia

Review of Neuraxial Agents Producing Analgesia

Multimodal Pain Management in Orthopedic Surgery

A Prospective Comparative Study of Fentanyl and Buprenorphine as an Adjuvant to Intrathecal Chloroprocaine for Perianal Surgeries

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