Epidural analgesia after scoliosis surgery: electrophysiologic and clinical assessment of the effects of bupivacaine 0.125% plus morphine versus ropivacaine 0.2% plus morphine

Dang, Charles Pham; Delécrin, J.; Péreón, Yann; Falconi, Isabelle; Passuti, N.; Malinge, M.; Pinaud, M.

doi:10.1016/j.jclinane.2007.07.007

Cited by 12 publications

(8 citation statements)

References 28 publications

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“…90,91 Pain scores at 24 hrs were decreased in 5 trials, 90Y92,94,97 whereas 4 found no benefit. 85,93,95,96 At 48 hrs after surgery, similar results were obtained, with 4 trials reporting benefit of the regimen 90,93,94,97 and 4 others reporting no benefit. 85,92,95,96 Local anesthetic 87Y89 and opioids, 84,92 when used alone, decreased postoperative pain for 48 hrs.…”

Section: Continuous Epidural Analgesiasupporting

confidence: 54%

Beyond Opioid Patient-Controlled Analgesia

Sharma

Balireddy

Vorenkamp

et al. 2012

Regional Anesthesia and Pain Medicine

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Postoperative pain control in patients undergoing spine surgery remains a challenge for the anesthesiologist. In addition to incisional pain, these patients experience pain arising from deeper tissues such as bones, ligaments, muscles, intervertebral disks, facet joints, and damaged nerve roots. The pain from these structures may be more severe and can lead to neural sensitization and release of mediators both peripherally and centrally. The problem is compounded by the fact that many of these patients are either opioid dependent or opioid tolerant, making them less responsive to the most commonly used therapy for postoperative pain (opioid-based intermittent or patient-controlled analgesia). The purpose of this review was to compare all published treatment options available that go beyond intravenous opiates and attempt to find the best possible treatment modality.

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Section: Continuous Epidural Analgesiasupporting

confidence: 54%

Beyond Opioid Patient-Controlled Analgesia

Sharma

Balireddy

Vorenkamp

et al. 2012

Regional Anesthesia and Pain Medicine

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“…These investigations include those comparing continuous epidural analgesia of a combination of opioids and local anesthetics to PCA or IV morphine alone 1112 13 14 15 16 17 Other studies involve comparisons of different epidural anesthetics18 19 as well as optimization of dose of intrathecal morphine,20 21 22 23 with variable results. Still another investigation examined the efficacy of the combination of intrathecal morphine and continuous infusion of IV morphine without PCA, under strict protocol guidelines, as a postoperative pain management strategy for spinal fusion surgery 24.…”

mentioning

confidence: 99%

Postoperative Pain Management after Spinal Fusion Surgery: An Analysis of the Efficacy of Continuous Infusion of Local Anesthetics

Reynolds

Legakis

Tweedie

et al. 2013

Global Spine Journal

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Spinal fusion surgery is a major surgery that results in severe postoperative pain, therefore pain reduction is a primary concern. New strategies for pain management are currently under investigation and include multimodal treatment. A 3-year retrospective analysis of patients with idiopathic scoliosis undergoing spinal fusion surgery was performed at our hospital, assessing patient pain scores, opioid use, and recovery. We evaluated the effect of adding continuous infusion of local anesthetics (CILA) to a postoperative pain management protocol that includes intraoperative intrathecal morphine, as well as postoperative patient-controlled analgesia and oral opioid/acetaminophen combination. The study compared 25 patients treated according to the standard protocol, with 62 patients treated with CILA in addition to the pain management protocol. Patients in the CILA group used nearly 0.5 mg/kg less opioid analgesics during the first 24 hours after surgery.

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“…In our study, two patients in control group, four patients in fentanyl group complained of nausea/ vomiting; pruritus was reported in seven patients in fentanyl group; shivering was observed in three patients in fentanyl group and one patient in control group; one patient in control group had bradycardia which was managed with injection atropine 0.6 mg; two patients in dexamethasone group had hypotension whereas one patient each in fentanyl and control group had hypotension which was managed with injection mephentermine 6 mg. None of the patients in the dexamethasone group had nausea or vomiting. This result may be due to the antiemetic effect of dexamethasone, which has been demonstrated in other studies using perioperative corticosteroids [22,23].…”

Section: Discussionmentioning

confidence: 56%

Prospective Randomized Control Trial Comparing Effect of Dexamethasone Versus Fentanyl as Adjuvants to Intrathecal Bupivacaine for Orthopedic Surgery

Kaur¹,

Misra²,

Mittal³

et al. 2021

Cureus

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IntroductionSpinal anesthesia is the most consistent block for lower limb orthopedic surgeries. We conducted this randomized prospective study to evaluate comparative efficacy of intrathecal dexamethasone with fentanyl and normal saline as adjuvants to hyperbaric bupivacaine in spinal anesthesia administered to patients scheduled for lower limb orthopedic surgery. Materials and methods105 patients scheduled for lower limb orthopedic surgeries under spinal anesthesia were included in this clinical trial. After randomization, patients received an intrathecal injection of hyperbaric bupivacaine (12.5 mg) with 4 mg of dexamethasone in group I, hyperbaric bupivacaine (12.5 mg) with 25 ug fentanyl with 0.5 ml of normal saline in group II and hyperbaric bupivacaine (12.5 mg) with normal saline (1 ml) in group III, so as to make volume of drug equal in all three groups. The observer evaluated the sensory and motor blocks and other parameters like time to self-void, stay in post-anesthesia care unit (PACU) and complications. ResultsThe total duration of sensory blockade was found to be 311. 43, 197.86 and 115.29 minutes and motor blockade of 223.43, 163.86 and 83.0 minutes in groups I, II and III respectively. The PACU stay was 233.14, 173.86 and 93.00 minutes in groups I, II and III, respectively. The average time to self-void was 400.00, 315.29 and 203.00 in three groups, respectively. ConclusionIntrathecal dexamethasone seemed to be an effective adjuvant to spinal bupivacaine as it prolongs the duration of analgesia, stable hemodynamic profile with minimal side effects. Further studies are required to evaluate the optimum dose and long-term safety of intrathecal dexamethasone.

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Epidural analgesia after scoliosis surgery: electrophysiologic and clinical assessment of the effects of bupivacaine 0.125% plus morphine versus ropivacaine 0.2% plus morphine

Cited by 12 publications

References 28 publications

Beyond Opioid Patient-Controlled Analgesia

Beyond Opioid Patient-Controlled Analgesia

Postoperative Pain Management after Spinal Fusion Surgery: An Analysis of the Efficacy of Continuous Infusion of Local Anesthetics

Prospective Randomized Control Trial Comparing Effect of Dexamethasone Versus Fentanyl as Adjuvants to Intrathecal Bupivacaine for Orthopedic Surgery

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