Epidural Analgesia With Low-concentration Levobupivacaine Combined With Fentanyl Provides Satisfactory Postoperative Analgesia for Colorectal Surgery Patients

Lin, Mei; Huang, Jui Yu; Lao, Hsuan Chih; Tsai, Pei‐Shan; Huang, Chun Jen

doi:10.1016/s1875-4597(10)60016-1

Cited by 8 publications

(3 citation statements)

References 15 publications

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“…In the literature, nausea and vomiting are the most common complications after epidural opioid administration (23). The use of opioids combined with local anaesthetics as compared to epidural opioid use reduces the incidence of side effects by reducing gastrointestinal paralysis, nausea and vomiting in the postoperative period, visceral reflex activity, and systemic opioid use (24). In contrast, in Group L, which was not an opioid group, we found less nausea and vomiting rates than LM and LT.…”

Section: Discussionmentioning

confidence: 56%

Comparison of the Effects of Epidural Levobupivacaine with Tramadol or Morphine Addition on Postoperative Analgesia following Major Abdominal Surgery

Türkoğlu¹,

Karacaer

Biricik

et al. 2019

Turk J Anaesthesiol Reanim

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Objective:The study was designed to compare the postoperative analgesic efficacy of epidural tramadol or epidural morphine as adjuvant to levobupivacaine in major abdominal surgery.Methods: Patients in ASA I-II group aged between 18 and 65 years were included in study. Epidural catheter was introduced. Patients were randomised into three groups to receive levobupivacaine (Group L), levobupivacaine+morphine (Group LM) and levobupivacaine+tramadol (Group LT). General anaesthesia was administered to all patients. The solution intended for Group L contained 25 mg 0.5% levobupivacaine+15 mL saline, that for Group LM contained 25 mg 0.5% levobupivacaine+14.5 mL salin+100 μg morphine and that for Group LT contained 25 mg 0.5% levobupivacaine+13 mL salin+100 mg tramadol, which was administered via epidural catheter as loading dose 30 min before the end of the operation. Patient-controlled analgesia device was connected to the epidural catheter to provide postoperative analgesia. Bolus dose was adjusted to 12 mg levobupivacaine in Group L, 12 mg levobupivacaine +1.2 mg morphine in Group LM and 12 mg levobupivacaine+12 mg tramadol in Group LT. Lock-out period was adjusted to 15 min in three groups. Quality of analgesia was evaluated using Visual Analogue Scale; administered and demand doses of levobupivacaine, morphine and tramadol were compared at 30 min, 1, 2, 6, 12 and 24 h postoperatively.Results: Visual Analogue Scale scores were significantly higher in Group L than Groups LM and LT. Nausea and vomiting observed in Group L were lesser than those in Groups LM and LT. Conclusion:Continuous epidural analgesia using levobupivacaine combined with morphine or tramadol is an effective method for managing postoperative analgesia in major abdominal surgery.

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Section: Discussionmentioning

confidence: 56%

Comparison of the Effects of Epidural Levobupivacaine with Tramadol or Morphine Addition on Postoperative Analgesia following Major Abdominal Surgery

Türkoğlu¹,

Karacaer

Biricik

et al. 2019

Turk J Anaesthesiol Reanim

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show abstract

“…M.C Lin, et al, compared epidural analgesia with local anesthetic and opioid with intravenous analgesia with an opioid for the treatment of postoperative pain in colorectal surgery. Nausea and vomiting were the main adverse effects presented by patients who received intravenous morphine, however, when opioids are associated with the epidural analgesia with local anesthetic they are considered very effective and had fewer adverse effects [20]. Dragana Radovanoviéc, et al conducted a study comparing thoracic epidural analgesia with patient-controlled intravenous analgesia after colorectal surgery and evaluated bowel function recovery, pain intensity, patient satisfaction and postoperative complications, and length of hospital stay.…”

Section: Discussionmentioning

confidence: 99%

“…Several factors can interfere with the results, such as the amount and types of medication administered through the epidural catheter, surgical technique, and surgery time. Some factors have been related to early postoperative ileus recovery with epidural analgesia, such as pain relief, sympathetic blockade, blockage of nociceptive afferent fibers and increased blood flow to the colon, in addition to a decrease in the consumption of systemic opioids, which reduces their adverse effects [8,20]. Frantzides, et al evaluated the effects of intravenous, intramuscular, and epidural morphine on colon myoelectric activity during ileal recovery.…”

Section: Analgesia and Anesthesia In Abdominal Surgeriesmentioning

confidence: 99%

Epidural Anesthesia with Opioids in Open Colorectal Surgeries is not Related to Postoperative Ileum

D¹,

A²,

B³

et al. 2022

Int J Anesthetic Anesthesiol

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Purpose of review: This is a short review describing recent data on the use of opioids in epidural anesthesia on abdominal surgery. It is known that postoperative pain has nociceptive, inflammatory and neuropathic components and must be prevented. The period following abdominal surgery is particularly challenging because it has other side effects related to the surgery, in addition to pain. Limiting these unwanted consequences requires a multidisciplinary team. Opioids remain the leading postoperative pain management drugs despite their known side effects, which are dose-dependent and may vary according to the route of administration. Sedation, dizziness, nausea, vomiting, and constipation are often related to opioid use. Since constipation or ileum are also directly related to abdominal surgery, temporary changes in gastrointestinal motility are inevitable after open surgeries. As such, there is concern that opioid-based anesthesia could make it worse and even increase postoperative morbidity and mortality. Recent findings:Several studies involving open colorectal surgery have shown that epidural analgesia, with or without opioid administration, is more effective in treating postoperative pain than intravenous analgesia, thus, this article intends to conduct a literature review to assess whether the association of opioids and local anesthetics in epidural analgesia for colorectal surgery increases the incidence and intensity of postoperative ileus.Summary: This review found no convincing evidence that the use of intrathecal opioids increases the incidence of postoperative ileus, in addition, it was shown to be an effective pain management tool, as expected.

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A Study on Evaluation of Epidural Levobupivacaine 0.125% and Ropivacaine 0.125% With and Without Fentanyl for Postoperative Pain Relief in Abdominal Surgeries

Shantiraj¹,

Kalyan²

2018

jebmh

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BACKGROUND Postoperative pain forms an acute category of non-malignant pain. Uncontrolled postoperative pain may produce range of detrimental acute and chronic effects. Postoperative epidural analgesia is an effective and well accepted modality of pain relief techniques after abdominal surgeries. The present study is to compare post-operative analgesia with epidural infusion of ropivacaine 0.125%, ropivacaine 0.125% with fentanyl, levobupivacaine 0.125%, levobupivacaine 0.125% with fentanyl for 24 hours in abdominal surgeries. MATERIALS AND METHODS The present study consists of 120 patients who got admitted in Viswabharathi Hospital, Kurnool and underwent abdominal surgeries during October 2014 to October 2015. RESULTS In this clinical study, 120 healthy patients of either sex belonging to ASA grade-I and grade-II were included. The patients were divided into four groups, group A, group B, group C and group D. Group A-Thirty patients received 0.125% Ropivacaine infusion for 24 hours at rate of 8 ml per hour epidurally. Group B-Thirty patients received 0.125% Ropivacaine with fentanyl 1 microgram per ml at the rate of 8 ml per hour infusion for 24 hours epidurally. Group C-Thirty patients received 0.125% Levobupivacaine infusion at the rate of 8 ml per hour for 24 hours epidurally. Group D-Thirty patients received 0.125% Levobupivacaine with fentanyl 1 microgram per ml at the rate of 8 ml per hour for 24 hours epidurally. The study was to compare quality of analgesia, haemodynamic changes, side effects, any associated motor block, amount of local anaesthetic consumed among 0.125% ropivacaine, 0.125% with fentanyl, 0.125% levobupivacaine, 0.125% levobupivacaine with fentanyl when administered as continuous epidural infusion for 24 hours. Analgesia was superior in levobupivacaine with fentanyl infusion and least in plain ropivacaine infusion. Differences in analgesia found in levobupivacaine, ropivacaine with fentanyl and plain levobupivacaine was not clinically significant. CONCLUSION We conclude from present study that levobupivacaine with fentanyl is an attractive option for postoperative epidural analgesia. Ropivacaine with fentanyl and levobupivacaine with fentanyl were of equianalgesic efficacy. Studies with levobupivacaine for postoperative analgesia are limited unlike ropivacaine. From the present study, it was found that plain 0.125% ropivacaine infusion is of lower analgesic efficacy probably due to the shorter duration of action and less potency of ropivacaine.

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Epidural Analgesia With Low-concentration Levobupivacaine Combined With Fentanyl Provides Satisfactory Postoperative Analgesia for Colorectal Surgery Patients

Abstract: Epidural analgesia with low-concentration levobupivacaine plus fentanyl provides satisfactory postoperative analgesia with few side effects for patients after colorectal surgery.

Cited by 8 publications

References 15 publications

Comparison of the Effects of Epidural Levobupivacaine with Tramadol or Morphine Addition on Postoperative Analgesia following Major Abdominal Surgery

Comparison of the Effects of Epidural Levobupivacaine with Tramadol or Morphine Addition on Postoperative Analgesia following Major Abdominal Surgery

Epidural Anesthesia with Opioids in Open Colorectal Surgeries is not Related to Postoperative Ileum

A Study on Evaluation of Epidural Levobupivacaine 0.125% and Ropivacaine 0.125% With and Without Fentanyl for Postoperative Pain Relief in Abdominal Surgeries

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