Post operative analgesia after incisional infiltration of bupivacaine v/s bupivacaine with buprenorphine

Abstract

Introduction:Opioid receptors have been demonstrated in the peripheral nerve endings of afferent neurons. Blockade of these receptors with peripherally administered opioid is believed to result in analgesia.Aim:To evaluate whether buprenorphine added to bupivacaine for wound infiltration can enhance post-operative analgesia via peripheral mechanisms.Materials and Methods:Forty ASA I and II adult patients scheduled for open donor nephrectomy were enrolled in this randomized double blind prospective study. In group A (n = 20) patients, the wound was infiltrated with bupivacaine 0.5% (2 mg/kg) and in group B (n = 20) with bupivacaine 0.5% (2 mg/kg) and buprenorphine (2 μg/kg). All patients were given diclofenac 75 mg IM at 8 h interval. Post-operative quality of analgesia was assessed by VAS (0-10) for 24 h and when VAS > 4 rescue analgesic was administered. Total dose of rescue analgesic and side effects were noted.Results:The time of administration of first rescue analgesic was significantly higher in group B (10.52±5.54 h) as compared to group A (3.275±1.8 h). Mean VAS was significantly lower in group B as compared to group A. The total dosage of rescue analgesic was more in group A as compared to group B patients.Conclusion:Addition of buprenorphine to the local anesthetic significantly prolonged the time to first rescue analgesic requirement and the total consumption of rescue analgesic in 24 h, thus providing evidence in support of the existence of peripheral opioid receptors.

Analgesic efficacy of peritubal infiltration of ropivacaine versus ropivacaine and morphine in percutaneous nephrolithotomy under ultrasonic guidance

“…[11] performed incisional infiltration of bupivacaine versus bupivacaine with buprenorphine in 40 open donor nephrectomy patients. They concluded that addition of buprenorphine to local anesthetic significantly prolonged the time to 1 st rescue analgesic demand and total consumption of rescue analgesic in 24 hours thus providing evidence in support of the existence of peripheral opioid receptors.…”

Buprenorphine Added to Bupivacaine Prolongs Femoral Nerve Block Duration and Improves Analgesia in Patients Undergoing Primary Total Knee Arthroplasty—A Randomised Prospective Double-Blind Study

“…However, differences in pain intensity rating (using a numerical rating scale) between the two buprenorphine-treated study groups were not statistically significant. The peripheral effects of buprenorphine were assessed by Mehta et al, who used buprenorphine to infiltrate the surgical wound following elective nephrectomy [21]. They reported significantly lower VAS scores in patients who had the wound anaesthetized by infiltration of a solution of bupivacaine with a buprenorphine adjuvant compared to infiltration with bupivacaine alone.…”

Effectiveness of butorphanol as an adjuvant to lidocaine for haematoma or periosteal block: A prospective, randomised, double blind study

“…There is lot of evidence for presence of peripheral opiod receptors and their role in alleviation of pain. [721] Stein et al . and Puhler et al .…”

“…conducted a study where they infiltrated incisional wound with bupivacaine and buprenorphine and concluded that ‘Addition of buprenorphine to the local anaesthetic significantly prolongs post operative analgesia’, thus providing evidence in support of the existence of peripheral opioid receptors. [7] Hence, we thought of using opioids for haematoma block.…”

“…Blockade of these receptors by peripherally administered opiod will result in potent analgesia. [7] Hence, we thought of adding an opiod to local anaesthetic so that it may prolong analgesia of haematoma block. The aim of this study is to evaluate the effectiveness and safety of butorphanol as an adjuvant to lidocaine for haematoma block.…”