The Addition of Epinephrine Increases Intensity of Sensory Block During Epidural Anesthesia With Lidocaine

Sakura, Shinichi; Sumi, Mariko; Shinzawa, Masahide; Toyota, Kosaku; Kosaka, Yoshihiro

doi:10.1097/00000542-199809150-00009

Cited by 3 publications

(4 citation statements)

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“…In a clinical study by Eisenach et al 8 , adrenaline hastened the onset and prolonged the duration of a bolus of epidurally administered 0.25% bupivacaine during labour. In our previous study 12 , lumbar epidural injection of 10 ml of lignocaine 1% with adrenaline produced more intense block of both large and small diameter sensory nerve fibres than that of plain lignocaine. The effects on epidural morphine were shown in a volunteer study by Bromage et al 5 , in which cutaneous hypoalgesia was more intense, of faster onset, and longer in duration after a combination of adrenaline and morphine than after plain morphine.…”

Section: Discussionmentioning

confidence: 73%

“…Animal studies have demonstrated their additive or synergistic effects with opioids 9,10 or local anaesthetics 1l . In a previous study we found that the addition of adrenaline improved the quality of sensory block during epidural anaesthesia with lignocaine 12 . However, the results of previous clinical studies investigating the effects of the alphaadrenergic agonists in a mixture with local anaesthetic and opioid for postoperative epidural analgesia have not been convincing.…”

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confidence: 90%

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Does Adrenaline Improve Epidural Bupivacaine and Fentanyl Analgesia after Abdominal Surgery?

Sakaguchi

Sakura

Shinzawa

et al. 2000

Anaesth Intensive Care

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The alpha-adrenergic agonists have been demonstrated to have synergistic effects with opioids and local anesthetics in animal research. The present study was performed to determine whether the addition of adrenaline improves the analgesic effects of an epidural infusion of a combination of fentanyl and bupivacaine after abdominal surgery. We studied 90 ASA 1 or 2 patients scheduled for abdominal surgery under epidural anaesthesia, with or without general anaesthesia. Patients were randomly divided into two groups to receive a postoperative epidural infusion of fentanyl 5 µg/ml in bupivacaine 0.2%, with or without adrenaline 5 µg/ml, at a rate of 2 ml/h for more than 48 hours. Postoperative pain relief was assessed using visual analog scales (VAS), both at rest and during coughing, at 2, 24, and 48 hours after surgery. The number of rescue analgesics and side-effects such as nausea, vomiting, pruritus, respiratory depression, headache, muscle weakness, and hypotension were recorded.Patients who received adrenaline (n=40) reported significantly lower mean VAS scores than those who received no adrenaline (n=37), both at rest at 24 hours postoperatively and during coughing at 24 and 48 hours. The number of additional analgesics and incidence of side-effects did not differ between groups. In conclusion, the results of the present study demonstrate that the addition of adrenaline to a combination of fentanyl and bupivacaine improves the quality of epidural analgesia after abdominal surgery. Under the conditions of the study, we did not detect any disadvantage from the addition of adrenaline.

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Section: Discussionmentioning

confidence: 73%

mentioning

confidence: 90%

Does Adrenaline Improve Epidural Bupivacaine and Fentanyl Analgesia after Abdominal Surgery?

Sakaguchi

Sakura

Shinzawa

et al. 2000

Anaesth Intensive Care

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“…Bela Vadodaria et al 16 described that caudal anesthesia is the easiest and safest approaches to the epidural space. When correctly performed there is a little danger of either the spinal or dura being punctured.…”

Section: Discussionmentioning

confidence: 99%

A Clinical Study of Caudal Epidural Anaesthesia for Transurethral Resection of Prostate

Yadav¹,

Gupta²,

Choudhary³

2015

jemds

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ABSTRACT:In the Urological surgery, the most commonly performed procedure in Transurethral Resection of Prostate. Most of these patients are elderly above the age of 60 years with various systemic problems. The common problem includes cardiovascular disorder, chronic obstructive pulmonary diseases and various old age problems. These patients present as a challenge to anaesthesiologists because they are high risk patients for endoscopic surgeries. Various worker since many years tried different type of anesthesia procedure. The regional techniques have been proved to be safe and less risky. It includes spinal, lumbar epidural, combined spinal epidural and caudal epidural. The caudal epidural block have been used by many workers for TURP in elderly patients since so many years. The Present study includes 50 patients of ASA grade I, II, III including cardiovascular problem, COPD, and other spinal deformities, scheduled for TURP. After pre anesthetic checkup and through investigation, caudal epidural block were given by standard technique. Observation and results were recorded by observing the onset and duration of analgesia, level of block, any side effects. The changes in pulse rate, blood pressure, SPO2, ECG were closely monitored throughout the procedure. The observation showed that 60% of patients having co-existing diseases and most of them having chronic Hypertension (30%), onset of analgesia was 10-15 mins in 30 patients. Motor blockade by modified bromage scale was observed and found that 45 patients (90%) has MBS-O. There were no significant changes observed in PR, BP, R/R, ECG and SPO2 throughout the procedure in all patients. Response to total procedure was found excellent in 40 patients (80%). There were no significant complication observed in maximum number of patients. Only 5 patients had complained of nausea and vomiting, which was successfully treated by antiemetics.

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“…However, large doses and higher concentrations of local anaesthesia can rapidly increase plasma concentrations responsible for systemic toxicity. These effects are reported with lidocaine, which is less lipophilic and less bound to plasma proteins than bupivacaine (Sakura and others 1999, Sinnot and others 2003). Additionally, it has been suggested that an increase of injected volume does not result in a linear increase of anaesthesia spread (Kaneko and Iwama 1999).…”

Section: Introductionmentioning

confidence: 87%

Hyaluronidase shortens levobupivacaine lumbosacral epidural anaesthesia in dogs

DeRossi

Barros

Silva-Neto

et al. 2011

J of Small Animal Practice

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The Addition of Epinephrine Increases Intensity of Sensory Block During Epidural Anesthesia With Lidocaine

Cited by 3 publications

References 0 publications

Does Adrenaline Improve Epidural Bupivacaine and Fentanyl Analgesia after Abdominal Surgery?

Does Adrenaline Improve Epidural Bupivacaine and Fentanyl Analgesia after Abdominal Surgery?

A Clinical Study of Caudal Epidural Anaesthesia for Transurethral Resection of Prostate

Hyaluronidase shortens levobupivacaine lumbosacral epidural anaesthesia in dogs

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