The influence of preemptive spinal anesthesia on postoperative pain

Anesthesia Department, Bnai-Zion Medical Center, Haifa, Israel.
Journal of Clinical Anesthesia (Impact Factor: 1.19). 09/2000; 12(5):374-7. DOI: 10.1016/S0952-8180(00)00174-4
Source: PubMed


To examine the influence of spinal anesthesia on postoperative pain and postoperative opioid requirements.
Prospective randomized study.
Bnai-Zion Medical Center, Haifa, Israel-a government hospital.
30 ASA physical status I and II unpremedicated women undergoing elective total abdominal hysterectomy were randomly allocated into two groups of 15 patients each using a sealed envelope technique. Patients in Group 1 were given a subarachnoid injection of 12 mg hyperbaric bupivacaine and after 10 minutes general anesthesia was induced. Patients in Group 2 received only general anesthesia. Anesthesia was induced with midazolam and maintained with oxygen, N2O, isoflurane, and pancuronium. No opioids were given intraoperatively. Postoperatively patient-controlled analgesia (PCA) with morphine was initiated in both groups (1 mg x mL(-1), bolus dose 1 mg, lockout interval 10 minutes, and background infusion 1 mg x mL(-1)) at patient first request for analgesic. Pain was assessed over 24 hours by cumulative morphine dose and visual analog score (VAS). Postoperative PCA morphine consumption at 2, 6, and 24 hours following patient first request for analgesic for Groups 1 and 2 were: 3.1 +/- 1 mg versus 7.2 +/- 3 mg (p = 0.04), 13.4 +/- 2 mg versus 17.2 +/- 4 mg (p = 0.03) and 35.9 +/- 8 mg versus 47.7 +/- 8 mg in Group 2 (p = 0.04). VAS scores at 4, 6, 12, and 24 hours postoperatively were not significantly different between the two groups.
Preoperative neural blockade may reduce postoperative analgesic requirements.

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    • "Vaida et al declared that the beneficial effects of neuraxial analgesia are reduction of stress hormones, inhibition of central hyper sensitization and ultimately shortening the duration of hospitalization. They believed that increase in pain severity and cognitive dysfunction in patients receiving general anesthesia resulted in longer hospitalization.20 Our findings demonstrated that the pain severity, especially at recovery room and on the 3rd aostoperative day was lower in neuraxial group. "
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    ABSTRACT: Surgery for hip fractures can be done under general or neuraxial anesthesia. This study aimed to compare these two methods concerning their postoperative complications, duration of operation, hospitalization and the mortality rate within a period of one month after surgery. 400 patients aged more than 30 years old and scheduled for elective operative fixation of fractured hip, randomly enrolled in two equal groups of general (GA) and neuraxial (NA) anesthesia. Hemoglobin level was measured before and 6 hours, 2, 3 and 5 days after the surgery. The intra and postoperative blood loss, duration of surgery, the severity of pain at the time of discharge from recovery and at the 2(nd), 3(rd) and 5(th) postoperative days were recorded. Statistical analysis was performed using SPSS version 12.0 by Mann-Whitney, chi-square, and t tests. P < 0.05 was considered significant. Both groups were similar regarding age, weight, and gender ratio. There was no significant difference in baseline hemoglobin, duration of surgery, length of hospitalization before surgery and the type of surgery. The mean of intraoperative blood loss and visual analogue score (VAS) in recovery and at the 3(rd) postoperative day, and also the length of hospitalization after surgery were significantly less in neuraxial anesthesia group. Both groups showed a significant decrease in hemoglobin values on the 2(nd) and 3(rd) postoperative days comparing to the baseline (p < 0.001). The morbidity and mortality rates of patients undergoing hip surgery were similar in both methods of anesthesia, but postoperative pain, blood loss, and duration of hospitalization were more in patients undergoing general anesthesia.
    Journal of research in medical sciences 03/2011; 16(3):323-30. · 0.65 Impact Factor
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    • "Therefore, no meaningful comparisons of the VAS pain scores and the bolus use of IV PCA in the groups could be obtained on the day of surgery. The other contributing factor would be that the SA provided preemptive analgesia [11]. Overall, all patients had excellent pain relief on the day of surgery. "
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    ABSTRACT: The optimal dose infusion of 0.125% bupivacaine via a femoral catheter after total knee replacement (TKR) has not been defined. This study examined various dose infusions of bupivacaine to determine the analgesic quality in patients receiving a continuous femoral nerve block (CFNB). Patients were randomized to receive a single-injection femoral nerve block (SFNB) or CFNB performed with 20 ml of 0.125% bupivacaine, followed by a continuous infusion of 0.125% bupivacaine in four groups (n = 20 per group): 1) 0 ml/h (SFNB), 2) 2 ml/h, 3) 4 ml/h, and 4) 6 ml/h. The pain intensity at rest and on knee movement was assessed using a visual analog scale (VAS) for the first 2 postoperative days. The cumulative bolus use of IV patientcontrolled analgesia (PCA) with a morphine-ketorolac combination was evaluated. A lower cumulative bolus of IV PCA was noted in all CFNB groups compared to SFNB on postoperative days (PODs) 1 and 2, respectively (P < 0.05). Lower VAS scores at rest were observed in the 4 ml/h and 6 ml/h groups than in the SFNB group on PODs 1 and 2, respectively, but only on POD 2 in the 2 ml/h group (P < 0.05). Lower VAS scores on movement were noted in the 4 ml/h than the SFNB group on PODs 1 and 2, but only on POD 1 in 6 ml/h (P < 0.05). The minimum effective infusion rate of 0.125% bupivacaine for CFNB after TKR appears to be 4 ml/h according to the VAS pain scores.
    Korean journal of anesthesiology 05/2010; 58(5):468-76. DOI:10.4097/kjae.2010.58.5.468
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    • "It has been suggested that combining drugs used to induce anaesthesia with potent analgesics such as opioids enhances the reduction of the volatile anaesthetic requirement and decreases the postoperative recovery time (Vaida et al. 2000). Morphine and buprenorphine are opioids that are often used in research involving pigs. "
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    ABSTRACT: The aim of this study was to determine the changes in minimal alveolar concentration (MAC) of isoflurane after treatment with medetomidine and tiletamine/zolazepam (MTZ), epidural morphine or systemic buprenorphine in 11 healthy crossbred pigs. The first part of this study was to measure the baseline values in pigs induced with isoflurane (5%) by face mask and maintained with isoflurane in air and oxygen for 2 h (ISO). Baseline isoflurane MAC was determined using mechanical stimulation. Thereafter, each pig was randomly chosen for a crossover test in which the same animal received three different treatments with at least one week in between treatments. The three treatments were as follows: induction of anaesthesia with medetomidine (0.05 mg kg(-1)) and tiletamine/zolazepam (2.5 mg kg(-1) each) given intramuscularly (MTZ); MTZ followed by epidural morphine (0.1 mg kg(-1); MTZ/M); and MTZ followed by intramuscular buprenorphine (0.1 mg kg(-1); MTZ/B). All pigs were maintained with isoflurane in oxygen and air for 2 h and their lungs were mechanically ventilated. The end-tidal isoflurane concentration, respiratory rate, inspiratory and expiratory O2 and CO2 concentrations, heart rate (HR) and arterial blood pressure were recorded every 10 min. Arterial blood gases were analysed every 20 min. Among the treatment groups, differences in isoflurane MAC were tested using GLM and Tukey's method for further comparison; P < 0.05 was adopted as significant. Isoflurane MAC was 1.9 +/- 0.3%. MTZ reduced isoflurane MAC to 0.6 +/- 0.1%. Additional morphine or buprenorphine reduced the MTZ isoflurane MAC further to 0.4 +/- 0.2 and 0.3 +/- 0.1%, respectively. During MTZ, MTZ/M and MTZ/B mean arterial blood pressure was higher and the alveolar-arterial oxygen tension difference was lower compared with ISO. In conclusion, induction of anaesthesia with MTZ reduced the isoflurane MAC in pigs by 68%. Additional epidural morphine or systemic buprenorphine decreased MTZ isoflurane MAC by 33 and 50%, respectively.
    Laboratory Animals 01/2008; 42(1):62-70. DOI:10.1258/la.2007.006048 · 1.12 Impact Factor
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