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ABSTRACT: In this study, we aimed to compare the effects of ropivacaine alone and ropivacaine plus tramadol administered epidurally for postoperative analgesia in children.
Following Ethics Committee approval and informed parent consent, 44 children aged between 2 and 12 years, with ASA physical status I or II, who were undergoing major abdominal surgery were included in the study. Following tracheal intubation, patients were placed into lateral decubitus position and an epidural catheter (22-24 G) was inserted by using a Tuohy needle. Patients were randomly divided into two groups to receive either ropivacaine alone (0.2%), 0.7 ml/kg, in group I, or ropivacaine (0.2%) plus tramadol (2 mg/kg), with total volume 0.7 ml/kg, in group II, epidurally in both groups. Hemodynamic variables, pain and sedation scores, duration of analgesia, and side effects were recorded postoperatively.
The duration of analgesia was significantly longer in group RT than in group R (298.6 ± 28 and 867.9 ± 106.8 min in group I and II, respectively) (P < 0.05). CHEOPS scores were significantly lower in group RT at 30 min, 45 min, and 3 h postoperatively than in group R (P < 0.05). However, sedation scores were similar between the two groups. Twenty-two patients (100%) in group R and 13 patients (59%) in group RT needed supplemental analgesia postoperatively. There were no significant differences in side effects between the groups.
In children undergoing major abdominal surgery, epidural tramadol, added to epidural ropivacaine, provided lower pain scores, longer duration of analgesia, and lower postoperative analgesic requirement.
Journal of Anesthesia 10/2010; 24(5):700-4. · 0.83 Impact Factor
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ABSTRACT: Administration of morphine with intravenous patient-controlled analgesia (PCA) is a routine technique in postoperative pain relief on laminectomy. In this study, we aimed to evaulate the effect of preemptive paravertebral somatic block with levobupivacaine on postoperative morphine consumption. After approval of the Medical Faculty Ethics Commitee and patient consent, aged 20-70 years, American Society of Anesthesiologist physical status I-II, 100 patients who were undergoing laminectomy, were included. Patients were randomly divided into 2 groups: 0.1 mg/kg intravenous boluse mophine was given to patients in the first group 20 minutes before the end of operation and intravenous PCA morphine (40 mg morphine in 100 mL isotonic saline, PCA demand dose 0.02 mg kg-1, 20 min lockout time) was given after the operation. The patients in the second group were placed prone position after intubation, bilateral paravertebral somatic block was performed with 5 mL levobupivacaine 0,5% for each nerve to upper dermatome of laminectomy level. Intravenous PCA morphine was started after the end of operation. All patients were recieved 8 mg ondansetron for antiemesis. Postoperative systolic and diastolic blood pressures, heart rate, peripheral oxygen saturation values, pain [Visual Analog Scale (VAS)] scores, total morphine consumption and side effects were recorded. Demographic data, operation times and hemodynamic parameters of groups were similar. VAS scores were higher in group 1 than group 2 on postoperative 4, 6, and 12 hours (P<0.05). Total morphine consumption was recorded as 29.46±9.34 mg in group 1 and 2 and 88±7.28 mg in group 2 for 24 hours. Total morphine consumption was significantly lower in group 2 than group 1 (P<0.05). We conclude that the application of preemptive lumbar paravertebral somatic block with levobupivacaine reduce morphine requirement, provides more efficient analgesia, without change in hemodynamic parameters or side effects.
Neurosurgery Quarterly 08/2009; 19(3):160-163. · 0.10 Impact Factor
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ABSTRACT: Volatile agents combined with opioids or α2 agonists may reduce inhalation agents concentration or provide optimal hemodynamic stability. We compared the hemodynamic stability brain relaxation, and recovery characteristics of sevoflurane anesthesia supplemented with an infusion of dexmedetomidine or remifentanil in patients undergoing supratentorial craniotomy. We enrolled 80 adult patients in a prospective randomized 2 group study. ASA I-III physical status patients who were undergoing intracranial surgery for either vascular or space-occupying lesions, were eligible if aged 17 to 65 years. Patients were randomly allocated in 2 groups. Anesthesia was induced with thiopental sodium (3 to 7 mg/kg) and remifentanil (0.5μg/kg/min) in remifentanil group. Anesthesia was maintained sevoflurane (maximum 1 MAC) and remifentanil infusion (0.25 μg/kg/min). In the second group (dexmedetomidine group), patients received intravenous dexmedetomidine 0.5μg/kg over 10 minutes. Anesthesia was induced thiopental sodium (3 to 7 mg/kg). Anesthesia was maintained sevoflurane (maximum 1 MAC) and dexmedetomidine infusion (0.6 μg/kg/h). Hemodynamic variables were recorded at baseline, induction of anesthesia, tracheal intubation, head holder application, skin incision, dural incision, and dural closure. Brain relaxation scores were evaluated by surgeon, intraoperatively. Hemodynamic variables were similar between the groups except heart rate. Eye opening, following the verbal commands and orientation time were significantly shorter in patients receiving remifentanil-sevoflurane than the other group. We conclude that any of the 2 anesthetic techniques are acceptable for intracranial surgery. Remifentanil plus sevoflurane anesthesia provide earlier recovery and cognition than the intraoperative use of dexmedetomidine plus sevoflurane anesthesia.
Neurosurgery Quarterly 05/2009; 19(2):116-119. · 0.10 Impact Factor
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ABSTRACT: The aim of this study was to compare the hemodynamic and recovery profiles of desflurane-remifentanil and desflurane-fentanyl in patients undergoing intracranial surgery. Adult patients with American Society of Anesthesiologist (ASA) II to III physical status who were undergoing intracranial surgery for vascular or space-occupying lesions were enrolled in a prospective randomized 2-group study. Anesthesia induction was performed by means of propofol and remifentanil or fentanyl. Anesthesia was maintained with an infusion of remifentanil at a rate of 0.25 μg/kg-1/min-1 plus 1.5% to 2% desflurane/50% N2O/50% O2 in the group administered desflurane-remifentanil (DR group) or bolus doses of fentanyl (2 μg/kg-1) plus 3% to 6% desflurane/50% N2O/50% O2 in the group administered desflurane-fentanyl (DF group). In both groups, hemodynamic variables were recorded at baseline and after anesthesia induction, tracheal intubation, head holder application, skin and dural incisions, and dural closure. At the end of the surgery, times to extubation, eye opening, following verbal commands, and side effects were recorded. After intubation and skin incision, diastolic arterial pressure, heart rate, and mean arterial pressure values were significantly higher in the DF group. Times to extubation, eye opening, and following verbal commands were significantly shorter in the DR group than in the DF group (P<0.05). Analgesic consumption and side effects were similar between the 2 groups. Remifentanil at a dose of 0.25 μg/kg-1/min-1 plus 1.5% to 2% desflurane led to rapid emergence from anesthesia, good control of hemodynamic responses, and similar side effects in patients undergoing intracranial surgery compared with giving bolus doses of fentanyl (2 μg/kg-1) plus 3% to 6% desflurane.
Neurosurgery Quarterly 11/2004; 14(4):204-208. · 0.10 Impact Factor
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ABSTRACT: In this study, the authors investigated the effect of the addition of remifentanil to tramadol or morphine for patient-controlled analgesia (PCA).
Prospective, randomized, double-blind, controlled study.
University Hospital.
The authors randomly allocated 133 patients undergoing major abdominal surgery to receive IV PCA with tramadol alone, tramadol plus remifentanil, morphine alone or morphine plus remifentanil.
Bolus doses of tramadol (0.2 mg/kg), tramadol (0.2 mg/kg) plus remifentanil (0.2 microg/kg), morphine (0.02 mg/kg), or morphine (0.02 mg/kg) plus remifentanil (0.2 microg/kg) were available every 10 minutes without time limit or background infusion.
Discomfort, sedation, pain scores, side effects, and total and bolus tramadol and morphine consumption were recorded for up to 24 hours after the start of PCA.
Pain scores at rest and movement were greater with tramadol alone than in the other groups at 1, 2, and 6 hours (p < 0.0125). The addition of remifentanil reduced cumulative tramadol consumption at 6, 12, and 24 hours, but not morphine consumption. More patients required supplementary rescue analgesia with meperidine, and with greater dosage, with tramadol alone (p < 0.001), and the incidence of nausea was greater with tramadol alone. The addition of remifentanil not only significantly improved discomfort scores in remifentanil groups, but also increased the degree of sedation in morphine-remifentanil group.
After major abdominal surgery, adding remifentanil to PCA tramadol resulted in better pain scores, lower analgesic consumption, and fewer side effects when compared with tramadol alone. However, analgesic outcome with remifentanil was not prominent in MR group as much as in TR group.
Journal of opioid management 5(5):247-55.
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ABSTRACT: In this prospective, randomized, double-blind, controlled study, we investigated the sensory, motor, and analgesic block characteristics oftwo diferent doses of morphine compared with saline when added to 0.5 percent levobupivacaine.
Prospective, randomized, double-blinded, controlled study.
University hospital. PATIENTS, PARTICIPANTS, INTERVENTIONS: One hundred and twelve ASA I or II adult patients undergoing cesarean section with combined-spinal epidural anesthesia (CSEA) were randomly allocated to receive 0.5 mL of0.9 percent sodium chloride in group S, 0.1 mg of morphine in group M1, or 0.2 mg of morphine in group M2 following 15 mg of isobaric spinal levobupivacaine 0.5 percent (3 mi). MAIN OUTCOME MEASURE(s): We recorded the following: onset and duration of sensory and motor block, duration of spinal anesthesia, time to first request for analgesia, and side effects.
The onset time ofsensory block was significantly less in group M2 (3.5 + 3 minutes) than S (4 +/- 3 minutes; p < 0.003). Parturientsgiven morphine had a significantly greater duration of analgesia (554 +/- 350 minutes in group M1 and 879 -725 minutes in group M2) than the saline group (80 +/- 70 minutes; p < 0.001). Similarly, the time to first request for analgesia was longer in groups M1 (582 +/- 470 minutes) and M2 (917+/- 709 minutes) than in group S (92 +/- 77 minutes; p < 0.001).
In patients undergoing cesarean delivery with CSEA, adding intrathecal morphine (0.1 and 0.2 mg) to 15 mg of spinal levobupivacaine prolonged the duration of spinal analgesia and provided rapid onset of action and longer time to first analgesic request without causing any significant side effect compared to saline.
Journal of opioid management 8(2):105-13.
