C. O. Hunt

Perioperative Analgesia with Subarachnoid Fentanyl–Bupivacaine for Cesarean Delivery

Addition of fentanyl to bupivacaine administered for spinal anesthesia for cesarean delivery was evaluated in 56 ASA physical status 1 term parturients. Preservative-free saline was added to 0, 2.5, 5, 6.25, 12.5, 25, 37.5, or 50 micrograms fentanyl to make a 1 ml total volume, which was injected intrathecally prior to bupivacaine in a double-blind, randomized fashion. Vital signs, sensory level, motor block, pain score, and side effects were recorded every 2 min for the first 12 min and then at 15, 30, 45, and 60 min and at 30-min intervals until the patient complained of pain. At delivery maternal vein, umbilical artery, and umbilical vein blood gases were obtained. Apgar scores at 1 and 5 min were recorded. Early Neonatal Neurobehavioral Scales (ENNS) were performed on days 1 and 2. Side effects and opioid requirements were recorded for the first 24 h. All of the patients in the control group reported a pain score greater than 0 during surgery and 67% required intraoperative opioids. None of the patients who received greater than or equal to 6.25 micrograms fentanyl required intraoperative opioids. Complete analgesia (time from injection to first report of pain) lasted 33.7 +/- 30.8 min (mean +/- SD) in the control group and increased to 130 +/- 30 min (P less than 0.05) with addition of 6.25 micrograms fentanyl. Duration of effective analgesia (time from injection to first parenteral opioid) was 71.8 +/- 43.2 min in the control group and increased (P less than 0.05) to 192 +/- 74.9 min with addition of 6.25 micrograms fentanyl.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia for the Obstetric Patient with Multiple Sclerosis

Data on all obstetric patients delivering at the Brigham and Womens Hospital during the years 1982 through 1987 were collected. The anesthetic techniques used, the type and amount of anesthetic agents administered, and the postpartum relapse rate of multiple sclerosis patients were compared. Women who received epidural anesthesia for vaginal delivery did not have a significantly higher incidence of relapse than those who received local infiltration. However, all of the women who experienced postpartum relapses had received concentrations of bupivacaine greater than 0.25%. This finding may suggest that a higher concentration of drug over a longer period of time may adversely influence the relapse rate.

Epidural butorphanol-bupivacaine for analgesia during labor and delivery.

A double-blind, randomized, dose-response study of a combination of 0.25% bupivacaine combined with 0, 1, 2, or 3 mg of butorphanol was studied in 40 laboring parturients. The optimal dose of butorphanol combined with 8.5 to 10 ml 0.25% bupivacaine was 2 mg; with 2 mg, the duration of analgesia was significantly greater and the time to onset of analgesia significantly shorter than when no butorphanol was added, and the amount of bupivacaine could be reduced 50%. Adverse fetal effects were not observed except that of a low amplitude sinusoidal fetal heart rate pattern with doses of 3 mg butorphanol. All neonatal observations were normal. It is concluded that epidural butorphanol can be a useful and safe adjunct to bupivacaine used for epidural analgesia during labor.

Butorphanol compared with fentanyl in general anaesthesia for ambulatory laparoscopy

Butorphanol was compared with fentanyl as the narcotic component of general anaesthesia for ambulatory laparoscopic surgery. This doubleblind, randomized study enrolled 60 healthy women who received equianalgesic doses of fentanyl 1 μg · kg−1 (F, n = 30) or butorphanol 20 μg · kg−1 (B, n = 30) prior to induction of anaesthesia. Tracheal anaesthesia was maintained with nitrous oxide/oxygen, isoflurane, and succinylcholine by infusion, lntraoperatively, patients who received B demonstrated lower pulse rate before and after intubation (P < 0.05, P < 0.01) and lower diastolic blood pressure after intubation (P < 0.01). Anesthesiologists judged the maintenance phase as satisfactory more often with B (P < 0.05). Postoperatively, there were no differences in analgesic need. No major sideeffects occurred in either group. Among minor sideeffects, patients who received B reported postoperative sedation more often, 77% vs 37% (P < 0.01), which occurred during the first 45 min of recovery (P < 0.05). Discharge times were not different. On the first postoperative day, more subjects who received B were satisfied with their anaesthesia experience (P < 0.05). Butorphanol 20 μg · kg−1 is an acceptable alternative analgesic in general anaesthesia for ambulatory laparoscopy.RésuméNous avons comparé les effets du butorphanol à ceux du fentanyl lors de laparoscopies faites en externe. Soixante patientes ont participé à cette étude doubleinsu. Avant l’ induction de l’anesthésie, on leur injectait à litre d’ équivalent analgésique, soit 1 μg · kg−1 de fentanyl (groupe F, n = 30), soit 20 μg · kg−1 de butorphanol (groupe B, n = 30). Après l’ intubation de la trachée, elles respiraient de l’ oxygène, du protoxyde d’ azote et de l’ isoflurane associés à une perfusion de succinylcholine. Les patientes du groupe B avaient un pouls plus lent avant et après l’ intubation (P < 0,05; P < 0,01) de meme qu’ une tension artérielle diastolique plus basse après l’ intubation (P < 0,01). Les anesthésistes ont jugé favorablement la phase de maintien de l’ anesthésie plus souvent chez les patientes du groupe B(P < 0,05). En période postopératoire, les besoins en analgésiques étaient les mêmes dans les deux groupes avec de la sédation qui, quoique plus fréquente dans le groupe B (77 vs 37%; P < 0,01) durait moins de 45 min (P < 0,05). Nous n’avons observe aucun effet secondaire important et la durée du séjour en salle de réveil était semblable chez les groupes F et B. Le lendemain de l’ intervention, les patientes du groupe B cotaient leur anesthésie avec plus de satisfaction (P < 0,05). Lors d’ une anesthésie générale pour fin de laparoscopie en externe, l’ usage de butorphanol est tout à fait acceptable.

Comparative Effects of Subarachnoid Hyperbaric Bupivacaine and Tetracaine-Procaine for Cesarean Delivery

&NA; Hyperbaric solutions of 0.75% bupivacaine (8.25% dextrose), and 1% tetracaine mixed with an equal volume of 10% procaine were compared in a double‐blind study of 22 parturients undergoing elective cesarean delivery and spinal anesthesia. The onset of sensory anesthesia and motor block was similar in the two groups. The maximal level of sensory anesthesia to pinprick was significantly higher after the use of the tetracaine‐procaine mixture. The adequacy of anesthesia was similar in both groups as indicated by the lack of differences with regard to anesthetic supplementation between the groups. However, a significantly shorter duration of sensory anesthesia and motor blockade occurred in the group in which bupivacaine was employed. The incidence of hypotension was higher in those patients receiving the tetracaine‐procaine mixture as indicated by the use of significantly higher total doses of ephedrine to maintain baseline blood pressure in this group. No differences in Apgar scores or blood gases were noted between the two groups of patients. This study suggests that hyperbaric 0.75% bupivacaine offers certain advantages over hyperbaric tetracaine‐procaine when used in equal volumes for spinal anesthesia cesarean delivery.

Epidural Butorphanol-Bupivacaine for Analgesia During Labor and Delivery

A double-blind, randomized, dose-response study of a combination of 0.25% bupivacaine combined with 0,1, 2, or 3 mg of butorphanol was studied in 40 laboring parturients. The optimal dose of butorphanol combined with 8.5 to 10 ml 0.25% bupivacaine was 2 mg; with 2 mg, the duration of analgesia was significantly greater and the time to onset of analgesia significantly shorter than when no butorphanol was added, and the amount of bupivacaine could be reduced 50%. Adverse fetal effects were not observed except that of a low amplitude sinusoidal fetal heart rate pattern with doses of 3 mg butorphanol. All neonatal observations were normal. It is concluded that epidural butorphanol can be a useful and safe adjunct to bupivacaine used for epidural analgesia during labor.