Background: Laparoscopic surgery is as very safe as traditional open surgery. A laparoscopic cholecystectomy is a surgical procedure during which the doctor removes your gallbladde. Objectives: This study was to assess the effect of local and intraperitoneal bupivacain infiltration on pain relief after laparoscopic cholecystectomy and the side effects of this technique. Subjects and method: In study group (n = 37), 25 mg bupivacain 0.25 % and 75 mg were infiltrated at Trocat incisions and at intraperitoneal surgery site, respectively. In placebo group (n = 44): no infiltration was used. VAS was measured controlling patient's pain during at rest, following inspiratory effort and movement; IV perfalgan requirement and the side effects of the technique were observed. Results: VAS at rest, following inspiratory effort and movement as well as perfalgan requirement during postoperative 6 hours were lower in study group (p < 0.05). \r\n", u'A significant decrease of heart rate after 10 - 30 minute of intraperitoneal infiltration of bupivacain was noted. Conclusions: Local and intraperitoneal bupivacain infiltrations had an effectiveness on pain relief during 6 hours after laparoscopic cholecystectomy. Moderate bradycardia was a main side effect of this technique. \r\n', u' \r\n', u'
Cholecystectomy/ methods ; Bupivacaine/ administration & ; dosage

OBJECTIVE: To explore the clinical efficacy of intrathecally administered low dose sufentanil-bupivacaine in transurethral resection of the prostate (TURP). METHODS. Ninety patient (ASA I - III) undergoing TURP were randomly divided into 3 groups (n = 30); Group A, B and C. Group A received 7.5 mg bupivacaine + 5 microg sufentanil + 10% glucose; Group B received 7.5 mg bupivacaine + 7.5 microg sufentanil + 10% glucose; Group C received 15 mg bupivacaine + 10% glucose. The volume was 3 mL in every group. SP, DP, HR, SpO2, the degree of motor and sensory blockade and the side effect were observed. RESULTS: SP/DP was significantly decreased in Group C than that in Group and Group B (p<0.05), HR and SpO2 in group B were decreased to different degrees 15 min after the injection (p<0.05). The complete recovery time of motor nerve blockade and the regression time of sensory blockade were obviously prolonged in Group C (p<0.05). There were no significant differences in analgesic effect among the three groups during the operation, but the incidence of pruritus was higher in both group A and Group B than that in Group C during the first 24 hours after the injection. CONCLUSION Spinal anesthesia with low dose sufentanil-bupivacaine possesses relatively steady hemodynamics. The blockade degree of motor and sensory blockade in this spinal anesthesia is lower than that in standard spinal bupivacaine in TURP.
Aged ; Anesthesia, Spinal ; Bupivacaine ; administration & dosage ; Humans ; Male ; Middle Aged ; Sufentanil ; administration & dosage ; Transurethral Resection of Prostate

BACKGROUND: We postulated that ketorolac as a component of surgical site infiltration would result in better analgesia than intravenous ketorolac. METHODS: Sixty patients who scheduled for elective total abdominal hysterectomy received ketorolac 60 mg (2 ml) either via surgical site infiltration directly (n=30) or parenteral route (n=30) with surgical site infiltration of 0.25% bupivacaine 18 ml 20 min before skin incision. RESULTS: Postoperative analgesic requirement, 48 hour total infusion dose and first 12 hour infusion dose of PCA fentanyl, were significantly lower in surgical site group. There were no significant differences in VAS score and side effects between two groups. CONCLUSION: Ketorolac improves analgesia when it is administered in the surgical site.
Administration, Intravenous* ; Analgesia ; Bupivacaine* ; Fentanyl ; Humans ; Hysterectomy ; Ketorolac* ; Passive Cutaneous Anaphylaxis ; Skin

Spinal Anesthesia employing 0.5% plain bupivacaine was administered to 40 patients scheduled for lower limb or perineum sThe plasma concentrations and pharmacokinetic parameters of lidocaine were studied in 4 patients under general anesthesia(halothane, or enflurane-N20-O2) following the introduction of an 1% lidocaine endotracheal spray(1.5mg/kg) through an epidural catheter. Poak plasma lidocaine levels were reached in 5 to 15 minutes and were within the nontoxic range. The pharmacokinetics of lidocaine in these patients can be described by a two-compartment model with a rapid alpha distribution(T 1/2 alpha 8.66+/-2.24 min.), and an extensive apparent volume of idstribution(1.32+/-0.46 1/kg) similar to that observed in normal subjects. The half-life of absorption was 3.65+/-1.21 minutes. However, the elimination half-life(T 1/2 beta 173.25+/-32.41 min.) was prolonged and the total plasma clearance( 6.15+/-3.25 ml/min/kg) was decreased. This potent inhalation anesthetic agent may reduce the hepatic blood flow and would be expected to reduce the plasma clearance of lidocaine by reducing the delivery of plasma lidocaine. This study suggests that tracheal administration of lidocaine will produce effective plasma lidocaine levels in many clinical situations as will intravenous administration.
Absorption ; Administration, Intravenous ; Anesthesia, General* ; Anesthesia, Spinal ; Bupivacaine ; Catheters ; Half-Life ; Humans ; Inhalation ; Lidocaine* ; Lower Extremity ; Perineum ; Pharmacokinetics* ; Plasma

A 49-year-old female presented with bilateral abducens nerve palsies. She had 75 prism diopter esotropia. The extraocular movement of the lateral rectus was -1 limitation for the right eye and -4 limitations for the left. After performing orbital magnetic resonance imaging (MRI), 2 mL of bupivacain (5 mg/mL) was injected into the left lateral rectus (LR). One month after injection, a further orbital MRI was performed. Subsequently, recession of both medial rectus (6 mm) and resection of the left LR (9 mm) were performed. After one month, bupivacaine had no hypertrophic effects. There was little change in angle of deviation. The orbital MRI scan showed a 1.91% increase in volume compared to the muscle prior to the injection. Histological findings showed no muscle fibers of the left LR muscle, only the fiber nucleus and the collagen that replaced the fibers. We report on the changes in stiffness and muscle volume and on the histology of the muscle one month after injecting bupivacaine into the paralyzed left LR muscle combined with standard surgical treatment.
Abducens Nerve/*pathology ; Abducens Nerve Diseases/*drug therapy/pathology ; Anesthetics, Local/*administration & dosage/adverse effects ; Bupivacaine/*administration & dosage/adverse effects ; Female ; Humans ; Magnetic Resonance Imaging ; Middle Aged

BACKGROUNDIntrathecal anesthesia is commonly used for cesarean section. Bupivacaine and ropivacaine have all been used as intrathecal drugs. The minimum effective local anesthetic dose (MLAD) of intrathecal ropivacaine for non-obstetric patients has been reported. However, few data are available on the MLAD of hyperbaric ropivacaine for obstetric patients and the relative potency to bupivacaine has not been fully determined. In this study, we sought to determine the MLAD of intrathecal ropivacaine and bupivacaine for elective cesarean section and to define their relative potency ratio.

METHODSWe enrolled forty parturients undergoing elective cesarean section under combined spinal-epidural anesthesia and randomized them to one of two groups to receive intrathecal 0.5% hyperbaric ropivacaine or bupivacaine. The initial dose was 10 mg, and was increased in increments of 1 mg, using the technique of up-down sequential allocation. Efficacy was accepted if adequate sensory dermatomal anesthesia to pin prick to T7 or higher was attained within 20 minutes after intrathecal injection, and required no supplementary epidural injection for procedure until at least 50 minutes after the intrathecal injection.

RESULTSThe intrathecal MLAD was 9.45 mg (95%confidence interval (CI), 8.45 - 10.56 mg) for ropivacaine and 7.53 mg (95%CI, 7.00 - 8.10 mg) for bupivacaine. The relative potency ratio was 0.80 (95%CI, 0.74 - 0.85) for ropivacaine/bupivacaine when given intrathecally in cesarean section.

CONCLUSIONRopivacaine is 20% less potent than bupivacaine during intrathecal anesthesia for cesarean delivery.

Adult ; Amides ; administration & dosage ; therapeutic use ; Anesthetics, Local ; Bupivacaine ; administration & dosage ; therapeutic use ; Cesarean Section ; methods ; Female ; Humans ; Injections, Spinal ; Pregnancy ; Young Adult

AIMTo investigate the effect of intratunical instillation of bupivacaine and methylprednisolone for scrotal pain, swelling and peritesticular fibrosis due to testicular sperm retrieval procedures.

METHODSA total of 65 patients were randomly divided into two groups. In the instillation group (GI), 34 patients were administered 2.5 mL of 0.5 % bupivacaine combined with 10 mg/ml methylprednisolone before closure of the tunica vaginalis. In the control group (GC), 31 patients only received analgesics postoperatively by intramuscular route. The pain (by visual analogue scale, VAS) and duration of pain-free period after surgery between the two groups were evaluated at 2 and 4 h and at days 2 and 7 postoperatively.

RESULTSThe mean pain scores were significantly lower in the GI than in the GC group at 2 and 4 h after surgery (P<0.05 and P<0.01, respectively). The mean duration of pain free interval after the procedure was 47.8 +/-16.9 (12-72) h in GI, which was significantly longer than that in GC [(9.9 +/-3.6; 4-20) h]. Besides, in the GI, 29 % of patients were completely free from pain and 67 % had no scrotal swelling, but in the GC, all the patients required additional NSAID injection due to pain and only 3 % had no scrotal swelling.

CONCLUSIONThis study confirms that direct intratunical instillation of bupivacaine and methylprednisolone around the testis reduces the postoperative pain, scrotal swelling and peritesticular fibrosis.

Adult ; Anesthetics, Local ; administration & dosage ; Anti-Inflammatory Agents ; administration & dosage ; Bupivacaine ; administration & dosage ; Humans ; Male ; Methylprednisolone ; administration & dosage ; Oligospermia ; surgery ; Pain, Postoperative ; drug therapy ; Scrotum ; Spermatozoa ; cytology ; Treatment Outcome

OBJECTIVETo investigate the effect of sufentanil administered intrathecally at different doses on the clinical effect of bupivacaine spinal anesthesia in gynecologic laparoscopy.

METHODSSixty patients with ectopic pregnancy undergoing elective laparoscopy (ASA class I-II) were randomized into 4 groups (groups A, B, C and D), and received spinal anesthesia with 15 mg bupivacaine and sufentanil at 0, 2.5, 5 and 7.5 microg, respectively. When the patients complained of discomforts, showed bodily movements, had heart rate over 100 beats/min, or showed blood pressure increment by 20%, additional doses of propofol were given. The onset time of sensory block, time to Bromage scale 3 motor block, time to the highest sensory block level, time of operation and recovery from anesthesia, and the total dosages of propofol were recorded along with the sedative score and the side effects.

RESULTSThe 4 groups were comparable for age, body weight, height and operation time (range 60-65 min) (P>0.05). Both the onset time of sensory block and the time of Bromage scale 3 motor block in groups C and D were significantly shorter than those in groups A and B (P<0.05). The time of the highest sensory block in group D was shorter than that in group A (P<0.05). Compared to the group A, the dose of propofol was reduced in groups B, C, and D by 7.1%, 28.1%, and 34.8%, respectively; propofol doses in groups C and D were significantly lower than those in groups A and B (P<0.05). Pruritus associated with the spinal anesthesia occurred in 4 (26.7%), 3 (20%), and 6 (40%) cases in groups B, C and D, respectively.

CONCLUSIONSIntrathecal sufentanil dose-dependently affect the effect of bupivacaine spinal anesthesia, and larger sufentanil dose produces better effects but more side effects. According to our results, 5.0 microg is the optimal dose for sufentanil.

Adult ; Analgesics, Opioid ; administration & dosage ; Anesthesia, Obstetrical ; methods ; Anesthesia, Spinal ; methods ; Anesthetics, Local ; administration & dosage ; Bupivacaine ; administration & dosage ; Female ; Humans ; Injections, Spinal ; Laparoscopy ; methods ; Pregnancy ; Pregnancy, Ectopic ; surgery ; Sufentanil ; administration & dosage ; Treatment Outcome ; Young Adult

BACKGROUND: Epidural administration of local anesthetics and opiate or intravenous administration of opiate and ketorolac has proven to be effective in the treatment of postoperative pain. Studies that compare epidual morphine-bupivacaine vs intravenous nalbuphine-ketorolac administration showed conflicting results. We compared the ability and side effects of epidural (EPI-PCA) morphine-bupivacaine versus intravenous (IV-PCA) nalbuphine-ketorolac for postoperative pain relief after cesarean delivery. METHOD: Sixty healthy women were randomly assigned to receive an epidural bolus of morphine 3 mg mixed with 0.5% bupivacaine 10 ml, followed by a EPI-PCA with 0.0125% morphine and 0.125% bupivacaine (basal infusion 2 ml/hr, bolus 0.5 ml, lock-out interval 15 min) or intravenous bolus of nalbuphine 5 mg, followed by a IV-PCA with 0.05% nalbuphine and 0.15% ketorolac (basal infusion 2 ml/hr, bolus 0.5 ml, lock-out interval 30 min) for pain relief after cesarean delivery. The intensity of pain was assessed by the patient, who was unawared of the dose given, using a visual analog scale (VAS). To compare intensity of pain, VAS was used at 1, 6, 12, 24 and 40 hour after the end of surgery. RESULT : EPI-PCA group had significant lower visual analog scale (VAS) at immediate postoperative period, whereas no significant difference was observed when pain was assessed at other time sequence. Pruritus was more frequent with EPI-PCA group, although the incidence of other side effects were the same. CONCLUSION: We conclude that EPI-PCA or IV-PCA using morphine-bupivacaine or nalbuphine- ketorolac is relatively effective and safe method for the postoperative pain control. Although EPI-PCA with morphine-bupivacaine shows lower VAS at immediate postoperative period, IV-PCA with nalbuphine-ketorolac is a safe and effective alternative to EPI-PCA with morphine-bupivacaine for providing pain relief after cesarean delivery.
Administration, Intravenous ; Analgesia* ; Analgesia, Patient-Controlled* ; Anesthetics, Local ; Bupivacaine ; Female ; Humans ; Incidence ; Ketorolac ; Morphine ; Nalbuphine ; Pain, Postoperative ; Postoperative Period ; Pruritus ; Visual Analog Scale

OBJECTIVETo investigate the effects of injecting Shenfu, an extract of traditional Chinese herbal medicines, on the central nervous system (CNS) and the cardiac toxicity of bupivacaine in rats.

METHODSSixteen male Sprague-Dawley rats, weighing form 280 to 320 g, were randomly assigned to two groups (n = 8 in each group). Animals in the control group received a saline injection 10 ml/kg while animals in the Shenfu group received an injection of Shenfu 10 ml/kg intraperitoneally 30 minutes before intravenous infusion of bupivacaine. Lead II of an electrocardiogram (EEG) was continuously monitored after 3 needles were inserted into the skin of both forelimbs and the left hind-leg of each rat. The femoral artery was cannulated for measurement of arterial blood pressure and blood sampling. The femoral vein was cannulated for the infusion of bupivacaine. After baseline measurement (arterial blood pressure, heart rate and arterial blood gas), 0.5% bupivacaine was infused intravenously at a rate of 2 mg.kg(-1).min(-1) to all animals until asystole occurred. The time of bupivacaine-induced convulsions, arrhythmia and asystole were determined. The dose of bupivacaine was then calculated at the corresponding time point.

RESULTSThe doses of bupivacaine that induced convulsions, arrhythmia and cardiac arrest were remarkably larger in Shenfu injection-treated animals than in saline-treated rats [convulsions, (10.5 +/- 1.9) mg/kg vs (7.2 +/- 1.5) mg/kg; arrhythmia (10.5 +/- 2.0) mg/kg vs (7.2 +/- 1.9) mg/kg; asystole, (32.8 +/- 8.5) mg/kg vs (25.0 +/- 5.0) mg/kg; P = 0.006, 0.009 and 0.044, respectively].

CONCLUSIONThe Shenfu injection is able to reduce the toxicity of bupivacaine to CNS and cardiac system in rats.

Anesthetics, Local ; toxicity ; Animals ; Bupivacaine ; toxicity ; Drugs, Chinese Herbal ; administration & dosage ; pharmacology ; Electrocardiography ; drug effects ; Heart Rate ; drug effects ; Injections, Intraperitoneal ; Male ; Random Allocation ; Rats ; Rats, Sprague-Dawley