Buprenorphine is a semisynthetic, highly lipophilic opioid derived from thebaine and it is 30 to 40 times more potent than morphine. This study was performed to compare the clinical effects of epidural buprenorphine on postoperative pain control with those of epidural morphine in 150 cesarean deliveries. They were physical status 1 or 2 by ASA classification and randomly divided into three groups. They were administered morphine 3 mg in group I, buprenorphine 0.15 mg in group II and buprenorphine 0.3 mg in group III as first dose mixed with 0.25% bupivacaine 10 ml respectively through indwelling epidural catheter at the time of ligation of umbilical cord. Second and third doses were administered with 8 hours intervals, morphine 3 mg with N/S 10 ml was injected in group I and buprenorphine 0.15 mg with N/S 10 ml was injected in group II and III respectively. Their analgesic effects were evaluated by VAS and severity of side effects was also evaluated. The Results were as follows; 1) VAS was significantly increased in group II compared to group I and III(p<0.05). There was no significant difference between group I and III. 2) Pruritus was lesser in group II and III than group I(p<0.05). 3) There was no significant difference in nausea and vomiting. 4) None of patients had respiratory depression. The authors' findings indicate that epidural administration of buprenorphine of suitable dose may be useful in the treatment of postoperative pain.
Analgesia ; Bupivacaine ; Buprenorphine* ; Catheters ; Classification ; Humans ; Ligation ; Morphine* ; Nausea ; Pain, Postoperative ; Pruritus ; Respiratory Insufficiency ; Thebaine ; Umbilical Cord ; Vomiting

OBJECTIVE: Oxycodone, a semi-synthetic thebaine derivative opioid, is commonly used for treating moderate to severe pain. The aim of this study was to compare the efficacy and side effects of oxycodone and fentanyl used for treating postoperative pain with intravenous patient-controlled analgesia (IV-PCA) after laparoscopic gynecologic surgery. METHODS: A total of 122 patients were randomized to receive postoperative pain treatment with either oxycodone (n=62, group O) or fentanyl (n=60, group F). Patients received 7.5 mg oxycodone and 150 mcg fentanyl with ketorolac 30 mg at the end of anesthesia, and then continued with IV-PCA (conversion dose ratio, 50:1) for 48 hours postoperatively. A blinded observer assessed postoperative pain based on a numerical rating scale, postoperative nausea and vomiting and other side effects, infused PCA dose, patient satisfaction, and sedation level. RESULTS: No significant differences were observed in patient satisfaction according to the analgesic used during the 48 hours postoperative period. CONCLUSION: Oxycodone showed similar efficacy for pain relief compared to fentanyl when used at a conversion dose ratio of 50:1. Therefore, oxycodone may be useful as an alternative to fentanyl for IV-PCA after laparoscopic gynecologic surgery.
Analgesia, Patient-Controlled ; Anesthesia ; Female ; Fentanyl ; Gynecologic Surgical Procedures ; Humans ; Ketorolac ; Oxycodone ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Patient Satisfaction ; Postoperative Nausea and Vomiting ; Postoperative Period ; Thebaine

BACKGROUND: Combined spinal epidural anesthesia has become the technique of anesthesia for cesarean section because of the reliability of spinal block with the flexibility of epidural block. Buprenorphine, a new synthetic thebaine derivative is a partial agonist of the opioid micro-receptor with high receptor affinity, great lipid solubility, and slow rate of opiate receptor association and dissociation. Continous epidural infusion of opioid can possibly produced undesirable effects, such as respiratory depression, pruritus, etc. METHODS: The present study was undertaken to compare the analgesic properties and side effects of continous epidural infusion of buprenorphine and morphine combined with bupivacaine in 60 patients following elective cesarean section in combined spinal epidural anesthesia. At the clothing of peritoneum, the initial bolus doses were 3 mg morphine (M group), 0.15 mg buprenorphine (0.15B group), 0.3 mg buprenorphine (0.3B Group) combined with 0.15% bupivacaine 10 ml and subsequent continous infusion doses were 6 mg morphine plus 0.125% bupivacaine 100 ml (M Group) and 0.6 mg buprenorphine plus 0.125% bupivacaine 100 ml (0.15B, 0.3B Group) during 48 hours. The assessment of analgesic efficacy and side effects were made at arrival of recovery room,postoperative 1, 4, 8, 24, 36, and 48 hours. RESULTS: The pain score during 48 hours was significantly higher in the 0.15B group than in the M group and 0.3B group except the pain score of recovery room. (p<0.05) and the number of patients requiring additional analgesics was higher in 0.15B group than in the M group and 0.3B group but, it was not significant. The incidence of pruritus and urinary retention was significantly higher in M group than in the 0.15B and 0.3B group, and the incidence of sedation, nausea and vomiting was similar in three group. The subjective rating of satisfaction was better in the 0.3B group and M group than in the 0.15B group. CONCLUSION: The above results suggest that continous epidural infusion of 0.6 mg buprenorphine after 0.3 mg buprenorphine initial bolus dose combined with low dose bupivacaine is an advisable method of postoperative pain control in combined spinal epidural anesthesia for cesarean section.
Analgesics ; Anesthesia ; Anesthesia, Epidural* ; Bupivacaine ; Buprenorphine* ; Cesarean Section* ; Clothing ; Female ; Humans ; Incidence ; Morphine* ; Nausea ; Pain, Postoperative* ; Peritoneum ; Pliability ; Pregnancy ; Pruritus ; Receptors, Opioid ; Recovery Room ; Respiratory Insufficiency ; Solubility ; Thebaine ; Urinary Retention ; Vomiting

BACKGROUND: Combined spinal epidural anesthesia has become the technique of anesthesia for cesarean section because of the reliability of spinal block with the flexibility of epidural block. Buprenorphine, a new synthetic thebaine derivative is a partial agonist of the opioid micro-receptor with high receptor affinity, great lipid solubility, and slow rate of opiate receptor association and dissociation. Continous epidural infusion of opioid can possibly produced undesirable effects, such as respiratory depression, pruritus, etc. METHODS: The present study was undertaken to compare the analgesic properties and side effects of continous epidural infusion of buprenorphine and morphine combined with bupivacaine in 60 patients following elective cesarean section in combined spinal epidural anesthesia. At the clothing of peritoneum, the initial bolus doses were 3 mg morphine (M group), 0.15 mg buprenorphine (0.15B group), 0.3 mg buprenorphine (0.3B Group) combined with 0.15% bupivacaine 10 ml and subsequent continous infusion doses were 6 mg morphine plus 0.125% bupivacaine 100 ml (M Group) and 0.6 mg buprenorphine plus 0.125% bupivacaine 100 ml (0.15B, 0.3B Group) during 48 hours. The assessment of analgesic efficacy and side effects were made at arrival of recovery room,postoperative 1, 4, 8, 24, 36, and 48 hours. RESULTS: The pain score during 48 hours was significantly higher in the 0.15B group than in the M group and 0.3B group except the pain score of recovery room. (p<0.05) and the number of patients requiring additional analgesics was higher in 0.15B group than in the M group and 0.3B group but, it was not significant. The incidence of pruritus and urinary retention was significantly higher in M group than in the 0.15B and 0.3B group, and the incidence of sedation, nausea and vomiting was similar in three group. The subjective rating of satisfaction was better in the 0.3B group and M group than in the 0.15B group. CONCLUSION: The above results suggest that continous epidural infusion of 0.6 mg buprenorphine after 0.3 mg buprenorphine initial bolus dose combined with low dose bupivacaine is an advisable method of postoperative pain control in combined spinal epidural anesthesia for cesarean section.
Analgesics ; Anesthesia ; Anesthesia, Epidural* ; Bupivacaine ; Buprenorphine* ; Cesarean Section* ; Clothing ; Female ; Humans ; Incidence ; Morphine* ; Nausea ; Pain, Postoperative* ; Peritoneum ; Pliability ; Pregnancy ; Pruritus ; Receptors, Opioid ; Recovery Room ; Respiratory Insufficiency ; Solubility ; Thebaine ; Urinary Retention ; Vomiting