ANALGESIA AFTER UPPER ABDOMINAL-SURGERY USING EXTRADURAL ADMINISTRATION OF A FIXED-DOSE OF BUPRENORPHINE IN COMBINATION WITH LIGNOCAINE GIVEN AT 2 INFUSION RATES - A COMPARATIVE-STUDY
Z. Wajima et al., ANALGESIA AFTER UPPER ABDOMINAL-SURGERY USING EXTRADURAL ADMINISTRATION OF A FIXED-DOSE OF BUPRENORPHINE IN COMBINATION WITH LIGNOCAINE GIVEN AT 2 INFUSION RATES - A COMPARATIVE-STUDY, Acta anaesthesiologica Scandinavica, 41(8), 1997, pp. 1061-1065
Background: Extradural administration of combinations of local anaesth
etics and opioids are frequently employed for postoperative pain relie
f. There is a scarcity of data on the analgesic effects of variations
of the dose of local anaesthetic drug admired to a fixed dose of opioi
d. Methods: Twenty-four patients were investigated after elective uppe
r abdominal surgery. During closure of the abdomen, 2% mepivacaine (8
mi) with buprenorphine 0.1 mg (0.5 mi) was given extradurally. After e
xtubation, patients were randomly allocated to receive continuous extr
adural infusion of a fixed dose of buprenorphine (0.017 mg/h) in combi
nation with 2% lignocaine at either 2.1 ml/h (low rate group, n = 14)
or 6.3 ml/h (high rate group, n = 10). Postoperative pain at rest was
assessed using visual analogue scale (VAS) scores and pain at movement
by Prince Henry Pain Scale (PHPS) scores. Venous plasma lignocaine co
ncentrations were measured. Results: VAS scores at rest were similar i
n the two groups at 3 h postoperatively, whereas at 6-24 h postoperati
vely, VAS scores were higher in the low rate group than in the high ra
te group. PHPS scores were similar in the two groups at 3 h and at 18
h postoperatively, whereas at 6, 9, 12 and 24 h postoperatively, PHPS
scores were higher in the low rate group than in the high rate group.
Plasma lignocaine concentrations were higher at 23 h postoperatively i
n the high rate group than at 16 h in both groups, and at 23 h in the
low rate group. At 3 h postoperatively, both the systolic and diastoli
c arterial pressures were higher in the low rate group than control va
lues obtained on admission. Side effects were observed in one patient
in the low rate group who complained of dizziness, and in one patient
in the high rate group who complained of nausea. Conclusions: When add
ed to a fixed dose of buprenorphine, continuous extradural infusion of
2% lignocaine at high rate provides better postoperative analgesia th
an when given at low rate without producing significant side effects.