Fentanyl and bupivacaine mixture for extradural blockade in orthopaedic surgery: effects on haemodynamic responses and pain related to the use of thigh tourniquet.
Analgesic and haemodynamic changes due to tourniquet application were investigated in a prospective double-blind study on orthopaedic patients submitted to extradural lumbar blockade with a bupivacaine and fentanyl mixture. The study was carried out in 161 healthy patients undergoing limb surgery with a thigh tourniquet. Patients were randomly assigned to two groups: each group received treatment with bupivacaine 0.5% containing 1:200,000 adrenaline. Normal saline (B:F o group) or 200 micrograms fentanyl (B:F 200 group) was added to this solution. An immediate increase in systolic and diastolic blood pressure (SBP and DBP) was provoked by tourniquet application in all patients, whilst heart rate (HR) showed no modification and the rate-pressure product (RPP) was hardly influenced in the B:F 200 group. A dramatic reduction in intra-operative supplemental analgesic needs was observed in the B:F 200 group. This group of patients also complained less of tourniquet pain than their counterparts, for the first 30 min of application. Our study underlines the value of fentanyl addition to bupivacaine in extradural blockade in orthopaedic surgery.
Rucci
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Trafficante
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Pippa
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D000328:Adult; D000767:Anesthesia, Epidural / Q000379:methods*; D001794:Blood Pressure / Q000187:drug effects; D002045:Bupivacaine / Q000008:administration & dosage* / Q000494:pharmacology; D002986:Clinical Trials as Topic; D004311:Double-Blind Method; D004338:Drug Combinations; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage* / Q000494:pharmacology; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009985:Orthopedics; D010146:Pain / Q000517:prevention & control; D011446:Prospective Studies; D011897:Random Allocation; D013848:Thigh; D013997:Time Factors; D014111:Tourniquets / Q000009:adverse effects
D004338:Drug Combinations; D005283:Fentanyl; D002045:Bupivacaine