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Efficacy of intrathecal neostigmine and fentanyl for the relief of pain in transurethral resection of prostate
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Posters
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Central Nerve Blocks
182. Efficacy of intrathecal neostigmine and fentanyl for the relief of pain in transurethral resection of prostate Email: [email protected] Department of Anaesthesiology and Reanimation Teaching and Research Hospital, Istanbul. korkadi sk. turizm sitesi 4.blok No:13 ulus/ istanbul Turkey Introduction: We evaluated the analgesic efficancy and safety of intrathecal (IT) neostigmine and IT fentanyl for the relief of pain and postoperative nausea and vomiting (PONV) in transurethral resection of prostate (TURP). Methods: Our study was performed in 45 patients of ASA I- III undergoing transurethral procedures were randomly assigned to three equal groups which received IT %5 hyperbaric bupivacaine 10mg with either normal saline 1ml, neositigmine 25g, or fentanyl 50g The onset of anaesthesia, duration of analgesia, time to use of first rescue analgesics, the overall 24h VAS pain scores and the incidance of side effects were recorded for 24h postdrug administrtion. Results: There were no statistically significant difference in onset of anesthesia, maximal level of sensory block among the three groups. The duration of analgesia in the fentanyl and neostigmine groups were prolonged to the saline group. Compered with the saline group, the fentanyl and neostigmine groups also showed a later onset of postsurgical pain, lower overall 24h VAS pain score and prolonged time to first rescue analgesic, and first rescue analgesic in the fentanyl group prolonged relative to the neostigmine group. The incidence of treatment for PONV was greater in patients receiving neositigmine (44%) than receiving saline (2%) and fentanyl (15%)(p⬍ 0.05). Conclusion: we conclude that neostigmine 25g, and fentanyl 50g with bupivacain produced an effective spinal analgesia for TURP. However, IT neostigmine increased incidence of nausea or vomiting was limited for clinical use.
183. Comparison of volume preloading with lactated Ringer’s versus different types of hydroxyethylstarch before spinal anaesthesia Sivrikaya G, Dobrucali H, T. kilinc L, K. erol M, Hanci A, Burgutoglu B Email: [email protected] Sisli Etfal Education and Research Hospital, Department of 2.Anaesthesiology and Reanimation Istanbul TURKEY Introduction: Hypotension is a frequent problem following spinal anaesthesia. One of the techniques to prevent hypotension is, intravascular volume expansion using intravenous fluid (“preload”) before spinal anaesthesia. The aim of this study was to determine if there was a difference between crystaloid and different colloid solutions on the effectiveness of prevention. Methods: The study was approved by the Medical Ethics Committee of the hospital and informed patient consent was obtained. 60 patients were allocated randomly to three groups to receive either; 10 ml.kg-1 lactated Ringer’s solution in Group I or 10 ml.kg-1 6% hydroxyethylstarch 200/0.5 in Group II or 10 ml.kg-1 6% hydroxyethylstarch 130/0.4 in Group III before spinal anaesthesia. Systolic and diastolic blood pressure, heart rate were recorded at 10 minutes intervals pre and peroperatively and then every 15 minutes for 2 hours postoperatively. Hypotension was defined as a decrease of 30% or more below baseline values or ⬍90 mmHg (systolic blood pressure) and was treated by intravenous ephedrine bolus doses. The incidence of hypotension, number of patients required a vasopressor and doses of ephedrine required to restore blood pressure were recorded. Nausea and vomiting were observed as adverse effects. Repeated measures of ANOVA, chi square tests were used for the statistical analyses. p⬍0.05 considered as significant. Results: The incidence of hypotension was significantly higher in Group I when compared with Group II and III. It was lower in Group III than Group II but the difference was not significant. Bradycardia was more frequent in Group I than Group II and III. Number of patients and doses of ephedrine required was significantly higher in Group I than Group II and III. These data were lower in Group III than Group II, but the difference was not significant. The incidence of nausea and vomiting was similar in all three groups. Conclusion: Fluid preloading considered to be a safe and effective method of reducing the incidence hypotension induced by spinal anaesthesia. The results of our study showed that colloid solutions are more effective on prevention of hypotension than crystaloid solution in spinal anaesthesia and 6% hydroxyethylstarch 130/0.4 appears to be superior to 6% hydroxyethylstarch 200/0.5 in this indication.
Posters
•
Central Nerve Blocks
182. Efficacy of intrathecal neostigmine and fentanyl for the relief of pain in transurethral resection of prostate Email: [email protected] Department of Anaesthesiology and Reanimation Teaching and Research Hospital, Istanbul. korkadi sk. turizm sitesi 4.blok No:13 ulus/ istanbul Turkey Introduction: We evaluated the analgesic efficancy and safety of intrathecal (IT) neostigmine and IT fentanyl for the relief of pain and postoperative nausea and vomiting (PONV) in transurethral resection of prostate (TURP). Methods: Our study was performed in 45 patients of ASA I- III undergoing transurethral procedures were randomly assigned to three equal groups which received IT %5 hyperbaric bupivacaine 10mg with either normal saline 1ml, neositigmine 25g, or fentanyl 50g The onset of anaesthesia, duration of analgesia, time to use of first rescue analgesics, the overall 24h VAS pain scores and the incidance of side effects were recorded for 24h postdrug administrtion. Results: There were no statistically significant difference in onset of anesthesia, maximal level of sensory block among the three groups. The duration of analgesia in the fentanyl and neostigmine groups were prolonged to the saline group. Compered with the saline group, the fentanyl and neostigmine groups also showed a later onset of postsurgical pain, lower overall 24h VAS pain score and prolonged time to first rescue analgesic, and first rescue analgesic in the fentanyl group prolonged relative to the neostigmine group. The incidence of treatment for PONV was greater in patients receiving neositigmine (44%) than receiving saline (2%) and fentanyl (15%)(p⬍ 0.05). Conclusion: we conclude that neostigmine 25g, and fentanyl 50g with bupivacain produced an effective spinal analgesia for TURP. However, IT neostigmine increased incidence of nausea or vomiting was limited for clinical use.
183. Comparison of volume preloading with lactated Ringer’s versus different types of hydroxyethylstarch before spinal anaesthesia Sivrikaya G, Dobrucali H, T. kilinc L, K. erol M, Hanci A, Burgutoglu B Email: [email protected] Sisli Etfal Education and Research Hospital, Department of 2.Anaesthesiology and Reanimation Istanbul TURKEY Introduction: Hypotension is a frequent problem following spinal anaesthesia. One of the techniques to prevent hypotension is, intravascular volume expansion using intravenous fluid (“preload”) before spinal anaesthesia. The aim of this study was to determine if there was a difference between crystaloid and different colloid solutions on the effectiveness of prevention. Methods: The study was approved by the Medical Ethics Committee of the hospital and informed patient consent was obtained. 60 patients were allocated randomly to three groups to receive either; 10 ml.kg-1 lactated Ringer’s solution in Group I or 10 ml.kg-1 6% hydroxyethylstarch 200/0.5 in Group II or 10 ml.kg-1 6% hydroxyethylstarch 130/0.4 in Group III before spinal anaesthesia. Systolic and diastolic blood pressure, heart rate were recorded at 10 minutes intervals pre and peroperatively and then every 15 minutes for 2 hours postoperatively. Hypotension was defined as a decrease of 30% or more below baseline values or ⬍90 mmHg (systolic blood pressure) and was treated by intravenous ephedrine bolus doses. The incidence of hypotension, number of patients required a vasopressor and doses of ephedrine required to restore blood pressure were recorded. Nausea and vomiting were observed as adverse effects. Repeated measures of ANOVA, chi square tests were used for the statistical analyses. p⬍0.05 considered as significant. Results: The incidence of hypotension was significantly higher in Group I when compared with Group II and III. It was lower in Group III than Group II but the difference was not significant. Bradycardia was more frequent in Group I than Group II and III. Number of patients and doses of ephedrine required was significantly higher in Group I than Group II and III. These data were lower in Group III than Group II, but the difference was not significant. The incidence of nausea and vomiting was similar in all three groups. Conclusion: Fluid preloading considered to be a safe and effective method of reducing the incidence hypotension induced by spinal anaesthesia. The results of our study showed that colloid solutions are more effective on prevention of hypotension than crystaloid solution in spinal anaesthesia and 6% hydroxyethylstarch 130/0.4 appears to be superior to 6% hydroxyethylstarch 200/0.5 in this indication.