Anaesthetic component of the Fast track surgery strategy: spinal anaesthesia with bupivacaine, prolonged by buprenorphine

S.N. Byshovets

Abstract


We studied 206 patients (age — 55.5 ± 3.3 years; weight — 84.8 ± 2.9 kg; I–III ASA), undergoing laparoscopic cholecystectomy, herniaplasty, ovarian cystectomy. Spinal ­anaesthesia was performed with hyperbaric bupivacaine (0.5%; 10–20 mg) in combination with 0.06 mg of buprenorphine. To prevent scapulohumeral pain syndrome, we have performed right superficial cervical plexus block with isobaric bupivacaine (0.125%, 10 ml) and diaphragmatic terminal anaesthesia with isobaric bupivacaine solution (0.25%, 15 ml; spray; through laparoscopic trocar). Places of intervention of laparoscopic ports were infiltrated by 0.25% isobaric bupivacaine. To create a pneumoperitoneum, nitrous oxide has been used with a pressure of 9–10 mmHg. Patients received 6 mg melatonin orally at bedtime, 1 h before laparoscopy, and on the first postoperative day at bedtime. Before surgery: oral/intravenously (I.V.) — 1 g of paracetamol, intramuscularly (I.M.) — 20 mg of nefopam, I.V. — 8 mg of dexamethasone, I.V. — 8 mg of ondansetron, I.V. — 50 mg of dexketoprofen. After operation for 1–1.5 days: per os/I.V. — 1 g of paracetamol every 8 h, I.M. — 50 mg of dexketoprofen every 8 h. Correction of hypotension was provided by epinephrine infusion by changing the injection rate depending on the level of blood pressure and heart rate, within the range of 0.09–0.18–0.27 mg/h. Postoperative pain was evalua­ted on a numeric pain rating scale from 0 to 10 in 3, 10, 24, 48 h, and following results were received, respectively: 0; 0.27 ± 0.02; 0.41 ± 0.07; 0.45 ± 0.06 points. Complications: urinary retention — 1 (0.49 %) case; postoperative nausea and vomiting — 31 (15.1 %) patients; itch — 25 (12.1 %) patients (it was effectively treated with I.V. administration of 0.4 mg of naloxone). Hospitalization period was 31.0 ± 1.6 h. Conclusions: spinal anaesthesia with solution of bupivacaine and buprenorphine is an effective method of anaesthesia in laparoscopy, which is characterized by a positive long-term postoperative analgesic profile; improving the quality of analgesia enables early activation and enteral nutrition of patients, therefore reducing the postoperative recovery period that is fully consistent with the concept of Fast track surgery; the combined intrathecal use of buprenorphine and bupivacaine is characterized by significantly fewer adverse side effects compared to other opioids.


Keywords


buprenorphine; spinal anaesthesia

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DOI: https://doi.org/10.22141/2224-0586.1.80.2017.94458

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