@2024 Afarand., IRAN
ISSN: 2252-0805 The Horizon of Medical Sciences 2016;22(4):261-266
ISSN: 2252-0805 The Horizon of Medical Sciences 2016;22(4):261-266
Effect of Fentanyl with Lidocaine on Hemodynamical Stability of Patients with History of Hypertension in TURP Surgery: A Double Blind Controlled Clinical Trial
ARTICLE INFO
Article Type
Original ResearchAuthors
Saheban Maleki M. (1)Kianmehr M. (2)
Talaei A.R. (*)
Moaven Saeidi Noghabi M. (3)
(*) 15th of Khordad Hospital, Gonabad University of Medical Science, Gonabad, Iran
(1) Anesthesiology Department, Medicine Faculty, Gonabad University of Medical Sciences, Gonabad, Iran
(2) Medical Physics Department, Medicine School, Gonabad University of Medical Sciences, Gonabad, Iran
(3) Occupational Medicine Department, Gonabad University of Medical Science, Gonabad, Iran
Correspondence
Address: 15th of Khordad Hospital, Safa Square, Baydokht, GonabadPhone: +98 (51) 57251002
Fax: +98 (51) 57231116
alirezatalaei@yahoo.com
Article History
Received: November 21, 2015Accepted: May 10, 2016
ePublished: October 1, 2016
ABSTRACT
Aims
Some severe hemodynamic changes are known as problems due to 5% lidocaine spinal anesthesia at the elderly. Such changes, also, may lead to the cardio-vascular or renal problems. The aim of this study was to compare between the hemodynamic changes in two spinal-cord anesthesia methods with 5% lidocaine (the current method) and with low 5% lidocaine dose with 50μg fentanyl in the elderly patients with a systemic blood-pressure increase history in the transurethral resection of the prostate (TURP).
Materials & Methods In the two-blinded clinical trial, 148 patients aged more than 50 years with benign prostate hypertrophy, who had referred to 15th of Khordad Hospital of Gonabad for TURP between 2011 and 2012, were studied. The subjects, selected via simple random sampling method, were randomly divided into two groups (n=74 per group). The first and the second groups underwent spinal-cord anesthesia with the administrations of 5% lidocaine (2cc; 100mg) and 5% lidocaine (1cc; 50mg) + fentanyl (1cc; 50μg), respectively. Blood-pressure and heart-rate were recorded immediately after the anesthesia and at every 5 minutes. Data was analyzed by SPSS 21 software using independent T and Fisher’s exact tests.
Findings Mean reductions in the systolic and the diastolic blood-pressures (p<0.001) and mean reduction in the heart-rate (p=0.009) in lidocaine+fentanyl group were significantly lower than lidocaine group. In lidocaine group, ephedrine and atropine administrations were required in 26 and 19 patients, respectively. Nevertheless, no administration either of ephedrine or of atropine was required in lidocaine + fentanyl group (p<0.001).
Conclusion Without any hemodynamic instability, low lidocaine dose (50mg) with fentanyl (50μg) may result in sufficient anesthesia and no-pain in the elderly patients with a history of controlled high-pressure, who undergo TURP.
Materials & Methods In the two-blinded clinical trial, 148 patients aged more than 50 years with benign prostate hypertrophy, who had referred to 15th of Khordad Hospital of Gonabad for TURP between 2011 and 2012, were studied. The subjects, selected via simple random sampling method, were randomly divided into two groups (n=74 per group). The first and the second groups underwent spinal-cord anesthesia with the administrations of 5% lidocaine (2cc; 100mg) and 5% lidocaine (1cc; 50mg) + fentanyl (1cc; 50μg), respectively. Blood-pressure and heart-rate were recorded immediately after the anesthesia and at every 5 minutes. Data was analyzed by SPSS 21 software using independent T and Fisher’s exact tests.
Findings Mean reductions in the systolic and the diastolic blood-pressures (p<0.001) and mean reduction in the heart-rate (p=0.009) in lidocaine+fentanyl group were significantly lower than lidocaine group. In lidocaine group, ephedrine and atropine administrations were required in 26 and 19 patients, respectively. Nevertheless, no administration either of ephedrine or of atropine was required in lidocaine + fentanyl group (p<0.001).
Conclusion Without any hemodynamic instability, low lidocaine dose (50mg) with fentanyl (50μg) may result in sufficient anesthesia and no-pain in the elderly patients with a history of controlled high-pressure, who undergo TURP.
CITATION LINKS
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[2]Kim SY, Cho JE, Hong JY, Koo BN, Kim JM, Kil HK. Comparison of intrathecal fentanyl and sufentanil in low-dose dilute bupivacaine spinal anaesthesia for transurethral prostatectomy. Br J Anaesth. 2009;103(5):750-4.
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[4]Ben-David B, Maryanovsky M, Gurevitch A, Lucyk C, Solosko D, Frankel R, et al. A comparison of minidose lidocaine-fentanyl and conventional-dose lidocaine spinal anesthesia. Anesth Analg. 2000;91(4):865-70.
[5]Ben-David B, Solomon E, Levin H, Admoni H, Goldik Z. Intrathecal fentanyl with small-dose dilute bupivacaine: better anesthesia without prolonging recovery. Anesth Analg. 1997;85(3):560-5.
[6]Maves TJ, Gebhart GF. Antinociceptive synergy between intrathecal morphine and lidocaine during visceral and somatic nociception in the rat. Anesthesiol. 1992;76(1):91-9.
[7]Wang C, Chakrabarti MK, Whitwam JG. Specific enhancement by fentanyl of the effects of intrathecal bupivacaine on nociceptive afferent but not on sympathetic efferent pathways in dogs. Anesthesiol. 1993;79(4):766-73.
[8]Penning JP, Yaksh TL. Interaction of intrathecal morphine with bupivacaine and lidocaine in the rat. Anesthesiol. 1992;77(6):1186-2000.
[9]Pöpping DM, Elia N, Wenk M, Tramèr MR. Combination of a reduced dose of an intrathecal local anesthetic with a small dose of an opioid: A meta-analysis of randomized trials. Pain. 2013;154(8):1383-90.
[10]Vaghadia H, Mcleod DH, Mitchell GW, Merrick PM, Chilvers CR. Small-dose hypobaric lidocaine-fentanyl spinal anesthesia for short duration outpatient laparoscopy. I. A randomized comparison with conventional dose hyperbaric lidocaine. Anesth Analg. 1997;84(1):59-64.
[11]Zohar E, Noga Y, Rislick U, Leibovitch I, Fredman B. Intrathecal anesthesia for elderly patients undergoing short transurethral procedures: a dose-finding study. Anesth Analg. 2007;104(3):552-4.
[12]Kim NY, Kim SY, Ju HM, Kil HK. Selective spinal anesthesia using 1 mg of bupivacaine with opioid in elderly patients for transurethral resection of prostate. Yonsei Med J. 2015;56(2):535-42.
[13]Vaghadia H. Spinal anesthesia for outpatients: controversies and new techniques. Can J Anaesth. 1998;45(Suppl 1):R64-75
[14]Liu S, Chiu AA, Carpenter RL, Mulroy MF, Allen HW, Neal JM, et al. Fentanyl prolongs lidocaine spinal anesthesia without prolonging recovery. Anesth Analg. 1995;80(4):730-4.
[15]Pöpping DM, Elia N, Marret E, Wenk M, Tramèr MR. Opioids added to local anesthetics for single-shot intrathecal anesthesia in patients undergoing minor surgery: A meta-analysis of randomized trials. Pain. 2012;153(4):784-93.
[16]Pasero C. Fentanyl for acute pain management. J Peri Anesth Nurs. 2005;20(4):279-84.
[17]Hamber EA, Viscomi CM. Intrathecal lipophilic opioids as adjuncts to surgical spinal anesthesia. Reg Anesth Pain Med. 1999;24(3):255-63.
[18]Kuusniemi KS1, Pihlajamäki KK, Pitkänen MT, Helenius HY, Kirvelä OA. The use of bupivacaine and fentanyl for spinal anesthesia for urologic surgery. Anesth Anal. 2000;91(6):1452-6.
[2]Kim SY, Cho JE, Hong JY, Koo BN, Kim JM, Kil HK. Comparison of intrathecal fentanyl and sufentanil in low-dose dilute bupivacaine spinal anaesthesia for transurethral prostatectomy. Br J Anaesth. 2009;103(5):750-4.
[3]Hines RL, Marschall K. Stoelting's anesthesia and co-existing disease. 6th edition. Canada: Elsevier; 2012. p. 353.
[4]Ben-David B, Maryanovsky M, Gurevitch A, Lucyk C, Solosko D, Frankel R, et al. A comparison of minidose lidocaine-fentanyl and conventional-dose lidocaine spinal anesthesia. Anesth Analg. 2000;91(4):865-70.
[5]Ben-David B, Solomon E, Levin H, Admoni H, Goldik Z. Intrathecal fentanyl with small-dose dilute bupivacaine: better anesthesia without prolonging recovery. Anesth Analg. 1997;85(3):560-5.
[6]Maves TJ, Gebhart GF. Antinociceptive synergy between intrathecal morphine and lidocaine during visceral and somatic nociception in the rat. Anesthesiol. 1992;76(1):91-9.
[7]Wang C, Chakrabarti MK, Whitwam JG. Specific enhancement by fentanyl of the effects of intrathecal bupivacaine on nociceptive afferent but not on sympathetic efferent pathways in dogs. Anesthesiol. 1993;79(4):766-73.
[8]Penning JP, Yaksh TL. Interaction of intrathecal morphine with bupivacaine and lidocaine in the rat. Anesthesiol. 1992;77(6):1186-2000.
[9]Pöpping DM, Elia N, Wenk M, Tramèr MR. Combination of a reduced dose of an intrathecal local anesthetic with a small dose of an opioid: A meta-analysis of randomized trials. Pain. 2013;154(8):1383-90.
[10]Vaghadia H, Mcleod DH, Mitchell GW, Merrick PM, Chilvers CR. Small-dose hypobaric lidocaine-fentanyl spinal anesthesia for short duration outpatient laparoscopy. I. A randomized comparison with conventional dose hyperbaric lidocaine. Anesth Analg. 1997;84(1):59-64.
[11]Zohar E, Noga Y, Rislick U, Leibovitch I, Fredman B. Intrathecal anesthesia for elderly patients undergoing short transurethral procedures: a dose-finding study. Anesth Analg. 2007;104(3):552-4.
[12]Kim NY, Kim SY, Ju HM, Kil HK. Selective spinal anesthesia using 1 mg of bupivacaine with opioid in elderly patients for transurethral resection of prostate. Yonsei Med J. 2015;56(2):535-42.
[13]Vaghadia H. Spinal anesthesia for outpatients: controversies and new techniques. Can J Anaesth. 1998;45(Suppl 1):R64-75
[14]Liu S, Chiu AA, Carpenter RL, Mulroy MF, Allen HW, Neal JM, et al. Fentanyl prolongs lidocaine spinal anesthesia without prolonging recovery. Anesth Analg. 1995;80(4):730-4.
[15]Pöpping DM, Elia N, Marret E, Wenk M, Tramèr MR. Opioids added to local anesthetics for single-shot intrathecal anesthesia in patients undergoing minor surgery: A meta-analysis of randomized trials. Pain. 2012;153(4):784-93.
[16]Pasero C. Fentanyl for acute pain management. J Peri Anesth Nurs. 2005;20(4):279-84.
[17]Hamber EA, Viscomi CM. Intrathecal lipophilic opioids as adjuncts to surgical spinal anesthesia. Reg Anesth Pain Med. 1999;24(3):255-63.
[18]Kuusniemi KS1, Pihlajamäki KK, Pitkänen MT, Helenius HY, Kirvelä OA. The use of bupivacaine and fentanyl for spinal anesthesia for urologic surgery. Anesth Anal. 2000;91(6):1452-6.