Strabismus surgery under augmented topical anesthesia.

PURPOSE: Recently, topical lidocaine 2% jelly had been used in phacoemulsification and trabeculectomy surgeries. The purpose of this study is to evaluate the efficacy and stability of one-stage adjustable suture using topical lidocaine jelly 2% in combination with intravenous nalbuphine (Nubain). METHODS: Forty adult patients aged 16 to 46 years (median, 24 years) underwent adjustable rectus muscle surgery under topical lidocaine jelly 2% and intravenous 10 mg nalbuphine given 10 minutes before surgery. Adjustment was performed on the operating table before conjunctival closure. The stability of adjustment was studied by comparing the postadjustment deviation to that at 1 day, 1 week, and 3 weeks postoperatively. Success was defined as alignment within 10 prism diopters on distant fixation. Analgesia was assessed using Verbal Description Scale. Changes in vital signs were recorded during surgery to evaluate the oculocardiac reflex. RESULTS: Forty rectus muscles were recessed, 22 muscles were resected, 3 muscles were tucked, and 2 muscles were retrieved. During the operation, 35 patients expressed no pain, 3 patients complained of discomfort, and 2 patients complained of distressing pain and required an additional 10 mg of intravenous nalbuphine. Thirty-eight patients (95%) were successfully aligned during the first postoperative day, 37 patients (92.5%) after 1 week, and 36 patients (90%) after 3 weeks. Intraoperative cardiac monitoring did not record positive oculocardiac reflex in any patient. CONCLUSION: Lidocaine jelly in combination with intravenous nalbuphine is an effective topical anesthesia strategy that provides for the patient's comfort and the surgeon's ability to fine-tune ocular alignment on the operating table.

Antinociceptive effect of a novel long-acting nalbuphine preparation.

BACKGROUND: A long-acting analgesic may be particularly desirable in patients suffering from long-lasting pain. The aim of the study was to evaluate the antinociceptive effect of a novel nalbuphine preparation and to determine its duration of action. METHODS: The antinociceptive effects of i.m. nalbuphine HCl in saline and nalbuphine base in sesame oil were evaluated in rats. The in vitro drug-releasing profiles of nalbuphine HCl and base in different preparations were also evaluated. RESULTS: We found that i.m. nalbuphine HCl 25, 50 and 100 micromol kg(-1) produced dose-related antinociceptive effects with a duration of action of 1.5, 2 and 3 h, respectively. i.m. nalbuphine base 100, 200 and 400 micromol kg(-1) also produced dose-related antinociceptive effects but with longer durations of action: 27, 49 and 55 h, respectively. In vitro studies demonstrated that nalbuphine base in sesame oil had the slowest drug-releasing profile of the different preparations. CONCLUSIONS: i.m. injection of an oil formulation of nalbuphine base produced a long-lasting antinociceptive effect.

Nalbuphine by PCA-pump for analgesia following hysterectomy: bolus application versus continuous infusion with bolus application.

The analgesic properties of the partial agonist-antagonist nalbuphine in the postoperative period are well known. When used for patient-controlled analgesia (PCA) the effectiveness of this substance is comparable to that of morphine or tramadol. However, the optimal programme for administration of nalbuphine in PCA-pumps has not been investigated. In particular, the combination of bolus administration vs bolus administration plus continuous basal administration is disputable. We hypothesized that the administration of an extra basal rate of nalbuphine in addition to the patient- triggered bolus administration and supplemental doses of diclofenac when required, would lead to a significant improvement in analgesia, without affecting the differences in vital signs and side effects. After approvement by the institutional ethics committee, 50 female patients (ASA I or II) scheduled for elective hysterectomy were included in a prospective, single-blinded study and randomized either into bolus-continuous (BC-)group (3 mg base rate/h, 1 mg bolus, 20 min lock out) or bolus (B-)group (no base rate, 1 mg bolus, 10 min lock out). During the observation period (up to 24 h postoperative) vital parameters, extent of analgesia (10-step VAS), and vigilance (5-step scale) were registered. Groups were compared by using unpaired Student t-test. A p<0.05 was considered to be significant. No differences were found in demographic data or vital parameters (MAP, PaO2, PaCO2, respiratory rate, heart rate, peripheral SaO2) during the observation period. Vital parameters showed no pathological changes in any group. With an identical rate of requirement for diclofenac (32 and 36%), analgesia in BC-group showed a decrease in VAS from 4.28+/-2.11 to 2.04+/-1.21 and from 3.64+/-2.20 to 2.08+/-0.96 in B-group. Vigilance was only marginally diminished in both groups. No serious side effects were found in either group. The consumption of nalbuphine (mg) was significantly higher in BC-group (70.28+/-13.85 vs. 47.44+/-22.99;p =0.0002) when compared to B-group. Subjective rating of effectiveness by the patients was similar in both groups. The two administration settings of nalbuphine by PCA pump have shown to be equally effective in the treatment of postoperative pain following hysterectomy. However, as the total amount of nalbuphine was significantly lower in B-group, the use of this administration schedule should be encouraged.

[Peribulbar anesthesia for peroperative and postoperative pain control in eye enucleation or evisceration: 31 cases]. / L'anesthésie péribulbaire pour le contrôle de la douleur per et postopératoire au cours des énucléations ou éviscérations. Trente et un cas.

OBJECTIVES: The aim of this prospective study was to assess peroperative and postoperative analgesia in eye enucleation or evisceration performed under peribulbar anesthesia. PATIENTS AND METHODS: We report 31 patients undergoing an eye enucleation (17 cases) or evisceration (14 cases). The surgical procedure was performed under local anesthesia alone in 22 patients. General anesthesia was associated with local anesthesia in 9 patients. Peribulbar block was achieved with the first insertion of the needle parallel to the inferior orbital floor and the second at level of supraorbital notch. A mixed anesthetic solution of equal quantity of lidocaine 2% with epinephrine (0.25 mg/20 ml) and bupivacaine 0.50% with epinephrine (0.10 mg/20 ml) was injected (total quantity 16.8 +/- 4.3 ml). RESULTS: To assess the peroperative pain we considered the patients with local anesthesia only (22 patients). One of these 22 patients needed one injection (0.50 mg/kg) of propofol for cutting the optic nerve. Surgery was ended without any other drug but that case was considered as a failure. Peroperative analgesia was obtained in 21 of 22 patients (95.4%). To assess analgesia in the postoperative period we included 31 patients. Analgesia was complete from the accomplishment of the peribulbar block to the 4th hour in all patients (efficacy 100%). From the 4th to the 24th hour, pain remained absent in 11 (enucleation 10 cases and evisceration 1 case) of the 31 patients and no drug was used. In 20 patients (enucleation 7 cases and evisceration 13 cases), pain appeared between the 4th and the 10th hour and patients were relieved by paracetamol alone in 14 cases (enucleation 6 cases and evisceration 8 cases) or by its association with nalbuphine in 5 cases (enucleation 1 case and evisceration 4 cases). In one patient (evisceration) the association of the drugs was uneffective. CONCLUSION: Peribulbar anesthesia is safe and generates major postoperative analgesia so we suggest to offer that technique to patients undergoing evisceration or enucleation.

Comparación entre la anestesia local y el bloqueo peridural en plastia inguinal / Comparison between local anesthesia and peridural block used in inguinoplasty

En este estudio se recomienda la anestesia local como procedimiento de elección en la reparación de la hernia inguinal unilateral y no complicada. Se presenta un estudio prospectivo, comparativo y aleatorio en 165 pacientes con hernia inguinal, dividiéndolos en dos grupos: grupo I, 80 pacientes operados con anestesia local; grupo II, 85 pacientes operados bajo bloqueo peridural. Se excluyeron los pacientes con hernia recidivante o complicada. El tiempo anestésico-quirúrgico empleado fue menor en el grupo I, con promedio de 71.5 minutos en comparación al II, que empleó 121.3 minutos en promedio. Las complicaciones fueron menores en el grupo I y la estancia hospitalaria fue significativamente menor en comparación al grupo II. Se considera que la anestesia local en la plastia inguinal unilateral y no complicada debe ser el procedimiento de elección por su buena tolerancia y efectividad, únicamente se requiere experiencia en su uso por parte del cirujano

Influence of ketamine and its interactions with morphine and nalbuphine on the level of enkephalins in some parts of the brain and spinal cord.

The aim of this paper was to study the influence of ketamine in a dose of 80 or 160 mg/kg ip on the level of leu-enkephalin (LENK) or met-enkephalin (MENK) in some parts of the brain and spinal cord, as well as to examine the interaction of ketamine with morphine or nalbuphine on this effect. The influence of ketamine on enkephalins release into the brain perfusate was also studied. Ketamine decreased the spinal cord enkephalins concentration mainly in cervical and lumbar part. These effect was antagonized by naloxone. Ketamine administered in a higher dose increased LENK release, and decreased the release of MENK into the brain perfusate. Morphine (20 mg/kg ip) increased the level of LENK in the hypothalamus, decreased the concentrations of MENK in the medulla oblongata and in the cervical part of the spinal cord, and increased the level of this neuropeptide in the thoracic part of the spinal cord. These effects were antagonized by ketamine. Ketamine and morphine administered simultaneously affected the level of enkephalins in some of the studied parts of the brain and spinal cord. Nalbuphine administered in doses ranging from 1 to 20 mg/kg changed the level of enkephalins in some parts of the central nervous system. Ketamine and nalbuphine administered simultaneously changed the level of enkephalins in the spinal cord and in the hypothalamus. It is concluded that: the decrease of the level of enkephalins in the spinal cord is an evident feature of ketamine action mediated probably by opioid receptors. Ketamine affects the release of LENK and MENK from the brain in a different way.(ABSTRACT TRUNCATED AT 250 WORDS)

Local anesthesia blocks the antiemetic action of P6 acupuncture.

The incidence of postoperative illness was monitored for 6 hours in 74 women premedicated with nalbuphine, 10 mg, and undergoing short gynecologic operations of similar duration under methohexitalnitrous oxide-oxygen anesthesia. Each patient received P6 acupuncture for 5 minutes at the time of administration of premedication. In random order the site of the acupuncture had been previously infiltrated with normal saline solution in half of the patients and 1% lidocaine in the remaining patients. Postoperative emetic sequelae occurred significantly more often in those who received lidocaine compared with the group that received saline solution. This demonstrates the ability of a local anesthetic administered at the point of stimulation to block the antiemetic action of P6 acupuncture in a manner similar to that shown by others for analgesia.

Double-blind comparison of nalbuphine and meperidine in combination with diazepam for intravenous conscious sedation in oral surgery outpatients.

Nalbuphine and meperidine were compared as analgesic components of intravenous conscious sedation in a double-blind, prospective trial of 47 patients undergoing elective oral surgery. Subjects were evaluated for pain intensity, pain relief, anxiety, sedation, recall, and vital signs at systematic observation points intraoperatively and postoperatively. At the conclusion of surgery 83% of patients who had received nalbuphine and 86% of patients treated with meperidine indicated complete pain relief. One observed adverse reaction was attributed to meperidine and another to the sedative component diazepam. No statistically significant differences were observed between nalbuphine and meperidine treatments.

Sedation and pain management during pacemaker implantation, electrophysiologic testing, and related procedures.

A technique for the management of pain and anxiety during pacemaker implantation, electrophysiologic studies, and related procedures is described. The technique involves the intravenous administration of small amounts of the narcotic agonist-antagonist nalbuphine and the benzodiazepine diazepam. The small amounts of medication used induce relaxation while allowing the patient to interact and cooperate during the procedure. The absence of side effects facilitates outpatient treatment. This method of pain management not only improves the quality of patient care but also encourages earlier hospital discharge.