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Biomedical subjects

A Van Steenberge

Publications and source records attributed to A Van Steenberge.

At least 19 recordsLinked to original sources
PubMed1999

A double-blind comparison of 0.125% ropivacaine with sufentanil and 0.125% bupivacaine with sufentanil for epidural labor analgesia.

BACKGROUND: This study intends to evaluate the benefits of the administration of intermittent bolus doses of ropivacaine (0.125%) compared with bupivacaine (0.125%) after addition of sufentanil for analgesia during labor. METHODS: One hundred thirty American Society of Anesthesiologists physical status 1 or 2 parturients were studied. The 90 initial patients were assigned randomly to receive 10 ml bupivacaine, 0.125%, plus 7.5 microg sufentanil (initial bupivacaine 0.125% group) or ropivacaine, 0.125%, plus 7.5 microg sufentanil (ropivacaine 0.125% group). Forty additional patients were recruited and received 0.125% bupivacaine plus 7.5 microg sufentanil (additional bupivacaine 0.125% group) or 0.100% bupivacaine plus 7.5 microg sufentanil (additional bupivacaine 0.100% group). The duration of analgesia, visual analogue scores for pain, motor blockade (using a six-point modified Bromage scale), patient satisfaction scores, nausea, pruritus, heart rate, and blood pressure were recorded. RESULTS: Bupivacaine 0.125% and ropivacaine 0.125% coadministered with sufentanil provided rapid and complete analgesia. Onset of analgesia occurred after +/-15 min and lasted +/-90 min. After the third epidural injection, patients in the ropivacaine group experienced significantly less severe motor blockade than patients in the initial bupivacaine 0.125% group. At this point, 93% of the patients in the ropivacaine group were free from motor impairment versus 66% in the bupivacaine group (P<0.05). Comparable levels of motor blockade were obtained in both additional groups. Patients' evaluation of their analgesia was worst in the bupivacaine 0.100% group. CONCLUSIONS: Ropivacaine 0.125% with sufentanil affords reliable analgesia with minimal motor blockade.

Adult↗
PubMed1999

Intrathecal ropivacaine for ambulatory surgery.

BACKGROUND: The rationale of this study was to evaluate intrathecal ropivacaine for ambulatory surgery. METHODS: One hundred fifty patients with American Society of Anesthesiologists physical status 1 scheduled for knee arthroscopy were studied. Patients were randomly assigned to receive 4 ml of one of five isobaric intrathecal solutions: Patients in group 1 (n = 30) received 8 mg of bupivacaine; patients in group 2 (n = 30) received 8 mg ropivacaine; patients in group 3 (n = 30) received 10 mg ropivacaine; patients in group 4 (n = 30) received 12 mg ropivacaine; and patients in group 5 (n = 30) received 14 mg ropivacaine. The level and duration of sensory anesthesia were recorded along with the intensity and duration of motor block. Patients were interviewed to identify transient neurologic symptoms. RESULTS: Intrathecal ropivacaine 10 mg produced shorter sensory anesthesia and motor blockade than bupivacaine 8mg (152 +/- 44 min and 135 +/- 41 min vs. 181 +/- 44 min and 169 +/- 52 min, mean +/- SD; P < 0.05). However, the quality of intraoperative analgesia was significantly lower in the 10-mg ropivacaine group (P < 0.05). Ropivacaine 12 mg produced sensory and motor block almost comparable to bupivacaine 8 mg. Ropivacaine 14 mg produced sensory and motor block comparable to ropivacaine 12 mg but significantly increased the time to void. No sign of transient radicular irritation were noted. CONCLUSION: Intrathecal ropivacaine 12 mg is approximately equivalent to bupivacaine 8 mg. At this dose, ropivacaine offers no significant advantage compared with bupivacaine.

Aged↗
PubMed1998

Intrathecal clonidine combined with sufentanil for labor analgesia.

BACKGROUND: Intrathecal sufentanil provides rapid-onset and complete analgesia for the first stage of labor. The dose required to produce this effect can be associated with maternal respiratory depression, hypotension, nausea, or pruritus. Because clonidine potentiates the analgesic effects of opioids without increasing their side effects, the authors wanted to determine the efficacy of low doses of intrathecal clonidine (15 and 30 microg) combined with sufentanil. METHODS: Ninety-eight parturient requesting labor analgesia were studied. In a combined spinal-epidural technique, patients were randomly assigned to receive one of the following intrathecal solutions: either 15 microg clonidine (n = 10); 30 microg clonidine (n = 10); 2.5 microg sufentanil (n = 13); 5 microg sufentanil (n = 13); 2.5 microg sufentanil and 15 microg clonidine (n = 13); 2.5 microg sufentanil and 30 microg clonidine (n = 13); 5 microg sufentanil and 15 microg clonidine (n = 13); or 5 microg sufentanil and 30 microg clonidine (n = 13). Visual analog scores for pain, blood pressure, heart rate, sensory levels, incidence of nausea and pruritus, and motor blockade, and maternal and cord blood concentrations of clonidine were recorded. RESULTS: Patients receiving 30 microg intrathecal clonidine with 2.5 or 5 microg intrathecal sufentanil had significantly longer-lasting analgesia (145 +/- 36 and 145 +/- 43 min vs. 104 +/- 35 for those receiving 5 microg intrathecal sufentanil alone). Clonidine levels were undetectable in maternal serum. CONCLUSIONS: Thirty micrograms of intrathecal clonidine combined with 2.5 or 5 microg intrathecal sufentanil significantly increased the duration of analgesia during the first stage of labor without adverse maternal or fetal effects.

Adult↗
PubMed1997

Intravenous regional anesthesia. Evaluation of 4 different additives to prilocaine.

Intravenous regional anesthesia (IVRA) is an effective method of producing anesthesia of the extremities. Disadvantages are the rapid loss of anesthesia after the deflation of the tourniquet and the rapid development of postoperative pain. This study compared the effect of four different additives to prilocaine with saline on the development of a complete sensory block, on the return of sensory function after deflation of the tourniquet and on the development of postoperative pain after IVRA for minor orthopedic surgery of the arm. Seventy-five patients, ASA class 1 or 2, were randomly divided into 5 groups. All patients received 30 ml. of prilocaine 1%, together with 5 ml. of additive. In group 1, the additive was saline, in group 2 bupivacaine 0.25%, in group 3 clonidine 150 micrograms in saline, in group 4 sufentanil 25 micrograms in saline and in group 5 tenoxicam 20 mg. The development of a complete sensory block proved significantly faster in the patients receiving sufentanil (4.8 min.) as compared to plain prilocaine (7.5 min.). The return of the sensory function was comparable for all groups. Postoperative pain scores were significantly better in the clonidine and tenoxicam groups.

Adjuvants, Anesthesia↗
PubMed1993

Does epidural injection of physiological saline facilitate the advancement of catheters?

Seventy patients (ASA I, ASA II), scheduled for a surgical intervention under epidural or combined spinal-epidural anaesthesia, were randomly allocated to one of two groups. The epidural space was identified by loss of resistance using air, followed by injection in Group A (35 patients) of 10 ml of physiological saline directed cephallad and in Group B (35 patients) by no injection. Thereafter an anaesthetist, different to the one who placed the Tuohy in the epidural space, advanced a catheter up to 10 cm into the epidural space. At each cm of advance the resistance was judged. No significant difference in resistance was found between the groups. The authors conclude that the injection of 10 ml of physiological saline into the epidural space does not facilitate the advancement of an epidural catheter.

Adolescent↗
PubMed1991

The effects of the addition of sufentanil to 0.125% bupivacaine on the quality of analgesia during labor and on the incidence of instrumental deliveries.

In a double-blinded, randomized, prospective multi-center study of 695 women, we investigated whether epidural injection of sufentanil added to 0.125% bupivacaine with epinephrine (1:800,000) reduces the total amount of local anesthetic required, resulting in less motor blockade and reduced incidence of instrumental deliveries, and improves the quality of analgesia provided by this low concentration of local anesthetic without jeopardizing the safety of the baby. In addition, other potential benefits of sufentanil (such as decrease in the incidence of shivering) and side effects were examined. It was found that adding incremental doses of 10 micrograms sufentanil up to a maximum of 30 micrograms reduced the incidence of instrumental deliveries from 36 to 24% (P less than 0.01) and significantly improved quality and duration of analgesia without depressing the neurobehavioral status of the baby. No other benefits from adding sufentanil were found. The only side effect that occurred more frequently after sufentanil was pruritus. We conclude that epidural injection of 10-30 micrograms sufentanil added to 0.125% bupivacaine with epinephrine (1:800,000) improved the quality of analgesia during labor and reduced the incidence of instrumental deliveries without jeopardizing the safety of the baby.

Adult↗
PubMed1988

Comparison between propofol and midazolam as sedative agents for surgery under regional anaesthesia.

Propofol (25 patients) or midazolam (25 patients) was used to provide sedation in patients who underwent abdominal or orthopaedic surgery under epidural anaesthesia after intravenous premedication with droperidol 1 mg and fentanyl 20 micrograms. The quality of sedation whilst the block was performed, was assessed as good in 19 patients after propofol 1.49 mg/kg but six patients exhibited uncontrolled movement. Good sedation was provided in 22 patients after midazolam 3 mg. A mean infusion rate of propofol of 1.74 mg/kg/hour resulted in easily controllable sedation during the procedure. Eleven patients given midazolam required no further sedation but a mean of 5.79 mg was needed in the remaining 14 patients; the dose was unpredictable in individual patients. Recovery was significantly more rapid in the propofol group.

Adolescent↗
PubMed1987

Extradural bupivacaine with sufentanil for vaginal delivery. A double-blind trial.

The combination of sufentanil with bupivacaine plus adrenaline given extradurally for pain relief during labour was studied in a double-blind trial. One hundred and twenty patients were randomly divided into three groups and received a 10-ml extradural injection of sufentanil 15 micrograms + bupivacaine 12.5 mg + adrenaline 12.5 micrograms, sufentanil 7.5 micrograms + bupivacaine 12.5 mg + adrenaline 12.5 micrograms, or bupivacaine 12.5 mg + adrenaline 12.5 micrograms (control group). A second injection, which was given upon request, was identical to the first. Subsequently, patients received a further 10 ml of bupivacaine + adrenaline, if required. The addition of sufentanil significantly decreased the latency, and increased the duration, of the analgesia. Moreover, the quality of analgesia was better and less bupivacaine was required, resulting in less motor blockade at delivery. There were no differences between the three groups in regard to Apgar scores. The only side effect of sufentanil was pruritus.

Adult↗
PubMed1987

Sedatives in regional anesthesia.

In regional anesthesia our experience shows that the association of small dose of fentanyl (20 mcg i.v.) and droperidol (1 mg i.v.) with a small dose of benzodiazepine i.v. injected 5' after provides a good sedation during surgery. The choice of the benzodiazepine is based on the duration of anesthesia: midazolam (1.5 or 3 mg i.v.) in anesthesia with a duration less or equal to 1 h 30'; flunitrazepam (0.2 mg or 0.4 mg i.v.) in anesthesia with a duration longer than 1 h 30'.

Adjuvants, Anesthesia↗
PubMedDate not supplied

Ambulatory combined spinal-epidural analgesia for labor. Influence of epinephrine on bupivacaine-sufentanil combination.

BACKGROUND AND OBJECTIVES: Subarachnoid sufentanil 5 micrograms during labor is known to have variable results. However, subarachnoid sufentanil 5 micrograms plus bupivacaine 1 mg provides good quality labor analgesia of 100 minutes' average duration. The objective of this study was to examine the effects of adding epinephrine 25 micrograms to this mixture. METHODS: Forty-two parturients with less than 5 cm cervical dilation participated in this double-blind, randomized study. A combined spinal-epidural technique was used for subarachnoid administration of sufentanil 5 micrograms and bupivacaine 1 mg with or without epinephrine 25 micrograms. Analgesia was assessed by visual analog scores. Time elapsed until first request for additional analgesia, blood pressure, heart rate, sensory levels, motor block, and incidence of pruritus, nausea, and sedation were noted. RESULTS: Addition of epinephrine prolonged the duration of analgesia from 103.8 +/- 28.2 minutes to 142 +/- 54.3 minutes and lowered the median cephalad level of sensory block from T3 to T6. The incidence of side effects was similar in both groups, as was the motor performance; 19 patients were able to ambulate in each group. CONCLUSIONS: This minimal bupivacaine-sufentanil-epinephrine mixture allows high-quality analgesia of 142 +/- 54.3 minutes' duration, with a low sensory block level and no motor block. However, hypotension can occur as a late side effect.

Adrenergic alpha-Agonists↗
PubMedDate not supplied

Guillain-Barre syndrome after obstetrical epidural analgesia.

Guillain Barre Syndrome (GBS) occurred 24 hours post-partum following an obstetrical epidural anesthetic (OEA) procedure. Clinical diagnosis was confirmed by cerebrospinal fluid (CSF) findings and nerve conduction velocity studies. GBS is an immune mediated process. Because of short latency between the onset of symptoms and the performance of the epidural block, a cause and effect relationship between epidural block and GBS in this patient is unlikely.

Adult↗