The effect of epidural bupivacaine on induction and maintenance doses of propofol (evaluated by bispectral index) and maintenance doses of fentanyl and vecuronium
Language: 
English
Abstract: 

The growing interest in combining local and general anesthesia has led to studies investigating possible interactions between general anesthesia and local anesthetics administered via spinal, epidural, IV, or IM routes. However, no study has evaluated the effect of local anesthetics on all three components of balanced anesthesia, i.e., hypnosis, analgesia, and muscle relaxation. In this prospective, randomized, double-blind study, we investigated the effect of epidural bupivacaine on the dose requirement of propofol (as evaluated by using the bispectral index [BIS]), fentanyl, and vecuronium for general anesthesia. This study consisted of 30 adults, ASA physical status I and II, undergoing Whipple's pancreaticoduodenectomy for periampullary carcinoma lasting >4 h. An epidural catheter was placed between T9-10. Depending on the group allocation, 10 mL of the study drug was administered as a bolus followed by an infusion at 6 mL/h via the epidural catheter. Patients were divided into 2 groups of 15 each. Patients in the control group received epidural normal saline whereas those in the bupivacaine group received epidural bupivacaine 0.1%. Induction of anesthesia was performed with IV fentanyl 2 mug/kg and propofol titrated to achieve BIS between 40-50. Endotracheal intubation was facilitated by the IV administration of vecuronium 0.1 mg/kg and patient's lungs were ventilated with 66% nitrous oxide in oxygen. After intubation, infusion of propofol 1% was titrated to maintain BIS between 40-50. Inadequate analgesia was defined as an increase in systolic blood pressure and/or heart rate by >20% of baseline values in response to surgical stimulus and was treated with bolus fentanyl 0.5 mug/kg. Neuromuscular monitoring was used to assess the need for additional doses of vecuronium. Data were analyzed by using the Student's t-test and P </= 0.05 was considered significant. The requirement of propofol for induction and maintenance of anesthesia in the bupivacaine group was 1.3 +/- 0.3 mg/kg and 2.4 +/- 0.9 mg . kg(-1) . h(-1), respectively, compared with 2.4 +/- 0.6 mg/kg and 4.4 +/- 1.6 mg . kg(-1) . h(-1) observed in the control group (P < 0.05). Significant reduction was also observed in the requirement of vecuronium and fentanyl during maintenance in the bupivacaine group (P < 0.05). We conclude that epidural bupivacaine given before induction of anesthesia reduces the requirement of propofol, fentanyl, and vecuronium during general anesthesia.

Author(s): 
Agarwal, Anil
Pandey, Ravindra
Dhiraaj, Sanjay
Singh, Prabhat K.
Raza, Mehdi
Pandey, Chandra K.
Gupta, Devendra
Choudhury, Arindam
Singh, Uttam
Item Type: 
Journal Article
Publication Title: 
Anesthesia and Analgesia
Journal Abbreviation: 
Anesth. Analg.
Publication Date: 
12/4/2015
Publication Year: 
2004
Pages: 
1684-1688, table of contents
Volume: 
99
Issue: 
6
ISSN: 
0003-2999
DOI: 
10.1213/01.ANE.0000136422.70531.5A
Library Catalog: 
PubMed
Extra: 
PMID: 15562054

Turabian/Chicago Citation

Anil Agarwal, Ravindra Pandey, Sanjay Dhiraaj, Prabhat K. Singh, Mehdi Raza, Chandra K. Pandey, Devendra Gupta, Arindam Choudhury and Uttam Singh. 12/4/2015. "The effect of epidural bupivacaine on induction and maintenance doses of propofol (evaluated by bispectral index) and maintenance doses of fentanyl and vecuronium." Anesthesia and Analgesia 99: 6: 1684-1688, table of contents. 10.1213/01.ANE.0000136422.70531.5A.

Wikipedia Citation

<ref> {{Cite journal | doi = 10.1213/01.ANE.0000136422.70531.5A | issn = 0003-2999 | volume = 99 | pages = 1684-1688, table of contents | last = Agarwal | first = Anil | coauthors = Pandey, Ravindra, Dhiraaj, Sanjay, Singh, Prabhat K., Raza, Mehdi, Pandey, Chandra K., Gupta, Devendra, Choudhury, Arindam, Singh, Uttam | title = The effect of epidural bupivacaine on induction and maintenance doses of propofol (evaluated by bispectral index) and maintenance doses of fentanyl and vecuronium | journal = Anesthesia and Analgesia | date = 12/4/2015 | pmid = | pmc = }} </ref>