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AJAICAJAIC-Vol. (10
(10)
2007
10) No. 1 Marsh 2007
AJAICAJAIC-Vol. (10
(10)
2007
10) No. 1 Marsh 2007
AJAICAJAIC-Vol. (10
(10)
2007
10) No. 1 Marsh 2007
Table I: Patient characteristics, surgical procedures, blood loss, fluid replacement and
urine output
Group I
(Bupivacaine 0.125%)
(n = 20)
14/6
5411
6913
1689
AJAICAJAIC-Vol. (10
(10)
2007
10) No. 1 Marsh 2007
Group II
(Bupivacaine 0.25%)
(n =20)
15/5
5316
6811
1707
1
16
3
371114
459167
16
2
2
1030483
1246474*
1000500
640390
1000500
4,5602,660
Group II
(bupivacaine 0.25%)
(n= 20)
Epidural site:
T 10-11
7
6
T 11-12
13
14
Loss of sensation to cold
T 5 (T4-T10)
T4 (T3-T9)
Loss of sensation to pinprick
T5 (T4-T11)
T4 (T4-T10)
Loss of sensation to touch
T 8 (T6-T12)
T 6 (T4-T12)*
Base-line CVP (mmHg)
93
9 4
Base-line HR (beat/min)
7614
7716
Base-line mean BP (mm Hg)
7916
7615
Base-line BIS
96.80.7
97.20.8
Data are presented as mean (SD), absolute number or median (10th, 90th percentiles).
*P<0.05 between two groups
Table III: Anesthetic induction and recovery and total requirements of propofol and
fentanyl.
Group I
Group II
(bupivacaine 0.125%)
(bupivacaine 0.25%)
(n= 20)
(n= 20)
T1: Loss of lash reflex (s)
66 16
6411
T2: Return of gag reflex (s)
498112
501120
T3: Verbal command (s)
528134
534137
Total IV propofol (mg)
14252
11324*
Total IV fentanyl (g)
412310
24640**
Data are presented as mean (SD). *P<0.05 , **P<0.001
AJAICAJAIC-Vol. (10
(10)
2007
10) No. 1 Marsh 2007
Table IV: BIS, FISEVO and E'SEVO, SBP, HR and dose of ephedrine during surgery
Group I
(bupivac. 0.125%)
(n= 20)
47.12.3
3.42.4
1.410.36*
0.190.31*
1.220.33*
0.130.07*
98.815.7
7.95.7
70.314.5
5.24.6
8.87.9
Group II
(bupivac, 0.25%)
(n= 20)
44.72.2
3.73.1
1.130.34
0.120.23
0.890.19
0.070.04
95.913.6
6.65.1
68.110.4
6.15.8
21.311.3**
Mean BIS
Change in BIS (/5 min)
Mean FISEVO (%)
Change in FISEVO (% /5 min)
Mean E'SEVO (%)
Change in E'SEVO (% /5 min)
Mean SBP (mm Hg)
Change in SBP (mm Hg /5 min)
Mean HR (beats min1)
Change in HR (beats/5min)
Dose of ephedrine (mg)
Data are presented as mean (SD).
Mean BIS, FISEVO, E'SEVO, SBP, and HR reflect the average of corresponding values recorded
every 5 min for the first 2 h during surgery. Changes in BIS, FISEVO, E'SEVO and SBP were
calculated from the absolute values of the changes in respective values every 5 min.
*P<0.05 between groups, **P<0.001
Table V: Changes in serum epinephrine and Cortisone in both groups
Parameters
Group I
Group II
Serum Epinephrine (pg/ml):
0 hr (baseline value)
20.93.3
20.63.6
After 1 hr
63.59.7*
36.88.9*
After 2 hr
61.99.8*
33.38.3*
Serum Cortisone (g/ml):
0 hr (baseline value)
24.14.2
23.74.1
After 1 hr
75.613.6*
40.89.8*
After 2 hr
84.414.3*
44.99.7*
P is significant in group I compared to group II. * P is significant related to baseline values
in both groups
70
60
50
40
group I
30
group II
20
10
0
0 hr
1 hr
2 hr
90
80
70
60
50
40
30
20
10
0
group I
group II
0 hr
1 hr
2 hr
and cortisone (
g/ml) in both groups
AJAICAJAIC-Vol. (10
(10)
2007
10) No. 1 Marsh 2007
Table VI: VAS (Visual Analogue Scale) in the two groups after surgery
Group I
(bupivac. 0.125%)
(n= 20)
2.9 1.1
2.9 1.8
3.2 2.1
2.9 1.9
2. 41.1
100%
11.43.7
2.30.6
VAS 0
VAS 2
VAS 6
VAS 12
VAS 24
Patients satisfaction
Time of first bolus [(h)SD]
Total number of bolus doses
Group II
(bupivac. 0.25%)
(n= 20)
2.8 1.0
2.8 1.6
3.3 2.4
2.7 1.8
2.31.2
100%
11.13.4
2.40.4
Table VII: Side effects, time of first bolus dose, number of bolus dose and patient
satisfaction score in the two groups
Nausea/Vomiting [n (%)]
Pruritus [n (%)]
Respiratory depression [n (%)]
Patient satisfaction score (range)
Group I
(bupivac. 0.125%)
(n= 20)
4 (20)
1 (5%)
0 (0)
9.2 (8-10)
DISCUSSION
The
key
pathogenic
factor
in
postoperative morbidity is the surgical
stress response with its potential for
multiorgan damage(12). Thoracic epidural
anesthesia (TEA) significantly dampens the
stress response, and relieves the
postoperative pain. In contrast to lumbar
epidural analgesia, TEA, aimed at placing
the tip of the catheter at the dermatomal
midpoint of the surgical incision, allows the
use of small amounts of opioids and
concentrated local anesthetic. It offers
maximal sympathetic blockade of the heart
and bowel, which promotes coronary
perfusion and gastrointestinal motility, and
provides freedom from lower extremity
motor blockade and opioid-induced side
effects(13). Moreover, in upper-abdominal
surgery, there could be additional routes of
transmission of noxious stimuli to the CNS
through the phrenic nerve and the vagus
nerve(14,15), which almost need very high
doses of opioids in case of giving general
anesthesia without neuraxial block. These
observations were obvious from the results
of 0.25% group II of the present study,
where the total requirements of fentanyl and
Group II
(bupivac. 0.25%)
(n= 20)
3 (15)
0 (0)
0 (0)
9.3 (8-10)
AJAICAJAIC-Vol. (10
(10)
2007
10) No. 1 Marsh 2007
AJAICAJAIC-Vol. (10
(10)
2007
10) No. 1 Marsh 2007
1. Carlos
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3.
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AJAICAJAIC-Vol. (10
(10)
2007
10) No. 1 Marsh 2007
10
AJAICAJAIC-Vol. (10
(10)
2007
10) No. 1 Marsh 2007