Combinations of bupivacaine, fentanyl, and clonidine for lumbar epidural postoperative analgesia: A novel optimization procedure
The authors developed and applied a method to optimize the combination of bupivacaine, fentanyl, and clonidine for continuous postoperative lumbar epidural analgesia. One hundred eighteen patients undergoing knee or hip surgery participated in the study. Postoperative epidural analgesia during 48 h...
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| Veröffentlicht in: | Anesthesiology (Philadelphia) 2004-12, Vol.101 (6), p.1381-1393 |
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| creator | SVETICIC, Gorazd GENTILINI, Andrea EICHENBERGER, Urs ZANDERIGO, Eleonora SARTORI, Valentina LUGINBÜHL CURATOLO, Michele |
| description | The authors developed and applied a method to optimize the combination of bupivacaine, fentanyl, and clonidine for continuous postoperative lumbar epidural analgesia.
One hundred eighteen patients undergoing knee or hip surgery participated in the study. Postoperative epidural analgesia during 48 h after surgery was optimized under restrictions dictated by side effects. Initially, eight combinations of bupivacaine, fentanyl, and clonidine (expressed as drug concentration in the solution administered) were empirically chosen and investigated. To determine subsequent combinations, an optimization model was applied until three consecutive steps showed no decrease in pain score. For the first time in a clinical investigation, a regression model was applied when the optimization procedure led to combinations associated with unacceptable side effects.
The authors analyzed 12 combinations with an allowed bupivacaine concentration range of 0-2.5 mg/ml, a fentanyl concentration range of 0-5 microg/ml, and a clonidine concentration range of 0-5 microg/ml. The best combinations of bupivacaine, fentanyl, and clonidine concentrations were 1.0 mg/ml-1.4 microg/ml-0.5 microg/ml, 0.9 mg/ml-3.0 microg/ml-0.3 microg/ml, 0.6 mg/ml-2.5 microg/ml-0.8 microg/ml, and 1.0 mg/ml-2.4 microg/ml-1.0 microg/ml, respectively, all producing a similarly low pain score. The incidence of side effects was low. The application of the regression model to combinations associated with high incidence of motor block successfully directed the optimization procedure to combinations within the therapeutic range.
The results support further study of the combinations of bupivacaine, fentanyl, and clonidine mentioned above for postoperative analgesia after knee and hip surgery. This novel optimization method may be useful in clinical research. |
| doi_str_mv | 10.1097/00000542-200412000-00019 |
| format | Article |
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One hundred eighteen patients undergoing knee or hip surgery participated in the study. Postoperative epidural analgesia during 48 h after surgery was optimized under restrictions dictated by side effects. Initially, eight combinations of bupivacaine, fentanyl, and clonidine (expressed as drug concentration in the solution administered) were empirically chosen and investigated. To determine subsequent combinations, an optimization model was applied until three consecutive steps showed no decrease in pain score. For the first time in a clinical investigation, a regression model was applied when the optimization procedure led to combinations associated with unacceptable side effects.
The authors analyzed 12 combinations with an allowed bupivacaine concentration range of 0-2.5 mg/ml, a fentanyl concentration range of 0-5 microg/ml, and a clonidine concentration range of 0-5 microg/ml. The best combinations of bupivacaine, fentanyl, and clonidine concentrations were 1.0 mg/ml-1.4 microg/ml-0.5 microg/ml, 0.9 mg/ml-3.0 microg/ml-0.3 microg/ml, 0.6 mg/ml-2.5 microg/ml-0.8 microg/ml, and 1.0 mg/ml-2.4 microg/ml-1.0 microg/ml, respectively, all producing a similarly low pain score. The incidence of side effects was low. The application of the regression model to combinations associated with high incidence of motor block successfully directed the optimization procedure to combinations within the therapeutic range.
The results support further study of the combinations of bupivacaine, fentanyl, and clonidine mentioned above for postoperative analgesia after knee and hip surgery. This novel optimization method may be useful in clinical research.</description><identifier>ISSN: 0003-3022</identifier><identifier>EISSN: 1528-1175</identifier><identifier>DOI: 10.1097/00000542-200412000-00019</identifier><identifier>PMID: 15564946</identifier><identifier>CODEN: ANESAV</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott</publisher><subject><![CDATA[Adolescent ; Adrenergic alpha-Agonists - administration & dosage ; Adrenergic alpha-Agonists - adverse effects ; Adrenergic alpha-Agonists - therapeutic use ; Adult ; Aged ; Aged, 80 and over ; Analgesia, Epidural - adverse effects ; Analgesics, Opioid - administration & dosage ; Analgesics, Opioid - adverse effects ; Analgesics, Opioid - therapeutic use ; Anesthesia ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Anesthetics, Local - administration & dosage ; Anesthetics, Local - adverse effects ; Anesthetics, Local - therapeutic use ; Biological and medical sciences ; Bupivacaine - administration & dosage ; Bupivacaine - adverse effects ; Bupivacaine - therapeutic use ; Clonidine - administration & dosage ; Clonidine - adverse effects ; Clonidine - therapeutic use ; Drug Combinations ; Female ; Fentanyl - administration & dosage ; Fentanyl - adverse effects ; Fentanyl - therapeutic use ; Hip - surgery ; Humans ; Knee - surgery ; Male ; Medical sciences ; Middle Aged ; Models, Statistical ; Nerve Block ; Orthopedic Procedures ; Pain Measurement - drug effects ; Pain, Postoperative - drug therapy ; Regression Analysis]]></subject><ispartof>Anesthesiology (Philadelphia), 2004-12, Vol.101 (6), p.1381-1393</ispartof><rights>2005 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=16312017$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15564946$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>SVETICIC, Gorazd</creatorcontrib><creatorcontrib>GENTILINI, Andrea</creatorcontrib><creatorcontrib>EICHENBERGER, Urs</creatorcontrib><creatorcontrib>ZANDERIGO, Eleonora</creatorcontrib><creatorcontrib>SARTORI, Valentina</creatorcontrib><creatorcontrib>LUGINBÜHL</creatorcontrib><creatorcontrib>CURATOLO, Michele</creatorcontrib><title>Combinations of bupivacaine, fentanyl, and clonidine for lumbar epidural postoperative analgesia: A novel optimization procedure</title><title>Anesthesiology (Philadelphia)</title><addtitle>Anesthesiology</addtitle><description>The authors developed and applied a method to optimize the combination of bupivacaine, fentanyl, and clonidine for continuous postoperative lumbar epidural analgesia.
One hundred eighteen patients undergoing knee or hip surgery participated in the study. Postoperative epidural analgesia during 48 h after surgery was optimized under restrictions dictated by side effects. Initially, eight combinations of bupivacaine, fentanyl, and clonidine (expressed as drug concentration in the solution administered) were empirically chosen and investigated. To determine subsequent combinations, an optimization model was applied until three consecutive steps showed no decrease in pain score. For the first time in a clinical investigation, a regression model was applied when the optimization procedure led to combinations associated with unacceptable side effects.
The authors analyzed 12 combinations with an allowed bupivacaine concentration range of 0-2.5 mg/ml, a fentanyl concentration range of 0-5 microg/ml, and a clonidine concentration range of 0-5 microg/ml. The best combinations of bupivacaine, fentanyl, and clonidine concentrations were 1.0 mg/ml-1.4 microg/ml-0.5 microg/ml, 0.9 mg/ml-3.0 microg/ml-0.3 microg/ml, 0.6 mg/ml-2.5 microg/ml-0.8 microg/ml, and 1.0 mg/ml-2.4 microg/ml-1.0 microg/ml, respectively, all producing a similarly low pain score. The incidence of side effects was low. The application of the regression model to combinations associated with high incidence of motor block successfully directed the optimization procedure to combinations within the therapeutic range.
The results support further study of the combinations of bupivacaine, fentanyl, and clonidine mentioned above for postoperative analgesia after knee and hip surgery. This novel optimization method may be useful in clinical research.</description><subject>Adolescent</subject><subject>Adrenergic alpha-Agonists - administration & dosage</subject><subject>Adrenergic alpha-Agonists - adverse effects</subject><subject>Adrenergic alpha-Agonists - therapeutic use</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Analgesia, Epidural - adverse effects</subject><subject>Analgesics, Opioid - administration & dosage</subject><subject>Analgesics, Opioid - adverse effects</subject><subject>Analgesics, Opioid - therapeutic use</subject><subject>Anesthesia</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Anesthetics, Local - administration & dosage</subject><subject>Anesthetics, Local - adverse effects</subject><subject>Anesthetics, Local - therapeutic use</subject><subject>Biological and medical sciences</subject><subject>Bupivacaine - administration & dosage</subject><subject>Bupivacaine - adverse effects</subject><subject>Bupivacaine - therapeutic use</subject><subject>Clonidine - administration & dosage</subject><subject>Clonidine - adverse effects</subject><subject>Clonidine - therapeutic use</subject><subject>Drug Combinations</subject><subject>Female</subject><subject>Fentanyl - administration & dosage</subject><subject>Fentanyl - adverse effects</subject><subject>Fentanyl - therapeutic use</subject><subject>Hip - surgery</subject><subject>Humans</subject><subject>Knee - surgery</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Models, Statistical</subject><subject>Nerve Block</subject><subject>Orthopedic Procedures</subject><subject>Pain Measurement - drug effects</subject><subject>Pain, Postoperative - drug therapy</subject><subject>Regression Analysis</subject><issn>0003-3022</issn><issn>1528-1175</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2004</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkFtLxDAQhYMoul7-guTFt63m0rSpb8viDQRf9LlM24lE2qQk3YX1yZ9uVlc3kBkyOecMfIRQzq45q8obtj0qF5lgLOepsCxdXh2QGVdCZ5yX6pDM0kxmkglxQk5j_EjPUkl9TE64UkVe5cWMfC390FgHk_UuUm9osxrtGlqwDufUoJvAbfo5BdfRtvfOdumDGh9ovxoaCBRH260C9HT0cfIjhhS1xqSH_h2jhVu6oM6vsad-nOxgP39W0TH4FpMRz8mRgT7ixa6fkbf7u9flY_b88vC0XDxnrdDFlOVGSiVRaI3AC12wCoTMRdWBKBrQEtAIVBXTHMttUa1hXWcAKoOGcS3PiP7NbYOPMaCpx2AHCJuas3oLtf6DWv9DrX-gJuvlr3VcNQN2e-OOYhJc7QQQW-hNANfauNcVMsXxUn4DVXKCBQ</recordid><startdate>20041201</startdate><enddate>20041201</enddate><creator>SVETICIC, Gorazd</creator><creator>GENTILINI, Andrea</creator><creator>EICHENBERGER, Urs</creator><creator>ZANDERIGO, Eleonora</creator><creator>SARTORI, Valentina</creator><creator>LUGINBÜHL</creator><creator>CURATOLO, Michele</creator><general>Lippincott</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope></search><sort><creationdate>20041201</creationdate><title>Combinations of bupivacaine, fentanyl, and clonidine for lumbar epidural postoperative analgesia: A novel optimization procedure</title><author>SVETICIC, Gorazd ; GENTILINI, Andrea ; EICHENBERGER, Urs ; ZANDERIGO, Eleonora ; SARTORI, Valentina ; LUGINBÜHL ; CURATOLO, Michele</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c286t-4f3353e288ea168609a23429da26ba83aef2e59081e7081e5cf0ddfaa9fef0183</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2004</creationdate><topic>Adolescent</topic><topic>Adrenergic alpha-Agonists - administration & dosage</topic><topic>Adrenergic alpha-Agonists - adverse effects</topic><topic>Adrenergic alpha-Agonists - therapeutic use</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Analgesia, Epidural - adverse effects</topic><topic>Analgesics, Opioid - administration & dosage</topic><topic>Analgesics, Opioid - adverse effects</topic><topic>Analgesics, Opioid - therapeutic use</topic><topic>Anesthesia</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Anesthetics, Local - administration & dosage</topic><topic>Anesthetics, Local - adverse effects</topic><topic>Anesthetics, Local - therapeutic use</topic><topic>Biological and medical sciences</topic><topic>Bupivacaine - administration & dosage</topic><topic>Bupivacaine - adverse effects</topic><topic>Bupivacaine - therapeutic use</topic><topic>Clonidine - administration & dosage</topic><topic>Clonidine - adverse effects</topic><topic>Clonidine - therapeutic use</topic><topic>Drug Combinations</topic><topic>Female</topic><topic>Fentanyl - administration & dosage</topic><topic>Fentanyl - adverse effects</topic><topic>Fentanyl - therapeutic use</topic><topic>Hip - surgery</topic><topic>Humans</topic><topic>Knee - surgery</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Models, Statistical</topic><topic>Nerve Block</topic><topic>Orthopedic Procedures</topic><topic>Pain Measurement - drug effects</topic><topic>Pain, Postoperative - drug therapy</topic><topic>Regression Analysis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>SVETICIC, Gorazd</creatorcontrib><creatorcontrib>GENTILINI, Andrea</creatorcontrib><creatorcontrib>EICHENBERGER, Urs</creatorcontrib><creatorcontrib>ZANDERIGO, Eleonora</creatorcontrib><creatorcontrib>SARTORI, Valentina</creatorcontrib><creatorcontrib>LUGINBÜHL</creatorcontrib><creatorcontrib>CURATOLO, Michele</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><jtitle>Anesthesiology (Philadelphia)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>SVETICIC, Gorazd</au><au>GENTILINI, Andrea</au><au>EICHENBERGER, Urs</au><au>ZANDERIGO, Eleonora</au><au>SARTORI, Valentina</au><au>LUGINBÜHL</au><au>CURATOLO, Michele</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Combinations of bupivacaine, fentanyl, and clonidine for lumbar epidural postoperative analgesia: A novel optimization procedure</atitle><jtitle>Anesthesiology (Philadelphia)</jtitle><addtitle>Anesthesiology</addtitle><date>2004-12-01</date><risdate>2004</risdate><volume>101</volume><issue>6</issue><spage>1381</spage><epage>1393</epage><pages>1381-1393</pages><issn>0003-3022</issn><eissn>1528-1175</eissn><coden>ANESAV</coden><abstract>The authors developed and applied a method to optimize the combination of bupivacaine, fentanyl, and clonidine for continuous postoperative lumbar epidural analgesia.
One hundred eighteen patients undergoing knee or hip surgery participated in the study. Postoperative epidural analgesia during 48 h after surgery was optimized under restrictions dictated by side effects. Initially, eight combinations of bupivacaine, fentanyl, and clonidine (expressed as drug concentration in the solution administered) were empirically chosen and investigated. To determine subsequent combinations, an optimization model was applied until three consecutive steps showed no decrease in pain score. For the first time in a clinical investigation, a regression model was applied when the optimization procedure led to combinations associated with unacceptable side effects.
The authors analyzed 12 combinations with an allowed bupivacaine concentration range of 0-2.5 mg/ml, a fentanyl concentration range of 0-5 microg/ml, and a clonidine concentration range of 0-5 microg/ml. The best combinations of bupivacaine, fentanyl, and clonidine concentrations were 1.0 mg/ml-1.4 microg/ml-0.5 microg/ml, 0.9 mg/ml-3.0 microg/ml-0.3 microg/ml, 0.6 mg/ml-2.5 microg/ml-0.8 microg/ml, and 1.0 mg/ml-2.4 microg/ml-1.0 microg/ml, respectively, all producing a similarly low pain score. The incidence of side effects was low. The application of the regression model to combinations associated with high incidence of motor block successfully directed the optimization procedure to combinations within the therapeutic range.
The results support further study of the combinations of bupivacaine, fentanyl, and clonidine mentioned above for postoperative analgesia after knee and hip surgery. This novel optimization method may be useful in clinical research.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott</pub><pmid>15564946</pmid><doi>10.1097/00000542-200412000-00019</doi><tpages>13</tpages></addata></record> |
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| subjects | Adolescent Adrenergic alpha-Agonists - administration & dosage Adrenergic alpha-Agonists - adverse effects Adrenergic alpha-Agonists - therapeutic use Adult Aged Aged, 80 and over Analgesia, Epidural - adverse effects Analgesics, Opioid - administration & dosage Analgesics, Opioid - adverse effects Analgesics, Opioid - therapeutic use Anesthesia Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Anesthetics, Local - administration & dosage Anesthetics, Local - adverse effects Anesthetics, Local - therapeutic use Biological and medical sciences Bupivacaine - administration & dosage Bupivacaine - adverse effects Bupivacaine - therapeutic use Clonidine - administration & dosage Clonidine - adverse effects Clonidine - therapeutic use Drug Combinations Female Fentanyl - administration & dosage Fentanyl - adverse effects Fentanyl - therapeutic use Hip - surgery Humans Knee - surgery Male Medical sciences Middle Aged Models, Statistical Nerve Block Orthopedic Procedures Pain Measurement - drug effects Pain, Postoperative - drug therapy Regression Analysis |
| title | Combinations of bupivacaine, fentanyl, and clonidine for lumbar epidural postoperative analgesia: A novel optimization procedure |
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