THE EFFECT OF TRANSDERMAL NITROGLYCERINE ON ANALGESIC EFFECT OF INTRATHECAL SUFENTANIL IN LOWER EXTREMITY SURGERY
Abstract
Introduction: Sufentanil is a potent but short-acting analgesic that used intrathecally to manage postoperative pain. The goal of study is determining the effect of transdermal nitroglycerine on duration of analgesic effect of spinal sufentanil in lower extremity surgery .
Methods and Material: In a clinical trial study with convenience sampling ASA (I), ASA(II)patients in 18 -65 old -age condidated for lower extremity surgery in Isfahan st. AlZAHRA medical center in 2001-2002 were randomized to one of four groups. (each group contains ten patients) Patients received 15 mg bupivacaine 0.5% plus 2ml of the test drug intrathecally (saline or 10 mic.gram sufentanil). 30 min after the spinal puncture, a transdermal patch of either 5mg nitroglycerinor placebo was applied. The control group (A) received spinal saline and transdermal placebo. The sufentanil group (B) received spinal sufentanil and transdermal placebo. The nitroglycerine group (C) received spinal saline and transdermal nitroglycerine patch. Finally, the sufentanil-nitroglycerine group (D) received spinal sufentanil and transdermal nitroglycerine. Pain was evaluated using a 10 - cm visual analog scale. Results were analyzed by ANOVA and chi-square tests.
Results:
1- The four groups showed no differences regarding ASA, gender, age, weight and height .(P>0.05)
2- Mean and standard deviation of painless time in (B) group (268.5 ±59.7 min) and (D) group (297.7±43.8 min) was longer compared with (A) group (246.3±4.1 min ). (P<0.05)
3- There is no differences regarding mean and standard deviation of painless time between:
a) (C) group (218.5 ± 52.9 min) and (A) group (246.3 ± 44.1). (P>0.05)
b) (D) group (297.7 ± 43.8 min) and (B) group (268.5 ± 59.7min). (P>0.05)
c) (C) group (218.5 ± 52.9 min) and (B) group (268.5 ± 59.7 min). (P>0.05)
4- Mean and standard deviation of painless time in (D) group (297.7 + 43.8 min) was longer compard with (C)group (218.5 ± 52.9in). (P<0.05)
5-Mean and standard deviation of the pain VAS score was similar among (A) group (7.5±1) , (B) group (8 ±0.8), (C) group (7.2 ± 0.78) and (D) group (8 ±0.66). (P>0.05)
6- Mean and standard deviation of changes mean blood pressure 5,10,20,30,40,50,60 min after the spinal injection were also the same in all groups. (P>0.05)
In this study, respiratory arrest and decrease of consciousness (complicatications of intrathecal opiate) was not seen.
Conclusion: In the same previus study in Brazil show that transdermal nitroglycerine significantly prolonged the analgsic effect of spinal sufentani (10)
This study was performed in minor operation. (Arthroscopy) (10) That did not cause sever tissue trauma and postoperative pain.(2) (10) Our study showed that: Transdermal nitroglycerine has no effect on prolongation of analgesic effect of intrathecal sufentanil. Our study performed in patients with osseous fracture that can cause sever tissue trauma and postoperative pain. (probably reason for this difference) Also, our study showed that: Transdermal nitroglycerine alone (5mg/day) did not result in postoperative analgesia itself.
Methods and Material: In a clinical trial study with convenience sampling ASA (I), ASA(II)patients in 18 -65 old -age condidated for lower extremity surgery in Isfahan st. AlZAHRA medical center in 2001-2002 were randomized to one of four groups. (each group contains ten patients) Patients received 15 mg bupivacaine 0.5% plus 2ml of the test drug intrathecally (saline or 10 mic.gram sufentanil). 30 min after the spinal puncture, a transdermal patch of either 5mg nitroglycerinor placebo was applied. The control group (A) received spinal saline and transdermal placebo. The sufentanil group (B) received spinal sufentanil and transdermal placebo. The nitroglycerine group (C) received spinal saline and transdermal nitroglycerine patch. Finally, the sufentanil-nitroglycerine group (D) received spinal sufentanil and transdermal nitroglycerine. Pain was evaluated using a 10 - cm visual analog scale. Results were analyzed by ANOVA and chi-square tests.
Results:
1- The four groups showed no differences regarding ASA, gender, age, weight and height .(P>0.05)
2- Mean and standard deviation of painless time in (B) group (268.5 ±59.7 min) and (D) group (297.7±43.8 min) was longer compared with (A) group (246.3±4.1 min ). (P<0.05)
3- There is no differences regarding mean and standard deviation of painless time between:
a) (C) group (218.5 ± 52.9 min) and (A) group (246.3 ± 44.1). (P>0.05)
b) (D) group (297.7 ± 43.8 min) and (B) group (268.5 ± 59.7min). (P>0.05)
c) (C) group (218.5 ± 52.9 min) and (B) group (268.5 ± 59.7 min). (P>0.05)
4- Mean and standard deviation of painless time in (D) group (297.7 + 43.8 min) was longer compard with (C)group (218.5 ± 52.9in). (P<0.05)
5-Mean and standard deviation of the pain VAS score was similar among (A) group (7.5±1) , (B) group (8 ±0.8), (C) group (7.2 ± 0.78) and (D) group (8 ±0.66). (P>0.05)
6- Mean and standard deviation of changes mean blood pressure 5,10,20,30,40,50,60 min after the spinal injection were also the same in all groups. (P>0.05)
In this study, respiratory arrest and decrease of consciousness (complicatications of intrathecal opiate) was not seen.
Conclusion: In the same previus study in Brazil show that transdermal nitroglycerine significantly prolonged the analgsic effect of spinal sufentani (10)
This study was performed in minor operation. (Arthroscopy) (10) That did not cause sever tissue trauma and postoperative pain.(2) (10) Our study showed that: Transdermal nitroglycerine has no effect on prolongation of analgesic effect of intrathecal sufentanil. Our study performed in patients with osseous fracture that can cause sever tissue trauma and postoperative pain. (probably reason for this difference) Also, our study showed that: Transdermal nitroglycerine alone (5mg/day) did not result in postoperative analgesia itself.
Keywords
Transdermal nitroglycerine, Sufentanil, Intrathecal, Bupivacaine