The effect of verapamil as an adjuvant agent with local anesthetic on sensory block level, hemodynamic and postoperative pain

Objective: Coadministration of verapamil with local anesthetics could potentiate the sensory block of peripheral nerve, increase the duration of sensory nerve block and reduce postoperative pain and analgesic consumption. The aim of this study was to investigate the effect of verapamil as an adjuvant with bupivacaine on level of sensory block, post-operative pain and analgesic consumption among patients undergone elective surgery in Isfahan. Methodology: In this prospective randomized interventional clinical double-blind study ASA physical status I or II male patients referred for elective lower abdominal surgery were enrolled. They randomized in group A (20cc of 0.5% bupivacaine plus 5 mg verapamil) and B(20cc of 0.5% bupivacaine plus 2cc normal saline). The sensory level block, postoperative pain, opioid consumption and vomiting and nausa and hemodynamic state was recorded and compared in two groups. Results: Sixty two patients were studied. Mean of the sensory level block 20 minutes after stating epidural anesthesia and immediately after surgery, postoperative pain score, opioid consumption and nausea and vomiting and fluid intake was not significantly different in two groups (P>0.05). Mean of systolic and diastolic blood pressure and pulse rate changes was not significantly different in two groups (P>0.05). Conclusion: Verapamil as an adjuvant with bupivacaine could not significantly increase the level of sensory block and attenuate post-operative pain and analgesic consumption and hemodynamic condition of the patients. For more accurate results it is recommended to determine the effect of different dose of verapamil in larger sample size of the patients. Studying the effect of other Ca channel blockers would be favorable in this regard.

[1]  G. George,et al.  Epidural anesthesia and post-operative analgesia for bilateral inguinal mesh hernioplasty: Comparison of equipotent doses of ropivacaine and bupivacaine , 2011, Saudi Journal of Anaesthesia.

[2]  Z. Luo,et al.  Calcium channel functions in pain processing , 2010, Channels.

[3]  W. Kim,et al.  Role of PKG-L-type calcium channels in the antinociceptive effect of intrathecal sildenafil , 2010, Journal of Veterinary Science.

[4]  Ting Liu,et al.  [Verapamil effect and influence on postoperative epidural analgesia and cell factors TNFalpha, IL-6 and IL-2]. , 2007, Sichuan da xue xue bao. Yi xue ban = Journal of Sichuan University. Medical science edition.

[5]  H. Kehlet,et al.  The Role of the Anesthesiologist in Fast-Track Surgery: From Multimodal Analgesia to Perioperative Medical Care , 2007, Anesthesia and analgesia.

[6]  A. Ozcelik,et al.  Epidural magnesium reduces postoperative analgesic requirement. , 2007, British journal of anaesthesia.

[7]  D. Karakaya,et al.  Analgesic effects of interpleural bupivacaine with fentanyl for post-thoracotomy pain. , 2004, Journal of cardiothoracic and vascular anesthesia.

[8]  F. Smith,et al.  Influence of intracellular Ca2+ release modulating drugs on bupivacaine infiltration anesthesia in mice , 2004, European journal of pain.

[9]  D. Silverman,et al.  Optimizing postoperative outcomes with efficient preoperative assessment and management , 2004, Critical care medicine.

[10]  Ying Lu,et al.  The Combined Effects of N-type Calcium Channel Blockers and Morphine on A&dgr; Versus C Fiber Mediated Nociception , 2001, Anesthesia and analgesia.

[11]  Dong-Chan Kim,et al.  Epidural Verapamil Reduces Analgesic Consumption After Lower Abdominal Surgery , 1998, Anesthesia and analgesia.

[12]  Y. Han,et al.  Analgesic Effect with Epidural Bupivacaine and Verapamil in Lower Abdominal Surgery , 1996 .

[13]  C. Laurito,et al.  Effects of subcutaneous verapamil on the duration of local anesthetic blockade. , 1994, Journal of clinical anesthesia.

[14]  R. Tsien,et al.  Three types of neuronal calcium channel with different calcium agonist sensitivity , 1985, Nature.

[15]  S. Anant,et al.  Verapamil as an Adjunct to Local Anaesthetic for Brachial Plexus Blocks. , 2010, Medical journal, Armed Forces India.

[16]  A. Absalom,et al.  Features of regional anaesthesia. , 2002 .

[17]  J. Baeyens,et al.  Analgesic effects of diltiazem and verapamil after central and peripheral administration in the hot-plate test. , 1990, General pharmacology.

[18]  J. Wildsmith,et al.  Principles and practice of regional anaesthesia , 1987 .