Comparison of Intrathecal Bupivacaine with Clonidine Versus Intrathecal Bupivacaine with Fentanyl for Post-operative Pain Treatment in Lower Limb Procedures (original) (raw)
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Journal of Evidence Based Medicine and Healthcare, 2014
BACKGROUND: Hyperbaric bupivacaine has been the gold standard drug for the safe conduct of spinal anaesthesia. It offers duration of 1.5 to 2.5 hours of anaesthesia and analgesia, various adjuvants are being used with local anesthetics for prolongation of intraoperative and postoperative analgesia. clonidine, an α 2 adrenergic agonist is new neuraxial adjuvant gaining popularity. AIM: The purpose of this study was to compare the efficacy of sensory and motor block, degree of postoperative analgesia, and adverse effects of clonidine and fentanyl used intrathecally with hyperbaric bupivacaine for spinal anaesthesia. SETTINGS AND DESIGN: the study was conducted in prospective, double blind manner, included 60 ASA class I and II patients undergoing lower limb, lower abdominal, gynaecological and urological surgeries under spinal anaesthesia after approval from hospital ethics committee with written and informed consent of patients. MATERIALS AND METHODS: the patients were randomly allocated into two groups (30 patients each), group C received hyperbaric bupivacaine 15mg with clonidine 1µg. kg-1 and group F received hyperbaric bupivacaine15mg with fentanyl 25µg. This randomized study was conducted to compare the effects with regards to, Onset and duration of block, degree of post-operative analgesia (evaluated by VAS scale) and side effects associated with the drugs were recorded. RESULTS: Patients in group C had significantly longer sensory and motor block times than group F. The mean onset of sensory block in group C was 136.67sec and in group F was 138.33 sec. The mean onset of motor block in group C was 200.00sec and in group F was 206.67 sec. There were no differences with respect to the onset of block .The mean duration of sensory block in group C was 343.67min and in group F was 250.83min. CONCLUSIONS: There were no differences in the onset of sensory and motor blockade. The duration of analgesia, two segment regressions, and recovery of motor blockade were prolonged when clonidine 1µg.kg-1 was used as an additive to intrathecal hyperbaric bupivacaine compared to fentanyl 25µg for spinal anaesthesia, with side effects like bradycardia, hypotension and pruritus which did not require any treatment. Mild sedation was associated with intrathecal administration of clonidine 1µg.kg-1 which did not require any treatment. KEYWORDS: α 2 adrenorecepor agonist, bupivacaine, clonidine, fentanyl, spinal anaesthesia. INTRODUCTION: Hyperbaric bupivacaine has been the gold standard drug for the safe conduct of spinal anaesthesia. 1 It offers duration of 1.5 to 2.5 hours of anaesthesia and analgesia. Discovery of various spinal receptors like α 2-adrenergic, cholinergic, opioid, NMDA, GABA,
International journal of scientific research, 2017
Post operative analgesia is not only desirable but also is of utmost necessity for all surgical patients. Clonidineprolongs both sensory and motor effect of intrathecal bupivacaine through activation of post synaptic α2 receptors in substantia gelatinosa of spinal cord.The following study was undertaken to observe onset of motor block, sensory block, duration of postoperative analgesia by using 0.5% Bupivacaine heavy 3cc with clonidine 30 ug and without clonidine intrathecally.In conclusion, the addition of intrathecal Clonidine 30 mcg to hyperbaric Bupivacaine prolongs the duration of postoperative analgesia compared to Bupivacaine alone. There was a marked reduction in supplementary rescue analgesic demand in clonidine group.
Background: Single dose subarachnoid anesthesia is a commonly used anesthetic technique for pelvic and lower limb surgeries. Various adjuvants, e.g. opioids, alpha 2 agonists, neostigmine, midazolam etc. have been used to counter some of the shortcomings of the technique. Synthetic lipid soluble opioids like fentanyl for hemodynamic stability or clonidine for prolongation of duration have been used. We wanted to compare both the drugs with a control when used in conjunction with local anesthetics in lower abdominal and pelvic surgeries with regard to sensory and motor block with early postoperative analgesia along with their side effect profile.
International Journal of Medical Science and Public Health, 2015
Opioids and local anesthetics administered together intrathecally are known to have synergistic analgesic effects. [1] Fentanyl, a short-acting lipophilic opioid, was administered intrathecally along with local anesthetics by Belzarena. [2] Clonidine, an α 2 adrenergic agonist, has been used as an antihypertensive agent for many years. Recently its desirable anesthetic properties in human have been highlighted, which include reducing anesthetic requirements, improving hemodynamic stability, and providing analgesia. [3-5] The problem of postoperative pain relief seeks utmost attention since past few years. Postoperative pain treatment should be an integral component of the routine surgical and anesthetic management because it helps to reduce morbidity and complications as well as accelerate rehabilitation. [6] Good postoperative analgesia is an important avenue to attenuate the surgical stress response. [7] When local anesthetic bupivacaine is combined with intrathecal clonidine, complete surgical anesthesia could be obtained along with intra-and postoperative pain relief with fewer side effects. [5,8-10] Clonidine has been used as an Background: Various adjuvants have been used in spinal anesthesia to avoid intraoperative visceral and somatic pain and prolonged postoperative analgesia. Clonidine, partially selective α 2-agonist drug, is now being used as a neuraxial adjuvant. Objective: To compare the duration and quality of analgesia of clonidine and fentanyl used as adjuvants to intrathecal bupivacaine. Materials and Methods: American Society of Anesthesiologist grade 1 and 2 patients (90 patients) were randomly divided into three groups of 30 patients each for lower limb orthopedic surgeries. Group A received intrathecal 15 mg hyperbaric bupivacaine and 1 ml normal saline, group B received 15 mg hyperbaric bupivacaine and 1 ml (50 µg) fentanyl, and group C received 15 mg hyperbaric bupivacaine and 1 ml (150 µg) clonidine. The onset and duration of sensory and motor block, quality of analgesia, and the incidence of side effects in three groups were observed and compared. Results: Three groups were compared based on the demographic data, and the onset of sensory block at T 8 level and of motor block was compared among these groups. Significant prolongation of duration of sensory (P = 0.0000001) and motor block (P = 0.0000001) was found in group C. Significant hypotension was found in group C (P < 0.05) and the postoperative pain scoring chart (VAS chart) was 1.07 ± 0.87 in group C and 3.27 ± 0.67 in group B (P < 0.05). Conclusion: Intrathecal clonidine is associated with prolonged motor and sensory block, hemodynamic stability, and low postoperative pain score compared to fentanyl.
https://www.ijrrjournal.com/IJRR\_Vol.9\_Issue.1\_Jan2022/IJRR-Abstract035.html, 2022
Background: Intrathecal adjuvants to local anesthetic enhance the quality and duration of spinal anaesthesia. The present study was aimed to comparatively evaluate clonidine and butorphanol as adjuvants to intrathecal hyperbaric bupivacaine for subarachnoid blockade during lower abdominal and lower limb surgeries. Patients and Method: Sixty adult consented patients, undergoing elective lower-abdominal and lower-limb surgeries under subarachnoid blockade, were inducted in a blind randomized prospective study conducted in the Department of Anesthesia, GMC Jammu and allocated into 2 equal groups to receive either 3.2 ml of 0.5% hyperbaric bupivacaine (16mg) with 0.2 ml of Clonidine 30 µgm (Group I) or with 0.2 ml of Butorphanol 200 µgm (Group II). Patients were compared for the onset and duration of sensory and motor blockade, intraoperative hemodynamic changes, time to first rescue analgesia, etc. Result: The mean onset time of sensory block was 3.18±0.56 min in Group I and 3.69±0.83 min in Group II. Complete motor block was achieved in 11.53±3.05 min in Group I and in 12.72±3.17 min in Group II, with no significant difference. (p = 0.138) The duration of motor block was 294.28±33.85 min in Group I, as compared to patients of butorphanol group 245.71±30.92 min,(p = 0.046). The need for rescue analgesia was significantly earlier in Group II, ie at 211.09±20.74 min, while at 256.32±24.40 min in group I. Conclusion: Clonidine and butorphanol are good adjuvants to hyperbaric bupivacaine for spinal anaesthesia. Clonidine provides longer duration of sensory and motor blockade and prolonged duration of postoperative analgesia compared to butorphanol.
Journal of anaesthesiology, clinical pharmacology
Various adjuncts to local anesthetics have been used with the purpose of improving the quality of subarachnoid block. This randomized double-blind study was conducted to evaluate the efficacy of adding clonidine to bupivacaine and bupivacaine-fentanyl combination. A total of 100 patients scheduled for surgery under spinal anesthesia were randomly allocated into four groups (n = 25 each) to receive intrathecal bupivacaine 7.5 mg plus normal saline 0.5 ml (group BS), intrathecal bupivacaine 7.5 mg, and fentanyl 25 μg (group BF), intrathecal bupivacaine 7.5 mg and clonidine 75 μg (group BC), intrathecal bupivacaine 7.5 mg, clonidine 37.5 μg, and fentanyl 12.5 μg (group BCF). The time of onset and duration of sensory block, highest dermatome level of sensory block, time of onset of motor block, time to complete motor block recovery and duration of spinal anesthesia, intraoperative and postoperative hemodynamics and side effects if any were recorded. VAS, total number of patients who wer...
Journal of Evolution of Medical and Dental Sciences, 2015
BACKGROUND: Among all the spinal adjuvants, clonidine, an alpha-2 agonist has the ability to alleviate both the somatic and visceral pain and is more potent at spinal site, favoring its neuraxial administration. OBJECTIVE: This study was done to compare the onset and duration of sensory and motor blocks, duration of analgesia, haemodynamic and adverse effects of Clonidine, buprenorhine and fentanyl used intrathecally with hyperbaric 0.5% bupuvacaine. SETTINGS & DESIGN: This prospective, randomized and comparative study included 90 ASA class 1 & 2 patients undergoing lower abdominal and lower limb surgeries under spinal anesthesia after approval from hospital ethics committee with written informed consent of patients. MATERIALS AND METHODS: Patients were randomly allocated into three groups (n=30) and received 50μg of clonidine, 25μg of fentanyl and 75μg of buprenorphine respectively in group BC,BF and BB as adjuvants to 15mg of 0.5% hyperbaric bupivacaine (3.0ml). The onset time and duration of sensory and motor block, duration of analgesia, haemodynamic changes and side effects were recorded. RESULTS: The onset time of motor block and durations of sensory, motor blockade and analgesia were prolonged in-group BC as compared to group BF and BB (P<.001). There was no significant difference in the onset time of sensory block in three groups (P>.05). Group BC had lower heart rate and mean blood pressure and higher sedation score. CONCLUSION: Intrathecal Clonidine in a dose of 50μg is an effective adjuvant to local anesthetics in neuraxial blocks despite mild sedation and haemodynamic variations.
Background and Objectives: The purposes of this study were to evaluate the onset, quality and duration of sensory and motor blockade between hyperbaric bupivacaine and clonidine combination with bupivacaine alone when administered intrathecally for unilateral spinal anesthesia in below-knee orthopedic surgery, effi cacy of clonidine for post-operative analgesia and side-effects of clonidine, if any. Methods: Sixty ASA I and ASA II patients scheduled for elective surgery with time duration up to 90 min were studied. Patients were randomised in two equal groups by the lottery method. Group A (control group) was given Inj. bupivacaine (hyperbaric) 0.5% - 12.5 mg (2.5 ml) + 0.5 ml of normal saline intrathecally. Group B (clonidine group) was given Inj. bupivacaine (hyperbaric) 0.5% - 12.5 mg (2.5 ml) + 50 mcg clonidine in 0.5 ml volume intrathecally. Results: The mean peak sensory block was earlier in Group B (4.7±1.23 min) as compared with Group A (6.27±1.51 min). The mean peak motor block was earlier in Group B (6.17±1.20 min) as compared with Group A (8.63±1.71 min). The two-segment regression of sensory block was longer in Group B (106.23±9.17 min) as compared with Group A (104.43±17.75 min), which is clinically signifi cant. Requirement of rescue analgesia was considerably prolonged in Group B (450.33±95.10 min) as compared with Group A (220±36.36 min), which was also clinically highly signifi cant. Conclusion: Intrathecal clonidine potentiates bupivacaine induced spinal sensory block and, motor block and reduces the analgesic requirement in the early post-operative period in unilateral spinal anesthesia for lower limb below knee surgery. Key words: Below-knee surgery, bupivacaine, clonidine, intrathecal
Anesthesiology and Pain Medicine, 2014
Background: The addition of intrathecal opioids to local anesthetics seems to improve the quality of analgesia and prolong the duration of analgesia, when using a subarachnoid block in Iranian patients with their specific pain tolerance. Objectives: The aim of this study was to evaluate the effects of adding fentanyl or sufentanil, to intrathecal bupivacaine, in terms of the onset and duration of; sensory block, motor block, hemodynamic effects and postoperative pain relief. Patients and Methods: This randomized clinical trial included 90 patients who underwent orthopedic lower limb surgeries. Subjects were divided into experimental groups; intrathecal fentanyl 25 µg (F), and sufentanil 2.5 µg (S), along with a placebo 0.5 mL normal saline (C) group, which were added to bupivacaine 0.5%, 15 mg. Duration of complete and effective analgesia was recorded (by a visual analogue scale-VAS). The pain scores were assessed postoperatively. Intraoperative mean arterial pressure (MAP), heart rate and oxygen saturation (SPO 2 ) were recorded. The incidence of side effects such as; nausea, vomiting, pruritus, shivering, bradycardia and hypotension were also recorded. Results: MAP and heart rate results showed no significant changes at the designated time points among the three groups (P > 0.05). However, SPO 2 and VAS showed significant changes at the designated time points among the three groups (P < 0.05). The duration of complete and effective analgesia was also significantly longer in the sufentanil group (P < 0.05). Motor block did not exhibit any significant difference (P = 0.67). Only pruritus as a side effect was significantly higher in the sufentanil group (P < 0.05), while all other evaluated side effects were significantly lower in the sufentanil group (P < 0.05).
The Journal of Medical Sciences, 2017
ABSTRACTClonidine, a centrally acting α2 adrenergic agonist has been under use as an adjuvant with hyperbaric bupivacaine for prolonging analgesia and maintaining hemodynamic stability during lower limb orthopedic and lower abdominal surgeries.The purpose of our study was to compare the efficacy and safety of intrathecal Clonidine 50 and 75 μg as adjuvant to hyperbaric Bupivacaine 15 mg (3 mL), and hyperbaric Bupivacaine 3 mL with saline 0.5 mL for onset and duration of anesthesia, hemodynamic stability, and side effects if any.This prospective randomized controlled study was conducted on 120 patients scheduled for lower limb orthopedic surgeries under spinal anesthesia. The study population was divided into three groups with 40 patients in each group. Group I (controlled group) received 3 mL (15 mg) of 0.5% Bupivacaine heavy and 0.5 mL of normal saline. Group II received 50 μg of clonidine followed by Bupivacaine 0.5% 3 mL (15 mg) and group III received 75 μg of clonidine followed ...