A Study to Compare the Effect of Dexmedetomidine and Clonidine as an Adjuvant to Ropivacaine for Epidural Anesthesia in Infraumbilical Sugeries (original) (raw)
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Global Anesthesia and Perioperative Medicine, 2015
Background: Epidural block provides surgical anesthesia as well as post-operative analgesia in patients undergoing lower abdominal surgeries. Ropivacaine, is safe and effective for regional anesthetic techniques. Dexmedetomidine, alpha-2 agonist, as adjuvant to local anesthetic is reported to have synergistic effect for epidural anesthesia. The present study was designed with the aim to evaluate the efficacy and safety of dexmedetomidine as an adjuvant to epidural 0.75% ropivacaine in patients undergoing infraumbilical surgery. Method: Eighty adult consented patients 18-58 yr of age, of either sex, of ASA grade I/II undergoing infraumbilical surgeries were enrolled for the present study. Patients were randomised in two groups of 40 patients each: Group A received epidural ropivacaine only whereas Group B received epidural ropivacaine and dexmedetomidine. Patients of group A received 15 ml 0.75% ropivacaine + 1 ml Normal Saline and group B received 15 ml 0.75% ropivacaine + 0.6 µ kg-1 dexmedetomidine in 1 ml NS (group B) epidurally. Various block characterstics sensory onset time, time to complete motor block, time to two dermatome regression, duration of sensory analgesia and motor block, sedation scores, hemodynamic changes and any side effect were all recorded and statistically analysed by one way ANOVA and chi-square test. The p value<0.05 is considered significant and p<0.001 as highly significant. Results: The demographic profile of patients was comparable in both the groups. Onset of sensory block (2.50 ± 0.877 vs 7.00 ± 1.198 min) and establishment of complete motor blockade (17.20 ± 4.10 vs 23.90 ± 3.57 min) was significantly earlier in the ropivacaine with dexmedetomidine group. Postoperative analgesia was prolonged significantly in the ropivacaine with group (429.25 ± 58.34 min). Sedation scores were also higher in the dexmedetomidine group with statistically highly significant difference (p<0.001). Incidence of nausea, vomiting and shivering were were more in patients of ropivacaine alone group with statistically significant difference (p=0.003) Conclusion: Dexmedetomidine is effective adjuvant with ropivacaine for epidural block as it prolongs duration of motor block and analgesia with adequate sedation and minimal side effects.
Saudi Journal of Anaesthesia, 2015
cardio toxicity and lesser motor blockade. A slightly larger dose of ropivacaine may be required, but the addition of an adjuvant helps in the reduction of total required dose of local anesthetic and enhances the efficacy thereby providing increased duration and intensity of blockade. [6-8] The quality and duration of analgesia is improved when a local anesthetic is combined with alpha 2 adrenergic agonist. Both clonidine and dexmedetomidine are alpha 2 adrenergic agonists, which have analgesic properties and potentiate local anesthetic effects. [9-11] Neuraxial clonidine, enhances the action of local anesthetics, increases the intensity and duration of analgesia. It is known to have sedative properties and the side effects are hypotension and bradycardia. [12-15] Dexmedetomidine is about 8 times more selective towards the alpha 2 adrenoreceptor than clonidine and hence allows the use of higher doses with less α 1 effect. It has been found to have hemodynamic stability, sedative, anxiolytic, analgesic, neuroprotective and anesthetic sparing effect. It causes more intense motor blockade and cooperative sedation without increasing the incidence of side effects.
Panacea Journal of Medical Sciences
Background: Requirement of anesthetic agents is reduced due to addition of adjuvants in epidural anaesthesia as they augment the local anesthetic action and have analgesic properties as well. Effective epidural analgesia ensures stable hemodynamics and satisfactory perioperative period. Objective: To evaluate efficacy of epidural clonidine compared to dexmedetomidine as adjuvants in postoperative analgesia Materials and Methods: Comparative, randomized clinical study was carried out among 100 subjects undergoing abdominal and vaginal hysterectomies of age 44-65 years with ASA grade I and II. They were divided randomly into two group of 50 each. Group A received 17ml of 0.5% of bupivacaine with 2mcg per kg clonidine. Group B received 17ml of 0.5% of bupivacaine with 1.5mcg per kg dexmedetomidine. Various parameters related to sensory and motor blockade, Ramsay sedation scale for sedation score, Hemodynamic parameters were monitored continuously and recordings were made at regular intervals. Results: Both groups were comparable in terms of age, weight, duration of surgery, ASA grades and type of surgery. Parameters pertaining to time for onset of sensory and motor block were significantly higher in clonidine group compared to the dexmedetomidine group (p<0.05). Postoperative block duration was significantly higher in dexmedetomidine group compared to clonidine group (p<0.05). The hemodynamic parameters and Ramsay sedation score at pre-operative and at 120min were comparable (p>0.05) between two groups except for heart rate which was significantly less in dexmedetomidine group at 120min compared to clonidine group (p<0.05). Conclusion: Dexmedetomidine added to bupivacaine epidurally prolonged postoperative analgesia longer than clonidine.
Dexmedetomidine and clonidine in epidural anaesthesia: A comparative evaluation
Indian Journal of Anaesthesia, 2011
Efforts to find a better adjuvant in regional anaesthesia are underway since long. Aims and objectives are to compare the efficacy and clinical profile of two α-2 adrenergic agonists, dexmedetomidine and clonidine, in epidural anaesthesia with special emphasis on their sedative properties and an ability to provide smooth intra-operative and post-operative analgesia. A prospective randomized study was carried out which included 50 adult female patients between the ages of 44 and 65 years of (American Society of Anaesthesiologists) ASAI/II grade who underwent vaginal hysterectomies. The patients were randomly allocated into two groups; ropivacaine + dexmedetomidine (RD) and ropivacaine + clonidine (RC), comprising of 25 patients each. Group RD was administered 17 ml of 0.75% epidural ropivacaine and 1.5 μg/kg of dexmedetomidine, while group RC received admixture of 17 ml of 0.75% ropivacaine and 2 μg/kg of clonidine. Onset of analgesia, sensory and motor block levels, sedation, duration of analgesia and side effects were observed. The data obtained was subjected to statistical computation with analysis of variance and chi-square test using statistical package for social science (SPSS) version 10.0 for windows and value of P < 0.05 was considered significant and P < 0.0001 as highly significant. The demographic profile, initial and post-operative block characteristics and cardio-respiratory parameters were comparable and statistically nonsignificant in both the groups. However, sedation scores with dexmedetomidine were better than clonidine and turned out to be statistically significant (P < 0.05). The side effect profile was also comparable with a little higher incidence of nausea and dry mouth in both the groups which was again a non-significant entity (P > 0.05). Dexmedetomidine is a better neuraxial adjuvant compared to clonidine for providing early onset of sensory analgesia, adequate sedation and a prolonged post-operative analgesia.
Background: The pain experienced after upper abdominal surgery leads to a reduction in 70-75% of vital capacity which leads to postoperative pulmonary complications. The ideal adjuvant for epidural analgesia in patients undergoing upper abdominal surgery seems to be every effective for better outcome and early immobilization in the immediate postoperative period. With this background we planned to conduct a study on epidural analgesia by comparing two alpha 2 agonists. Methods: 50 patients who have planned for elective upper abdominal surgery under general anaesthesia were enrolled in our study. Before induction of general anaesthesia, epidural catheterization was done. The surgical procedure was carried out under routine general anaesthesia with endotracheal controlled ventilation. The patients were given either Dexmedetomidine or Clonidine in the dosage of 2mcg/Kg with 0.125% Bupivacaine via epidural catheter after extubation. Patients were shifted to Post Anaesthesia Care Unit for observation. Sedation and pain were assessed with monitoring of vital parameters. The side effects were also noted. Results: Statistical analysis showed that the duration of analgesia was prolonged in the patients who received Dexmedetomidine as an adjuvant with local anaesthetic agent (417.32±67.36 minutes, p value < 0.05). The time to first rescue analgesia was comparatively delayed in Dexmedetomidine group while comparing with Clonidine group (425.6±64.27 minutes, p value < 0.05). The incidence of hypotension and bradycardia was greater in Clonidine group. There was no significant statistical difference with respect to side effects in both groups. Conclusion: From our study we concluded that Dexmedetomidine provides both analgesia and sedation with better hemodynamic status while compared to Clonidine used as adjuvants in epidural analgesia. But needs further study to optimize the dosage of these two adjuvants while giving via epidural route along with local anaesthetic agent.
Comparative Evaluation of Epidural Clonidine and Dexmedetomidine in Post Operative Analgesia
https://www.ijrrjournal.com/IJRR\_Vol.5\_Issue.10\_Oct2018/Abstract\_IJRR002.html, 2018
Background and Aims: Clonidine and dexmedetomidine are -2 adrenergic agonists with analgesic proprieties which potentiate local anesthetic effects when epidurally administered. The present study was undertaken with following aims: 1. To compare onset & duration of analgesia, incidence of side effects and complications of epidural clonidine and dexmedetomidine in post operative analgesia. 2. To study the potentiating effect of epidural clonidine /dexmedetomidine associated with ropivacaine (0.2%) 3. To know hemodynamics related to epidural clonidine and dexmedetomidine. Materials & Methods: After taking institutional approval and consent from patients, the study was carried out on 60 patients of A.S.A. grade I and grade II between 18-50 years. All patients were divided into two groups group 1 and 2 randomly. Group-1: received Ropivacaine 0.2% plus clonidine 1 mcg/kg Group-2: received Ropivacaine 0.2% plus dexmedetomidine 1 mcg/kg. Result: Statistically significant values were observed on comparison of post-operative block characteristics among the two groups (p < 0.001), both for time to two segment regression and time for first rescue top-up. Dexmedetomidine provided a smooth and prolonged post-operative analgesia as compared to clonidine. There was significant change in VAS score at 5 and 10 min post injection of drug in both groups as p value is <0.001 (very highly significant) at both time intervals, but mean VAS sore were higher in clonidine group in comparison to Dexmedetomidine group. There was decreasing trend of mean Pulse rate after 4 hours post injection & this decrease was very highly significant in the RC group (group 1) compared to RD group (group 2). The incidence of dry mouth was significantly higher in both the groups but it was statistically non-significant on comparison (P > 0.05). Conclusion: Dexmedetomidine is a better adjuvant than clonidine in epidural post operative analgesia as far as patient comfort, stable cardio-respiratory parameters, and post-operative analgesia is concerned.
Journal of Evolution of Medical and Dental Sciences, 2017
BACKGROUND Epidural anaesthesia is one of the most common regional anaesthetic techniques used for lower abdominal and lower limb surgeries. Epidural anaesthesia provides effective surgical anaesthesia and can also achieve the extended duration of surgical needs, provides prolonged postoperative analgesia, lowers the incidence of haemodynamic changes. The quality and duration of analgesia is improved when a local anaesthetic is combined with alpha-2 adrenergic agonist as neuraxial adjuvants. The aim of our study is to compare the effect of Clonidine and Dexmedetomidine when used as an adjuvant to epidural Ropivacaine in lower abdominal and lower limb surgeries. MATERIALS AND METHODS A prospective randomised double blinded study was conducted in 60 patients of either sex between the ages of 20 and 60 years of (American Society of Anaesthesiologists) ASA I/II grade who underwent lower abdominal and lower limb surgeries. The patients were randomly allocated into two groups; Ropivacaine + Clonidine (RC) and Ropivacaine + Dexmedetomidine (RD) comprising of 30 patients each. Group RC received 15 mL of Ropivacaine (0.75%) with 75 µg Clonidine and group RD received 15 mL of Ropivacaine (0.75%) with Dexmedetomidine 50 µg epidurally. Onset of sensory analgesia using bilateral pin-prick method, onset of motor blockade using Bromage scale, time to two dermatome regression of sensory level, time to first demand for analgesia, intraoperative haemodynamic parameters and complications were observed. Statistical analysis was done by chi-square test for qualitative data and unpaired student t-test for quantitative data using statistical package for social science (SPSS) version 19 for windows and value of p<0.05 was considered significant and p<0.001 as highly significant. RESULTS The demographic profile and cardiorespiratory parameters were comparable and statistically non-significant in both the groups. The side effect profile was also comparable with a little higher incidence of nausea and dry mouth in both the groups which was again a non-significant entity (P>0.05). Dexmedetomidine group (RD) had rapid onset of sensory and motor blockade (p<0.05), prolonged duration of sensory and motor block (p<0.05) and postoperative analgesia (p<0.05). CONCLUSION Dexmedetomidine is a better neuraxial adjuvant to epidural Ropivacaine compared to clonidine for providing early onset and long duration of sensory analgesia and motor blockade, longer post-operative analgesia.
Journal of Medical Science
Background. Spinal anesthesia was a commonly used technique in anesthetic practice for lower abdominal and lower limb surgeries. To prolong the duration of bupivacaine spinal anesthesia adjuvants like α2 agonists and opioids have been used intrathecally. Clonidine and dexmedetomidine have also been found to prolong the duration of spinal anesthesia when given intravenous. Dexmedetomidine was more suitable adjuvant to spinal anesthesia compared to clonidine as it has more sedative and analgesic effects due to more selective α2A receptor agonist activity. Dexmedetomidine has been shown to prolong the duration of analgesia of spinal anaesthesia in various studies. Here we compare the two doses of Dexmedetomidine in prolonging the duration of analgesia. Material and methods. 60 American Society of Anaesthesiologists(ASA) physical status I/II patients scheduled for elective lower abdominal and lower limb surgeries under spinal anesthesia were randomized into two groups of 30 each. Immedi...
Journal of Evolution of Medical and Dental Sciences
BACKGROUND Epidural anaesthesia is now increasingly being used for lower limb surgeries for its certain advantages. Different adjuvants have been used with epidural ropivacaine to prolong the intraoperative and postoperative analgesia. Evidence is growing in favour of dexmedetomidine as an epidural adjuvant. Different doses of dexmedetomidine have been used with epidural ropivacaine with variable success in modifying the block characteristics and adverse event profile. The aim of the present study was to compare the block characteristics between epidural ropivacaine with dexmedetomidine (2 µg/kg) as adjuvant and epidural ropivacaine alone in patients undergoing lower limb surgeries. MATERIALS AND METHODS In this randomised, double-blinded study, 88 adult patients of either sex, aged between 40-65 years, scheduled for elective lower limb surgery under epidural anaesthesia, were randomly allocated into two groups to receive either 0.75% ropivacaine alone (Group A) or dexmedetomidine (2 µg/kg) as an adjuvant to ropivacaine 0.75% (Group B) in epidural space. Data from 40 patients of each group were finally analysed. The time to achieve T6 sensory block (Primary outcome), time to reach maximum sensory block, time to achieve complete motor block, time to two-segment regression of sensory block and duration of analgesia were noted in all cases. The incidences of adverse events such as nausea, vomiting, hypotension, dry mouth, bradycardia, desaturation, respiratory depression, etc. were also noted. Statistical analysis was performed using independent sample Student's 't' test for normally distributed variables and Pearson Chi-square test for categorical data. The level of significance was set as P < 0.05. RESULTS The time to achieve sensory block at T6 level in group B (9.45±1.04 minutes) was significantly shorter than group A (13.65±1.12 minutes), P<0.05. The time to achieve maximal sensory block and time to achieve complete motor block were also found shorter in dexmedetomidine group. Sensory block regressed later in dexmedetomidine group compared to control (157.03±7.87 versus 118.47±7.32 minutes, respectively, P <0.05). The time to first rescue epidural top-up was prolonged in dexmedetomidine group compared with ropivacaine alone group (346.12±17.29 versus 327.98±17.60 minutes, respectively). Incidences of adverse events were comparable. CONCLUSION Epidural dexmedetomidine is a reliable adjuvant with ropivacaine (0.75%) to provide early onset of sensory block and longer duration of analgesia in lower limb surgeries.
Introduction: Epidural blockade is one of the best procedures, providing better intra operative hemodynamic control, post operative pain relief and rapid recovery from surgery specially pelvic surgeries and orthopedic surgeries. Selective alpha 2 adrenergic agonist used as adjuvant in epidural blockade. Dexmedetomidine a more powerful and highly selective alpha 2 adrenoceptor agonist than clonidine. This study was designed to investigate appropriate doses 1.0, 1.5, 2.0 mcg/kg of dexmedetomidine added to bupivacaine for epidural block to prolong postoperative pain relief and reduce the requirement of rescue analgesia in pelvic and lower limb orthopedic surgeries with least side effects. Material and methods: In our randomized control trial study, total 100 ASA class I and II patients of age between 15 to 65 years undergoing lower limb orthopedic and pelvic surgeries were given epidural block and studied for addition of dexmedetomidine on intra operative hemodynamic and post operative analgesia. Patients received 0.5% bupivacaine 20 ml alone in one group and with added Dexmedetomidine 1.0, 1.5, 2.0 mcg/kg in the other 3 groups respectively. All the patients were monitored for onset of sensory and motor blockade, intra operative hemodynamic, post operative analgesia, adverse effect and complications. Result: Onset of sensory and motor blockade was same in all four groups. Addition of Dexmedetomidine increases the post operative pain free period significantly with all doses of dexmedetomidine. An increase of dose beyond 1.5 mcg/Kg did not further improved pain free period and in fact lowered by 1.24 hours and the incidences of complications started appearing which were absent up to 1.5 mcg/Kg dose. The incidence of side effects like hypotension, Bradycardia and shivering were not seen in patients receiving 1.0 and 1.5 mcg/Kg of Dexmedetomidine with bupivacaine. In patients receiving 2.0 mcg/Kg dexmedetomidine with bupivacaine 24 % of the patients had hypotension and Bradycardia and 4 % had shivering. Conclusion: Addition of Dexmedetomidine in dose range of 1.0 to 1.5 mcg/Kg substantially prolongs postoperative analgesia without altering block characteristics offered by Bupivacaine for epidural blockade with no side effects and appears to be safe and reliable adjuvants.