A Comparison of Analgesic Effects of Clonidine with Ropivacaine and Dexmedetomidine with Ropivacaine for Caudal Analgesia in Children Undergoing Lower Abdominal Surgeries (original) (raw)
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Indian journal of applied research, 2016
Background: Caudal epidural analgesia is reliable, safe and has become most popular and commonly performed regional blocks in paediatric anaesthesia. Dexmedetomine is a potent adjuvant which apart from its analgesic effects has concomitant benefits like sedation and sympatholysis. In this study we determined the efficacy of Dexmedetomidine as an adjuvant to caudal anaesthesia for postoperative analgesia in paediatric patients undergoing lower abdominal surgeries. Methods: The study consisted of 60 infants and children (1yr-6yr) of ASA physical status I, of either sex, undergoing lower abdominal surgery who were randomised into two groups of 30 each namely Group R and group RD. After induction of anaesthesia caudal block was performed on all patients. Depending on results of randomisation, drug used for caudal anaesthesia in R Group was 0.5ml/kg 0.25% ropivacaine whereas in Group RD it was 0.5ml/kg 0.25% ropivacaine with Dexmeditomidine 1 mcg/kg. Heart rate (HR), mean arterial pressure (MAP) and oxygen saturation (SpO2) were recorded before surgery and every 5 min till 20 minutes after skin incision and at the end of surgeries. The time from caudal block to end of surgery, time for first rescue analgesia, total consumption of rescue analgesia in the period of 24 hours were recorded. In the postanaesthesia care unit, FLACC and ramsay sedation scores were assessed on arrival (0) and at 4, 8,12,16, 20 and 24 hours. Results: There was a significant reduction in FLACC score in group RD at 4,8 and 12 hours postoperatively compared to group R. At the 16 ,20 and 24 hours there was no significant difference.The mean duration of postoperative analgesia(time of first rescue analgesia) was significantly prolonged in group RD compared to group R.The mean total consumption of rescue analgesia in 24 hours postoperatively was significantly decreased in group RD (217±65.054) mg when compared with the group R(464±1.456) mg. Mean sedation score using Ramsay Sedation Scores was very significant (p≤0.001) at 4 and 8 hrs. Perioperative haemodynamic changes between the groups were comparable and were not statistically significant and required no treatment. Conclusion: We find dexmedetomidine is an effective adjuvant for caudal analgesia in paediatrics age group with lower abdominal surgeries.
National Journal of Medical Research, 2017
Introduction: Clonidine, an a2 adrenergic agonist, prolongs analgesia without significant respiratory depression. The analgesic action of epidurally-administered clonidine is due to stimulation of descending noradrenergic medullospinal pathways inhibiting the release of nociceptive neurotransmitters in the dorsal horn of spinal cord. The present study was done with the objective of assessing advantages of use of clonidine with Ropivacaine for caudal analgesia in paediatric age group among lower abdominal and lower limb surgery. Methodology: A randomized controlled study consisted in two groups of thirty paediatric patients (1-10 years) each with lower abdominal and lower limb surgery was carried out at Department of Anaesthesia, SMIMER Hospital, Surat during Jan to Dec 2012.Total 60 patients were randomly allocated in two groups by chit method. In Group R patients Inj.Ropivacaine0.25% (0.5 ml/kg) was given and in Group RC patients Inj. Ropivacaine 0.25%(0.5 ml/kg)+ Inj. Clonidine 2mg/kg was given. Patients were assessed for pain Modified objective pain score and sedation assessed with Four Point sedation score. Results: Mean age of patient was 4.77 ± 2.487 years in Group R and 5.37 ± 2.723 yrs in Group RC. Total Male:Female ratio was 9:1. Majority of patients were operated for congenital herniotomy (68.3%) followed by Hypospadiasis repair (16.6%).Mean modified pain score was measured at each hour postoperatively. It was higher at each level in Group R and this difference was statistically significant. The mean duration of analgesia was 7.17 hrs in Group R and 12.93 hrs in Group RC. This difference was also statistically significant (p-Value < 0.001). Conclusion: From the study, it was concluded that the addition of clonidine 2µg/kg to single shot caudal block with Ropivacaine 0.25% prolongs the duration of postopertive analgesia while maintaining hemodynamic stability. Clonidine 2µg/kg is safe & effective adjuvant in caudal block for paediatric lower abdominal and lower limb surgery.
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.
IOSR Journals , 2019
Background: Caudal analgesia is good, reliable and easy method to provide intra operative and postoperative analgesia in the lower abdominal surgeries in pediatric patients. Many additives were used in combination with local anaesthetics in caudal block to increase the quality of anaesthesia, to prolong the post-operative analgesia, to reduce the dose of local anaesthetics and to reduce side effects. Aim of the study: This study is aimed to study and compare the effects of 1mcgs/kg Dexmedetomidine and 0.1mg/kg Dexamethasone as adjuncts to 0.25%Bupivacaine on intra operative haemodynamics, prolongation of duration of postoperative analgesia, complications if any, in paediatric patients undergoing lower abdominal surgeries. Material & Methods: This study was done in 100 patients of both the sexes, aged between 1-5 years, with ASA Status I, II posted for lower abdominal surgeries under general anaesthesia. Group I: 0.25% Bupivacaine in a dose of 0.5ml/kg with Dexamethasone 0.1mg/kg caudally. Group 2: 0.25% Bupivacaine in a dose of 0.5ml/kg with Dexmedetomidine 1mcg/kg caudally. Parameters assessed were-Heart rate and Mean arterial pressure at base line, after induction, after caudal block, every 5min for first 15min and every 15min for 3hr from start of operation in operative room, Modified objective pain score (MOPS) at 30min, 1hr, 2hr, 3hr, 6hr, 12hr. Ramsay Sedation score at the time of pain, any side effects. Results: Intra operative haemodynamics were comparable in both the groups, there was a marginal increase in the duration of post-operative analgesia and there was a sedation which is arousable in Dexmedetomidine group when compared to Dexamethasone group, no side effects were noted in both the groups.
Effects of dexmedetomidine added to caudal ropivacaine in paediatric lower abdominal surgeries
Indian Journal of Anaesthesia, 2011
Purpose: The objectives of this study were to compare the effects of caudal dexmedetomidine combined with ropivacaine to provide postoperative analgesia in children and also to establish its safety in the paediatric population. Methods: In a randomised, prospective, parallel group, double-blinded study, 60 children were recruited and allocated into two groups: Group RD (n=30) received 0.25% ropivacaine 1 ml/kg with dexmedetomidine 2 µg/kg, making the volume to 0.5 ml and Group R (n=30) received 0.25% ropivacaine 1 ml/kg + 0.5 ml normal saline. Induction of anaesthesia was achieved with 50% N 2 O and 8% sevoflurane in oxygen in spontaneous ventilation. An appropriate-sized LMA was then inserted and a caudal block performed in all patients. Behaviour during emergence was rated with a 4-point scale, sedation with Ramsay's sedation scale, and pain assessed with face, legs, activity, cry, consolability (FLACC) pain score. Results: The duration of postoperative analgesia recorded a median of 5.5 hours in Group R compared with 14.5 hours in Group RD, with a P value of <0.001. Group R patients achieved a statistically significant higher FLACC score compared with Group RD patients. The difference between the means of mean sedation score, emergence behaviour score, mean emergence time was statistically highly significant (P<0.001). The peri-operative haemodynamics were stable among both the groups. Conclusion: Caudal dexmedetomidine (2 µg/kg) with 0.25% ropivacaine (1 ml/kg) for paediatric lower abdominal surgeries achieved significant postoperative pain relief that resulted in a better quality of sleep and a prolonged duration of arousable sedation and produced less incidence of emergence agitation following sevoflurane anaesthesia.
INTRODUCTION: Regional anaesthesia is safe, cost-effective approach wherever feasible and also it is the technique of choice for providing excellent postoperative analgesia. Spinal anaesthesia, regional anaesthetic technique, the early-onset and sure success of the method, ease in technique but duration of anaesthesia and analgesia is limited. Epidural anaesthesia, has many advantages for a prolonged duration with frequent top-ups for delivering excellent postoperative analgesia. It contributes to intraoperative hemodynamic stability reduce perioperative stress response, decrease in complications and improving patient outcome by relieving postoperative pain, decreases the incidence of thromboembolic events. AIMS AND OBJECTIVES OF THE STUDY: To evaluate the efficacy of dexmedetomidine and clonidine, adjuvant to ropivacaine in epidural anaesthesia for lower abdominal and lower limb surgeries. Compare Onset and duration of sensory blockade, motor blockade, duration of analgesia, haemodynamic changes and side effects. MATERIALS AND METHODS: 60 patients aged between 18 and 60 belonging to ASA I and II divided into two groups, each group consist of 30 patients. Group RC: Receives 15ml of 0.75 % ropivacaine with 1 µg/kg clonidine. Group RD: Receives 15ml of 0.75 % ropivacaine with 1 µg/kg dexmedetomidine. Injected epidurally undergoing lower abdominal and lower limb surgeries. All patients are managed similarly and the effect of onset, duration of sensory, motor blockade, haemodynamic and complications are evaluated. Results obtained were tabulated and analysed. RESULTS: The onset and duration of sensory blockade were faster in group RD than group RC which was statistically significant. The onset and duration of Motor blockade is more intense and Sedation score is greater in RD group than RC group which is highly significant. Side effects are more with RD group than RC which are treatable. CONCLUSION: The addition of Dexmedetomidine to Ropivacaine for epidurally to shorten the onset of block and prolong the duration of block. The dosage of 1µg/kg used in the study significantly increase the duration of the analgesia.
2019
Background: Pain is the most common complain causing distress to the patients in immediate postoperative period. Various studies have shown that transverse abdominal plane (TAP) 13 block is effective modality for postoperative pain relief using ropivacaine or bupivacaine. But duration of these blocks with local anesthetics only is limited to few hours. The present study was conducted with the aim to compare the postoperative analgesia amongst subjects receiving ropivacaine and clonidine versus ropivacaine alone. Subjects and Methods: The present prospective and double blinded study involving 70 patients was performed for a period of 2 years at the Department of Anesthesiology. Monitors were attached and baseline (preoperative) heart rate by ECG, systolic and diastolic blood pressure was measured by noninvasive blood pressure monitoring. The duration of postoperative analgesia and complications like nausea, vomiting or any other were noted during the procedure. Student t test was used for statistical analysis and probability value of less than 0.05 was considered as significant. Results: Abdominal Hysterectomy was performed in 4 patients in Group c and 6 patients in Group R. Hernioplasty was performed in 5 patients in Group c and 7 patients in Group R. The mean time for first dose in Group c was 646.83 mins and in group R was 393.43 mins. The mean time for second dose in Group c was 1284.89 mins and in group R was 393.43 mins. Conclusion: TAP block under USG guidance should be used to provide better analgesia in postoperative Period. Adjuvants like clonidine should be used along with local anesthetics for prolongation of analgesic effect of TAP block in post-operative period.
journal of medical science and clinical research, 2019
Original Research Article Comparative study of epidural ropivacaine with dexmeditomidine and ropivacaine with clonidine in patients undergoing lower abdominal surgeries Authors Dr Sundeep S.Matteda 1 , Dr Pradeep S. Indurkar 2 * 1 Senior Resident, Dept. of Anaesthesia, Mamata Medical College, Khammam, India 2 Professor, Dept. of Anaesthesia, Mamata Medical College, Khammam, India *Corresponding Author Dr Pradeep S. Indurkar Department of Anaesthesia, Mamata Medical College, Khammam, Telangana. India Abstract Regional Anaesthesia is an excellent choice which provides effective intra &post operative analgesia with a single technique which is being possible due to the availability of long acting amide local anaesthetics like Ropivacaine and by the addition of adjuvants like clonidine and Dexmedetomidine. A good adjuvant must improve the speed of onset, the quality and/ or duration of analgesia with desirable sedation. Method: 50 patients divided in two groups were studied. Group RC rec...
Aims and Objectives:To compare epidural ropivacaine 0.75% alone and Ropivacaine 0.75% with alpha 2 agonists. Variables like block characteristics, hemodynamics, sensory and motor recovery, side effects are analysed. Materials: With Institutional ethical committee clearance, clinical Study conducted at R.L.J.H, Kolar. After obtaining informed written consent,90 patients of(American Society of Anaesthesiologists) ASA Grade I and II in age group 18 to 55 years, of either sex, posted for elective lower abdominal and lower-limb surgeries were selected. Methods:Patients were randomly allocated into 3 groups of 30 each.Epidural block was administered.Patients in group"R" received 19ml 0.75% ropivacaine with 1ml of normal saline. Group "RC" patients received 19ml 0.75% ropivacaine with 75microgram(mcg) clonidine while patients in group "RD" received 19ml0.75% ropivacaine with 75 mcg dexmedetomidine. Block characteristics like onset of analgesia, maximum level of sensory blockade, complete motor blockade, hemodynamics, time to two segment regression, time for rescue analgesia, time to complete motor recovery, side effects were analysed. Results: Results showed that onset of blockade is faster when additives are added like clonidine and dexmedetomidine. Time for two segment regression was 30-35minutes earlier in Group "RC".(R<RC<RD). Time for rescue analgesia was longer in "RD" group(R<RC<RD). Group RC had mild sedation, group RD had moderate sedation with better analgesic profile when compared to other groups, except for incidence of bradycardia. Conclusion: Addition of alpha 2 agonists fastens the onset of action,better analgesia with dexmedetomidine ,insignificant incidence of sideeffects.
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.