A comparative evaluation of epidural clonidine vs. dexmedetomidine as adjuvants in post-operative analgesia (original) (raw)
Related papers
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.
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.
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.
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.
2015
Epidural anaesthesia with adjuvants is the preferred method for intra and postoperative pain relief in lower abdominal and lower limb surgeries but search for ideal adjuvant without any side effect goes on. This study was conducted to evaluate the onset, extent and duration of sensory and motor block and side effects of clonidine or dexmedetomidine when used as an adjuvant in epidural anaesthesia in lower abdominal and lower limb surgery. 60 patients of ASA status I and II, posted for lower abdominal and lower limb orthopaedic surgery were randomly allocated into two groups of 30 each. Group I(LC group) patients received 18 ml of 0.5% levo bupivacaine and clonidine 2mcg/kg. Group II(LD group) patients received 18 ml of 0.5% levo bupivacaine and dexmedetomidine 1.5mcg/kg. Preoperative and postoperative block characteristics as well as hemodynamic parameters were observed and recorded. The results were Dexmedetomidine had an earlier onset and longer duration of sensory and motor block...
https://www.ijrrjournal.com/IJRR\_Vol.5\_Issue.12\_Dec2018/Abstract\_IJRR0045.html, 2018
Background:-Bupivacaine is the standard local anaesthetic agent for intrathecal/epidural analgesia. Adjuvants are often added to improve analgesia and reduce the dose of bupivacaine thereby decreasing the cost of the drug used and minimize side effects. Aim:-A comparative evaluation of clonidine, dexmedetomidine and neostigmine used as adjuvants to 0. 5% bupivacaine in epidural anaesthesia for lower limb and lower abdominal surgery. Design and Place:-This is a comparative study which was carried out in 80(eighty) patients admitted in National Institute Of Medical Sciences & Research, Jaipur over a period of one year w.e.f. November 2017 to November 2018. Method:-80 patients of either sex ranging in age from 18-60 years, scheduled for lower limb and lower abdominal surgeries were divided into four study groups randomly by an investigator not directly linked to the study. All patients were given epidural anaesthesia for undergoing the proposed surgery. Epidural Neostigmine, Clonidine or Dexmedetomidine was added to bupivacaine depending upon the patient group and results in terms of efficacy, safety and prolongation of analgesic effect were noted. Result:-The use of these adjuvants prolonged the post operative analgesia and the prolongation was maximum in Dexmedetomidine group followed by Clonidine and then the Neostigmine group.Conclusion: When these non opioid adjuvants are added to 0.5% Bupivacaine in epidural anaesthesia, they prolong the analgesic effect with added advantage of opioid sparing effect as the use of epidural opioids is always associated with increased incidence of unwanted side effects.
2017
Epidural anesthesia is useful for providing both intraoperative anesthesia and postoperative analgesia. It provides intra operative hemodynamic stability, reduce perioperative stress response, helps in early mobilisation and thereby reducing complications and improving patient outcome. e quality and duration of analgesia is improved, when a local anesthetic is combined with alpha 2 adrenergic agonist. Aim of our study was to compare epidural dexmedetomidine and clonidine as an adjuvant to bupivacaine with respect to perioperative block characteristics, postoperative analgesia, sedation and hemodynamic profile. Methodology In our study, 90 patients of American Society of Anaesthesiologists grading I/ II of ages between 35-55 years posted for elective abdominal hysterectomy, were selected. e patients were randomly divided into three groups. Group B received 10 ml of 0.5% Bupivacaine+1ml of saline, Group BD received 10 ml 0.5% Bupivacaine plus 1.5 μg/kg Dexmedetomidine & Group BC rec...
Scholars Journal of Applied Medical Sciences
Original Research Article Background: Abdominal hysterectomy is a common and major surgery associated with moderate to severe pain. Various short and long term complications may occur if the pain is treated inadequately. Different drugs and interventions are currently being practiced for adequate pain management. Among them, preemptive analgesia was adopted with the aim to reduce the dose of opioid by preventing central sensitization. Thereby, avoiding dose related side effects despite providing adequate analgesia. The dexmedetomidine, a highly potent 2 agonist with several perioperative beneficial properties, was investigated for its status as preemptive analgesic. Objective: The present study was designed to evaluate the role of preemptive dexmedetomidine on postoperative analgesia following open abdominal hysterectomy under general anaesthesia. Methods: Forty ASA I and II, aged more than 18 years patients, undergoing open abdominal hysterectomy were allocated into 2 equal groups (n=20 in each group) by a computergenerated randomization table. Group A and B received equal volumetric (0.25ml/kg) dexmedetomidine and normal saline respectively, 20 minutes prior to induction of general anaesthesia. VAS and PCA morphine consumption, heart rate, mean arterial pressure and capillary oxygen saturation was recorded at defined postoperative time points and adverse effects were noted. Results: The total amount of postoperative morphine requirement after 24 hours was 30.98±1.15 mg in group A and 32.15±2.16 mg in Group B (p value=0.039) which is significantly higher in group B. The group A had significantly lower VAS score in both the resting (P= 0.001, 0.001, 0.019, 0.010and 0.042) and movement state (P = 0.001, 0.006, 0.007, 0.029 and 0.035) for time points of 1 st , 2 nd , 6 th , 12 th and 24 th hours postoperatively, compared to the group A. Furthermore, we observed, there was significant obtundation of HR and MAP, evoked by intubation and extubation in group A. Similar response was seen just after extubation. HR was significantly (P<0.05) lower in group A at all postoperative follow up. Additionally, group A had lower MAP compared to group B. The opioid related adverse events were slightly lower in dexmedetomidine group. Conclusion: Preemptive use of intravenous dexmedetomidine reduced postoperative pain intensity, opioid requirement and rendered better haemodynamic stability.
2015
This was a prospective randomized double blind study was conducted to evaluate Dexmedetomidine as an adjuvant with Bupivacaine (Bupivacaine 0.5%-Heavy for spinal anesthesia) intrathecally in patient undergoing abdominal hysterectomy surgery. Aim and Objectives: 1. To evaluate the efficacy of Inj. Dexmedetomidine as an adjuvant to Inj. Bupivacaine (Heavy 0.5%) for Spinal anaesthesia. 2. To know the onset, duration & quality of sensory & motor block of spinal anaesthesia. 3. To know the hemodynamic stability & side effects of the drug under study. Methods: A total of 60 female patients' age between 35-70 years classified as ASA grade I and II were randomly divided into two equal groups scheduled for abdominal hysterectomy under spinal anesthesia. The dose of spinal anesthesia drug in Group I was 3.5 ml Bupivacaine with 0.05 ml (5μg) Dexmedetomidine and in Group II was 3.5 ml Bupivacaine with 0.05 ml Normal Saline. The onset of sensory and motor block, duration of sensory and motor block, haemodynamic stability, quality of surgical anesthesia, intraoperative complications, postoperative analgesia and side effects were recorded. Results: In Group I, early onset of sensory and motor block was noted as compared to Group II. The duration of sensory and motor block was significantly longer in Group I than Group II. The hemodynamic stability was observed in Group I. The quality of anesthesia was excellent in group I. The requirement of intraoperative sedation was significantly less in Group I when compared with Group II. The postoperative analgesia duration was significantly longer in Group I than Group II with minimal postoperative side effects. Conclusions: Inj. Dexmedetomidine 5 μg seems to be an excellent alternative adjuvant with spinal Bupivacaine (Heavy 0.5%) to increase duration of postoperative analgesia of spinal anesthesia in surgical procedure like abdominal hysterectomy.