Epidural Clonidine or Sufentanil for Intraoperative and Postoperative Analgesia (original) (raw)
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Comparison of epidural sufentanil plus clonidine with sufentanil alone for postoperative pain relief
Anaesthesia, 1990
Sufentanil 25 pg plus clonidine 1 pg/kg administered epidurally was compared with epidural sufentanil 50 pg alone in a double-blind fashion for pain relief in 40 patients after abdominal surgery. The duration of complete pain relief was significantly longer in those who received the mixture. Oxygen saturation was reduced 10 and 20 minutes after sufentanil alone, but remained stable after sufentanil and clonidine. There were significant decreases in arterial blood pressure in the latter group that were maximum between 20 and 120 minutes after administration.
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...
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.
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.
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.
PubMed, 2015
Background: Alpha-2 adrenergic agonists produce safe and effective analgesia, but most investigations studying the analgesic effect of alpha-2 adrenoceptor agonists postoperatively included previous or concomitant administration of other analgesics. Because clonidine potentiates the effect of these drugs, its own intrinsic analgesic effect has been difficult to establish. This study was designed to compare the intraoperative and postoperative effects of epidural clonidine vs bupivacaine for patients undergoing lower abdominal surgery. Methods: This randomized controlled trial included 40 patients aged 18-50 who were scheduled for elective lower abdominal surgery. Patients were randomly divided into 2 groups. Group I (n=20) received epidural clonidine; Group II (n=20) received epidural bupivacaine. Intraoperative and postoperative hemodynamics, pain scores, and complications were monitored. Results: Mean pain scores were significantly lower in Group I compared to Group II (1.5 ± 0.5 compared to 3.4 ± 1.0, respectively) in the first 12 hours after surgery. Sedation was more prominent in Group I until 9 hours after surgery. Opioid requirements were significantly lower in Group I. Respiratory rate was similar in the 2 groups. Group I had larger decreases from baseline in systolic blood pressure and diastolic blood pressure than Group II. Heart rate in Group I was reduced from baseline, while it was increased in Group II. Less postoperative nausea and vomiting, urinary retention, pruritus, and shivering were observed in Group I. Conclusion: Compared to bupivacaine, epidural clonidine provided effective intraoperative and postoperative analgesia in selected patients, resulting in a decreased intravenous pain medication requirement and prolonged duration of analgesia after epidural infusion was discontinued.
Anesthesia: Essays and Researches, 2015
Background: Many adjuvants are used to increase the efficacy of epidural local anesthetics for postoperative analgesia. Aims: The aim was to compare the efficacy of epidural morphine (0.1 mg/kg) and clonidine (2 µg/kg) with bupivacaine (0.125%) for postoperative analgesia in abdominal surgeries. Settings and Design: Double-blind retrospective randomized study. Methodology: All the patients (n = 60) varying from age group belonging to American Society of Anesthesiologists I-II were randomly allocated to receive epidural analgesia Group A-Morphine (0.1 mg/kg). + Bupivacaine (0.125%) (n = 30), Group B-Clonidine (2 µ/kg) + Bupivacaine (0.125%) (n = 30). We monitored vitals and requirement of inhalational gases intra-operatively, pain by visual analogue score (VAS) and vitals postoperatively. We used rescue analgesics (injection diclofenac 1 mg/kg intravenous) when VAS score > 5. Postoperatively, various parameters were monitored for first 2 h at intervals of 30 min and at 4, 8, 12, 16, and 24 hourly intervals after giving 1 st dose. Statistical Analysis Used: Continuous data are analyzed by Student's t-test (paired 't'-test for intragroup variations and unpaired 't'-test for intergroup variations). Chi-square test was used for categorical data. A P ≤ 0.05 was considered to be statistically significant. Results: Mean duration of analgesia was 8.35 ± 0.42 h in Group A (morphine) and 7.45 ± 0.44 h in Group B (clonidine). This difference was statistically significant (P < 0.001), indicating a prolongation of analgesia in group morphine. There was no need of rescue analgesia in any subjects. Group A patients were hemodynamically stable and required less inhalation agents intra-operatively compared to group B patients. Conclusions: Epidural morphine plus bupivacaine has a longer duration of analgesia and greater hemodynamic stability as compared to epidural clonidine plus bupivacaine for postoperative analgesia in abdominal surgeries.
Canadian Journal of Anaesthesia, 1996
Purpose: The aim of the study was to assess and compare in analogous controlled experimental conditions, the anaesthetic sparing and analgesic effects of the same dose of clonidine administered by the intramuscular (ira) and epidural (ep) routes. Methods: We used a randomized, double blind and placebo controlled protocol. Sixty patients undergoing abdominal hysterectomy were distributed into three groups who, 30 rain before surgical incision, received: 300 IJg ep clonidine plus im saline; ep saline plus 300 lag im clonidine; or ep and im saline (ss). General anaesthesia was maintained with 60% N20 in 02, and isoflurane administered at concentrations to maintain mean arterial pressure (MAP) and heart rate (HR) within 20% of basal values, lsoflurane requirements (mass spectrometry), cardiovascular variables (MAP, HR), and plasma concentrations of glucose, cortisol and prolactin were evaluated at criti-cal time points. In the recovery room (RR), sedation (Ramsay) and pain intensity (VAS) were estimated at the time of analgesia request (TAR). Results: Intramuscular and ep clonidine decreased isoflurane requirements similarly by about 85% (P < 0.00t). Patients in the ep group had lower MAP (P < 0.03) and FIR (P < 0.00t) than in the im group, but im and ep clonidine similarly blunted the plasma prolactin increase induced by intubation. In RR, ep but not im clonidine (P < 0.01) induced postoperative analgesia demonstrated by a prolonged TAR 80.8 • Z3 (ep) 35.9 • 3.2 (im) and44.5 +_ 5.1 (ss) min and a lower VAS (P < 0.05). Conclusions: Epidural and intramuscular clonidine decreased isoflurane requirements similarly, but only the epidural route provided postoperative analgesia, suggesting a spinal site for the analgesic action.
Journal of Dhaka Medical College
Background: Upper abdominal surgery (like- hepatobiliary surgery, gastrectomy, esophagectomy, hepatictomy, and whipples operations that involve large surgical incisions) lead to severe postoperative pain that lead to higher doses of opoids use in post-operative period as a result incidence of unwanted side effect and respiratory complication increase hospital stay and morbidity. To reduce the use of opioids clonidine can be used as a multimodal analgesic approach. It is reported that clonidine 150mcg intravenous (I/V) produce a similar analgesic effect to morphine 5mg in patient after orthopedic surgery. Because of its dose, route, and surgical variation it is very much important to specify the dose for upper abdominal surgery. Material and methods: After considering the inclusion and exclusion criteria the patients were randomized to receive Group: A (2mcg/kg oral clonidine) and Group: B (4mcg/kg oral clonidine), one hour (60minutes) before surgery as an oral premedication. All gro...
Effects of clonidine preemptive analgesia on acute postoperative pain in abdominal surgery
PubMed, 2007
Preemptive analgesia refers to blockade of afferent nerve fibers before a painful stimulus, which prevents or reduces subsequent pain even beyond the effect of the block. The aim of the study was to compare the effect of clonidine used before and at the end of operation on pain control in abdominal surgery. A total of 77 patients admitted for colorectal surgery were randomly classified into three groups: epidural clonidine before operation, epidural clonidine at the end of operation, and control group. After the operation on patient demand, analgesia with boluses of epidural morphine was instituted. The parameters of postoperative pain level using VAS score (visual analog scale), sedation and analgesics consumption were determined as outcome measures at 1, 2, 6, and 24 h of the operation. Clonidine administered before operation provided lowest pain scores at 6 and 24 h (p < 0.05). Clonidine administered at the end of operation had low pain scores at 1 and 2 h, with a significant pain breakthrough thereafter (6.93 +/- 1.66 at 6 h and 4.04 +/- 2.39 at 24 h) compared with the group administered clonidine before operation (3.60 +/- 2.94 and 3.71 +/- 1.82). Clonidine administered before operation provided less sedation (p < 0.05) and a significantly lower use of analgesics (p < 0.05). Blockade of nociceptive stimulus using the centrally acting alpha2-adrenergic agonist clonidine before the onset of pain stimulus resulted in reduced pain levels, sedation and analgesic requirement.