TO COMPARE DEXMEDETOMIDINE WITH CLONIDINE AS ADJUVANTS TO ROPIVACAINE IN EPIDURAL ANESTHESIA IN PATIENTS UNDERGOING LOWER ABDOMINAL SURGERIES
DOI:
https://doi.org/10.22159/ajpcr.2023.v16i6.46319Keywords:
Dexmedetomidine, Clonidine, Ropivacaine, Epidural anesthesia, Bromage scaleAbstract
Objective: The objective of the study is to compare dexmedetomidine with clonidine as adjuvants to ropivacaine in epidural anesthesia in the onset of sensory and motor blockade, duration of post-operative analgesia, level of sedation, and occurrence of side effects.
Methods: This study was a prospective randomized observational and comparative study. Sixty patients of age between 20 and 50 years with the American Society of Anesthesiologists grade I and II physical status belonging to both sexes undergoing abdominal surgeries under epidural anesthesia are included; patients were allocated randomly into two groups comprising 30 patients in each group. Group A patients are given injection dexmedetomidine, added to ropivacaine and Group B patients are given injection clonidine, added to ropivacaine by epidural route. Following parameters were observed intra and post-operatively: Onset of sensory and motor blockade and duration of motor blockade, level of sedation, duration of analgesia, and side effects. All data are presented in tabular form as mean ± standard deviation. The analysis is done by unpaired t-test. Statistical analysis is done using SPSS software.
Results: Mean time of onset of sensory blockade in Group A was 9.50 min with standard deviation of 1.85 and in Group B was 9.48 min with standard deviation of 1.60. Mean time of onset of motor blockade in Group A was 20.66 min with standard deviation of 2.83 and in Group B was 20.48 min with standard deviation of 2.52. Mean duration of analgesia in Group A was 312.66 min with standard deviation of 22.02 and in Group B was 314.20 min with standard deviation of 24.58. There is no statistical difference between two groups in the level of sedation which was assessed by Wilson’s sedation scale. Side effects most commonly observed are hypotension and bradycardia.
Conclusion: We conclude that both dexmedetomidine and clonidine are similar in efficacy and tolerability as adjuvants in the onset of sensory and motor blockade and post-operative analgesia when added to ropivacaine in epidural anesthesia.
Downloads
References
Nimmo SM. Benefit and outcome after epidural analgesia. Contin Educ Anaesth Crit Care Pain 2004;4:44-7. doi: 10.1093/bjaceaccp/mkh014
Park WY, Thompson JS, Lee KK. Effect of epidural anesthesia and analgesia on perioperative outcome: A randomized, controlled Veterans Affairs cooperative study. Ann Surg 2001;234:560-9; discussion 569. doi: 10.1097/00000658-200110000-00015, PMID 11573049
Holte K, Kehlet H. Epidural anesthesia and analgesia-effects on surgical stress responses and implications for postoperative nutrition. Clin Nutr 2002;21:199-206. doi: 10.1054/clnu.2001.0514, PMID 12127927
Rigg JR, Jamrozik K, Myles PS, Silbert BS, Peyton PJ, Parsons RW, et al. Epidural anesthesia and analgesia and outcome of major surgery: A randomized trial. Lancet 2002;359:1276-82. doi: 10.1016/S0140- 6736(02)08266-1, PMID 11965272
Moraca RJ, Sheldon DG, Thirlby RC. The role of epidural anesthesia and analgesia in surgical practice. Ann Surg 2003;238:663-73. doi: 10.1097/01.sla.0000094300.36689.ad, PMID 14578727
Ekenstam B, Egner B, Pettersson G. Local anaesthetic I, N-alkyl pyrrolodine and N-alkyl piperidine carboxylic acid amides. Acta Chem Scand 1957;11:1183-90.
McClellan KJ, Faulds D. Ropivacaine: An update of its use in regional anaesthesia. Drugs 2000;60:1065-93. doi: 10.2165/00003495- 200060050-00007, PMID 11129123
Gunter JB. Benefit and risks of local anesthetics in infants and children. Paediatr Drugs 2002;4:649-72. doi: 10.2165/00128072-200204100- 00003, PMID 12269841
Reddy VS, Shaik NA, Donthu B, Sannala VK, Jangam V. Intravenous dexmedetomidine versus clonidine for prolongation of bupivacaine spinal anesthesia and analgesia: A randomized double-blind study. J Anaesthesiol Clin Pharmacol 2013;29:342-7. doi: 10.4103/0970- 9185.117101, PMID 24106359
Harsoor S, Rani DD, Yalamuru B, Sudheesh K, Nethra SS. Effect of supplementation of low dose intravenous dexmedetomidine on characteristics of spinal anaesthesia with hyperbaric bupivacaine. Indian J Anaesth 2013;57:265-9. doi: 10.4103/0019-5049.115616, PMID 23983285
Agrawal A, Agrawal S, Payal YS. Comparison of block characteristics of spinal anesthesia following intravenous dexmedetomidine and clonidine. J Anaesthesiol Clin Pharmacol 2016;32:339-43. doi: 10.4103/0970-9185.188830, PMID 27625482
Förster JG, Rosenberg PH. Clinically useful adjuvants in regional anesthesia. Curr Opin Anaesthesiol 2003;16:477-86. doi: 10.1097/00001503-200310000-00007, PMID 17021500
Bajwa SJ, Bajwa SK, Kaur J, Singh G, Arora V, Gupta S, et al. Dexmedetomidine and clonidine in epidural anesthesia: A comparative evaluation. Indian J Anaesth 2011;55:116-21. doi: 10.4103/0019- 5049.79883, PMID 21712865
Swami SS, Keniya VM, Ladi SD, Rao R. Comparison of dexmedetomidine and clonidine (a2 agonist drugs) as an adjuvant to local anesthesia in supraclavicular brachial plexus block: A randomized double-blind prospective study. Indian J Anaesth 2012;56:243-9. doi: 10.4103/0019-5049.98767, PMID 22923822
Dinesh CN, Tej NA, Yatish B, Pujari VS, Kumar RM, Mohan CV. Effects of intravenous dexmedetomidine on hyperbaric bupivacaine spinal anesthesia: A randomized study. Saudi J Anaesth 2014;8:202-8. doi: 10.4103/1658-354X.130719, PMID 24843333
Mahendru V, Tewari A, Katyal S, Grewal A, Singh MR, Katyal R. A comparison of intrathecal dexmedetomidine, clonidine, and fentanyl as adjuvants to hyperbaric bupivacaine for lower limb surgery: A double-blind controlled study. J Anaesthesiol Clin Pharmacol 2013;29:496-502. doi: 10.4103/0970-9185.119151, PMID 24249987
Bharti N, Dontukurthy S, Bala I, Singh G. Postoperative analgesic effect of intravenous (i.v) clonidine compared with clonidine administration in wound infiltration for open cholecystectomy. Br J Anaesth 2013;111:656-61. doi: 10.1093/bja/aet130, PMID 23704191
Afonso J, Reis F. Dexmedetomidine: Current role in anesthesia and intensive care. Rev Bras Anestesiol 2012;62:118-33.
Memiş D, Turan A, Karamanlioğlu B, Pamukçu Z, Kurt I. Adding dexmedetomidine to lignocaine for IVRA. Anesth Analg 2004;98:835- 40. doi: 10.1213/01.ane.0000100680.77978.66, PMID 14980948
Esmaoglu A, Yegenoglu F, Akin A, Turk CY. Dexmedetomidine added to levobupivacaine prolongs axillary brachial plexus block. Anesth Analg 2010;111:1548-51. doi: 10.1213/ANE.0b013e3181fa3095, PMID 20889939
Bromage PR. Epidural Analgesia. Philadelphia, PA: W B Saunders; 1978. p. 144.
Wilson E, David A, MacKenzie N, Grant IS. Sedation during spinal anaesthesia: Comparison of propofol and midazolam. Br J Anaesth 1990;64:48-52. doi: 10.1093/bja/64.1.48, PMID 2302376
Eisenach JC, Shafer SL, Bucklin BA, Jackson C, Kallio A. Pharmacokinetics and pharmacodynamics of intraspinal dexmedetomidine in sheep. Anesthesiology 1994;80:1349-59. doi: 10.1097/00000542-199406000- 00023, PMID 7912045
Bajwa SJ, Kulshrestha A. Dexmedetomidine: An adjuvant making large inroads into clinical practice. Ann Med Health Sci Res 2013;3:475-83. doi: 10.4103/2141-9248.122044, PMID 24379995
Bagatini A, Gomes CR, Masella MZ, Rezer G. Dexmedetomidine: Pharmacology and clinical application. Rev Bras Anestesiol 2002;52:606- 17. doi: 10.1590/s0034-70942002000500012, PMID 19475232
Kanazi GE, Aouad MT, Jabbour-Khoury SI, Al Jazzar MD, Alameddine MM, Al-Yaman R et al. Effect of low-dose dexmedetomidine or clonidine on the characteristics of bupivacaine spinal block. Acta Anaesthesiol Scand 2006;50:222-7. doi: 10.1111/j.1399-6576.2006.00919.x
Al Ghanem SM, Massad IM, Al-Mustafa MM, Al-Zaben KR, Qudaisat IY, Qatawneh AM, et al. Effect of adding dexmedetomidine versus fentanyl to intrathecal bupivacaine on spinal block characteristics in gynaecological procedures: A double-blind controlled study. Am J Appl Sci 2009;6:882-7.
Oriol-Lopez SA, Maldonado-Sanchez KA, Hernandez-Bernal CE, Castelazo-Arredondo JA, Moctezuma RL. Epidural dexmedetomidine in regional anesthesia to reduce anxiety. Rev Mex Anestesiol 2008;31:271-7.
Neogi M, Bhattacharjee D, Dawn S, Chatterjee N. A comparative study between clonidine and dexmedetomidine used as adjuncts to ropivacaine for caudal analgesia in paediatric patients. J Anaesthesiol Clin Pharmacol 2010;26:149-53. doi: 10.4103/0970-9185.74900
Kumar S, Kushwaha BB, Prakash R, Jafa S, Malik W, Wahal R, et al. Comparative study of effects of dexmedetomidine and clonidine premedication in perioperative hemodynamic stability and postoperative analgesia in laparoscopic cholecystectomy. Internet J Anesthesiol 2014;33 :1-4.
Tripathi DC, Shah KS, Dubey SR, Doshi SM, Raval PV. Hemodynamic stress response during laparoscopic cholecystectomy: Effect of two different doses of intravenous clonidine premedication. J Anaesthesiol Clin Pharmacol 2011;27:475-80. doi: 10.4103/0970-9185.86586, PMID 22096279
Pöpping DM, Elia N, Marret E, Wenk M, Tramèr MR. Clonidine as an adjuvant to local anaesthetic for peripheral nerve and plexus blocks: A meta-analysis of randomized trials. Anesthesiology 2009;111:406-15. doi: 10.1097/ALN.0b013e3181aae897, PMID 19602964
Belleville JP, Ward DS, Bloor BC, Maze M. Effects of intravenous dexmedetomidine in humans. I. Sedation, ventilation, and metabolic rate. Anesthesiology 1992;77:1125-33. doi: 10.1097/00000542- 199212000-00013, PMID 1361310
Eren G, Cukurova Z, Demir G, Hergunsel O, Kozanhan B, Emir NS. Comparison of dexmedetomidine and three different doses of midazolam in preoperative sedation. J Anaesthesiol Clin Pharmacol 2011;27:367-72. doi: 10.4103/0970-9185.83684, PMID 21897510
Published
How to Cite
Issue
Section
Copyright (c) 2023 BYNDOOR YATISH, sagar
This work is licensed under a Creative Commons Attribution 4.0 International License.
The publication is licensed under CC By and is open access. Copyright is with author and allowed to retain publishing rights without restrictions.