Title: Dexmedetomidine and Clonidine as an Adjuvant to Ropivacaine for Epidural Anaesthesia

Authors: Gullapalli Hanumantharao, G. Bharathi, K. Nagarjuna Reddy

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i10.32

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. In our study we compared the effects of Clonidine (2mcg/kg) with Dexmedetomidine (1.5mcg/kg) as an adjunct to Epidural 0.75% Ropivacaine in lower abdominal and lower limb surgeries in adult patients. The mean time of onset of sensory blockade and mean time of onset of motor blockade in Dexmedetomidine group is significantly less than Clonidine group. The 2 segment regression time, The mean duration of sensory blockade and mean duration of motor blockade was significantly higher with Dexmedetomidine group than Clonidine group. The duration of analgesia was significantly prolonged and highest in the Dexmedetomidine group compared to Clonidine group. Both groups were similar in haemodynamic stability. We conclude that dexmedetomidine is a better adjuvant than clonidine in epidural anaesthesia as far as patient comfort, stable cardio-respiratory parameters, intra-operative and post-operative analgesia is concerned.

Keywords: Dexmedetomidine, Ropivacaine, Clonidine, Epidural, Regional Anaesthesia, Haemodynamics.

References

  1. Höhener D, Blumenthal S, Borgeat A. Sedation and regional anaesthesia in the adult patient. Br J Anaesth 2008;100:8-16.
  2. Helgeson LE. Sedation during regional anaesthesia: Inhalational versus intravenous. Curr Opin Anaesthesiol 2005;18:534-9.
  3. Asehnoune K, Albaladejo P, Smail N, Heriche C, Sitbon P, Gueneron JP, et al. Information and anaesthesia: What does the patient desire? Ann Fr Anesth Reanim 2000;19:577-81.
  4. Schnider TW, Minto CF. Predictors of onset and offset of drug effect. Eur J Anaesthesiol 2001;23:26-31.
  5. Mauro VA, Brandão ST. Clonidine and dexmedetomidine through epidural route for post-operative analgesia and sedation in a cholecystectomy. Rev Bras Anestesiol 2004;4:1-10.
  6. Schnaider TB, Vieira AM, Brandão AC, Lobo MV. Intra-operative analgesic effect of cetamine, clonidine and dexmedetomidine, administered through epidural route in surgery of the upper abdomen. Rev Bras Anestesiol 2005;55:525-31.
  7. Sukhminder Jit Singh Bajwa, Sukhwinder Kaur Bajwa, Jasbir Kaur, Gurpreet Singh, vikramjit Aroral, Sachin Gupta, Ashish Kulshrestha, Amarjit Singh, SSParmar, AnithaSingh, SPSGoraya. Dexmedetomidine and clonidine in epidural anaesthesia: A comparative evaluation -- Indian Journal of Anaesthesia, 2011 | Volume: 55 | issue: 2 | Page: 116-121.
  8. Pramila Soni. Comparison study for better adjuvant with ropivacaine in epidural anaesthesia-, anaesthesia essays and researches 2016 may-aug 10 (2)218-222.
  9. Sruthi arun kumar, V. Hemanth kumar, N. Krishnaveni, M. Ravi shanker, Velraj jaya and M. Aruloli. Comparison of dexmedetomidine and clonidine as adjuvant ropivacaine for epidural anaesthesia in lower limb and lower abdominal surgeries- Saudi Journal of Anaesthesia, 2015 | oct –dec 9(4) 404-408.
  10. MS Sravana babu,Anil kumar verma, Apurva agarwal, Chitra MS thyagi, Manoj upodhyay and Shiv shanker tripati Comparative study in the post-operative spine surgeries epidural ropivacaine with dexmedetomidine and ropivacaine with clonidine for post-operative analgesia - Indian Journal of Anaesthesia 2013 july-aug 57(4) 317-376.
  11. Safiya, Shaikh, Sarala, B. Mahesh. The efficacy and safety of epidural dexmedetomidine and clonidine with bupivacaine in patients undergoing lower limb orthopedic surgeries – Journal Of Anaesthesiology Clinical Pharmacology 2016 Apr- Jun v 32(2) 203- 209.
  12. W.Abdallah et al. Facilitatory effects of perineural dexmedetomidine on neuraxial and peripheral nerve block: a systematic review Br. J. Anaesth. (2013) doi: 10.1093/bja/aet066.
  13. M. Abd-Elwahab, A.M. Abd-Elmaksound, A.M. El-hennawy, H.S.El-Ozairy, S.R. Boulis. Addition of clonidine or dexmedetomidine to bupivacaine prolongs caudal analgesia in children, Br. J. Anaesth. (2009) 103 (2): 268-274.
  14. Salgado PF, Sabbag AT, Silva PC, Brienze SL, Dalto HP, Módolo NS, Braz JR, Nascimento P Jr. Hospital de Base da Faculdade de Medicina de São José do Rio Preto, SP-Synergistic effect between dexmedetomidine and 0.75% ropivacaine in epidural anesthesia -- Rev Assoc Med Bras. 2008 Mar-Apr;54(2):110-5.

Corresponding Author

G Bharathi

Email: This email address is being protected from spambots. You need JavaScript enabled to view it., Mobile no: 9866486733