Abstract
Background: Without a proper post operative analgesic plan, patients undergoing elective lumbar spine surgeries suffer from acute post operative pain and tend to develop chronic low back pain syndromes. A prospective randomised study was done to compare the analgesic profile of dexmedetomidine and clonidine as adjuvants to ropivacaine, when used via epidural route.
Methods: Forty four subjects, 24 male and 20 female, 20-65 years, belonging to American Society of Anaesthesiologists Physical Status I and II, who underwent elective lumbar spine surgery were randomly divided into 2 groups, ropivacaine + clonidine (group C) and ropivacaine + dexmedetomidine (group D). At the end of the surgery, an epidural catheter was placed by the surgeon under direct vision. Group C received 20 ml 0.2% ropivacaine + 2 µg/kg clonidine and group D received 20 ml 0.2% ropivacaine + 1 µg/kg dexmedetomidine through the catheter. Onset of analgesia, time to peak effect, duration of analgesia, haemodynamic parameters and side effects were noted.
Results: Patients of group D had faster onset, early peak effect, prolonged duration of analgesia and better haemodynamic stability. The incidence of nausea, vomiting, respiratory depression, dry mouth, motor block were comparable in both groups, but sedation scores were higher in group D.
Conclusion: Epidural analgesia with ropivacaine and alpha 2 adrenergic agonists provided safe and reliable pain relief in lumbar spine surgery in early post operative period. Dexmedetomidine as an adjuvant, was associated with better analgesic parameters, safe haemodynamics and less side effects compared to clonidine.
References
- Sandkuehler J. Fear the pain. Lancet 2002; 360:426.
- Perkins FM, Kehlet H. Chronic pain as an outcome of surgery: A review of predictive factors. Anesthesiology 2000; 93:1123–33.
- Smith GF. Perioperative care of the spine patient. In: White AH, Schofferman JA, editors. Spine care.St Louis :Mosby ;1995.
- Rodgers A, Walker N, Schug S, McKee A, Kehlet H, Van Zundert A, et al . Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: Results from an overview of randomized trials. BMJ 2000; 231:1493–7
- Liu S, Carpenter RL, Neal JM. Epidural anesthesia and analgesia: Their role in postoperative outcome. Anesthesiology 1995; 82:1474–506
- Kanazi GE, Aouad MT, Jabbour-Khoury SI, Al Jazzar MD, Alameddine MM, Al-Yaman R, et Effect of low-dose dexmedetomidine or clonidine on the characteristics of bupivacaine spinal block. Acta Anaesthesiol Scand 2006;50:222-7.
- Farmery AD,Wilson-MacDonald J.The analgesic effect of epidural clonidine after spinal surgery : A randomized placebo-controlled trial. Anaesth Analg 2009;108:631-4.
- Bajwa SJ, Bajwa SK,Kaur J,Singh G,Arora V,Gupta S ,Kulshrestha A,Singh A, Parmer SS, Singh A, Goraya SPS. Dexmedetomidine and clonidine in epidural anaesthesia: A comparative evaluation. Indian J Anaesthesia 2011;55:116-21.
- Zaric D, Nydahl PA, Philipson L, Samuelsson L, Heierson A, Axelsson K. The effect of continuous lumbar epidural infusion of ropivacaine (0.1%, 0.2%, and 0.3%) and 0.25% bupivacaine on sensory and motor block in volunteers: A double-blind study. Reg Anesth 1996;21:14-25.
- McClellan KJ, Faulds D. Ropivacaine: An update of its use in regional anesthesia. Drugs 2000;60:1065-93.
- Saravana Babu MS, Verma AK, Agarwal A, Tyagi CM, Upadhyay M, Tripathi A comparative study in the post operative spine surgeries : Epidural ropivacaine with dexmedetomidine and ropivacaine with clonidine for post-operative analgesia. Indian J Anaesth 2013;57:371-6.
- Bajwa SJ, Arora V, Kaur J, Singh A, Parmar SS. Comparative evaluation of dexmedetomidine and fentanyl for epidural analgesia in lower limb orthopedic surgeries. Saudi J Anaesth 2011;5:365-70.
- Gottschalk A, Freitag M, Tank S, Burmeister MA, Kreil S, Kothe R. Quality of postoperative pain using an intraoperatively placed epidural catheter after major lumbar spinal surgery. Anesthesiology. 2004 Jul;101(1):175-80.
- Blumenthal S,Min K, Nadig M, Borgeat A. Double Epidural Catheter with Ropivacaine versus Intravenous Morphine: A Comparison for PostoperativeAnalgesia after Scoliosis Correction Surgery. Anesthesiology 2005; 102:175–80.
- Antônio Mauro Vieira, Taylor Brandão Schnaider, Antônio Carlos Aguiar Brandão, Flávio Aparecido Pereira, Everaldo Donizeti Costa, Carlos Eduardo Povoa Fonseca : Epidural clonidine or dexmedetomine for post-cholecystectomy analgesia and sedation. Rev Bras Anestesiol, 2004 Aug;54(4):473-8.
- Aryan HE, Box KW, Ibrahim D, Desiraju U,Ames CP. Safety and efficacy of dexmedetomidine in neurosurgical patients. Brain Inj 2006;20:791-8.
- Kumar RJ, Menon KV, Ranjith TC. Use of epidural analgesia for pain management after major spinal surgery. J Orthop Surg (Hong Kong) 2003;11:67-72.
- Rechtine GR, Love The postoperative laminectomy pain control using bupivacaine and epidural morphine. Br J Anaesth 2005;95:59-68.
Corresponding Author
Dr Chiranjib Bhattacharyya
Address- Block- HA 280, Sector 3, Salt lake, Kolkata-700097, India
DOI: https://dx.doi.org/10.18535/jmscr/v7i9.82
