Abstract
Abdominal Hysterectomy surgeries. Regional anesthesia is preferred for lower abdominal surgeries. Local anaesthetics used commonly are Lignocaine, Bupivacaine & Ropivacaine. Clonidine and Dexmeditomedine are α2-adrenoreceptor agonists with anxiolytic and dose-related sedative properties. In addition to above properties, they provide good analgesia devoid of respiratory depression and good adjuncts to local anaesthetics.
Aim
1. To compare the clinical effects of epidural Dexmedetomidine and epidural Clonidine when used as adjuvant to epidural Ropivacaine
2. To find out the time of first epidural top up.
3. To find the number of analgesic requirement until the time of first epidural top up.
Materials And Methods
This study was conducted after obtaining approval of institutional technical committee and Human Ethical committee of Government Medical College Trivandrum.
Study design: Prospective cohort study
Study setting: Government Medical College Trivandrum.
120 patients were selected and divided into 3 groups randomly. First group received Ropivacaine alone(R), second Ropivacaine plus Clonidine(RC) and third group Ropivacaine plus Dexmeditomedine(R).
Inclusion Criteria
· Patients undergoing elective Abdominal Hysterectomy
· (ASA) I & II
· Age 30 – 60 years
· Weight 40 – 80 kg
· Height 145 – 165 cm
Exclusion Criteria
· Patient refusal
· Patients on sympathomimetics, sympatholytic or anticholinergic drugs
Known hypersensitivity to Dexmedetomidine/clonidine/local anaesthetics
References
1. Kenneth Drasner. Local Anesthetics. In: Ronald D. Miller, Manuel C. Pardo, ed. Basics of anesthesia 6th ed. Philadelphia: Elsevier Saunders 2011. p. 140.
2. Christopher M. Bernards. Epidural and Spinal Anesthesia. In: Paul G. Barash, Bruce F. Cullen, Robert K. Stoelting, Michael K. Cahalan, M. Christine Stock, ed. Clinical Anesthesia, 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2009. p. 538-39.
3. Kamibayashi T, Maze M. Clinical uses of alpha-2 adrenergic agonists. Anaesthesi-ology 2000; 93(5): 1345-9.
4. Frolich MA, Caton D: Pioneers in epidural needle design. Anesth Analg 2001;93:215–220
5. Pagés F: Metameric anesthesia, 1921. In: Faulconer A, Keys TE (trans): Found-ations of Anesthesiology. Springfield, IL, Charles C Thomas, 1965, p 927
6. Dogliotti A: A new method of block: Segmental peridural spinal anesthesia. Am J Surg 1933;20:107–118
7. Seow LT, Lips FJ, Cousins MJ: Effect of lateral position on epidural blockade for surgery. Anaesth Intensive Care 1973; 11:97.
8. Zarzur E: Genesis of “true” negative pressure in the lumbar epidural space: A new hypothesis. Anaesthesia 1984; 39:1101
9. Hamilton CL, Riley ET, Cohen SE: Changes in the position of epidural catheters associated with patient movement. Anesthesiology 1997; 86:778.
10. Beilin Y, Bernstein HH, Zucker-Pinchoff B: The optimal distance that a multi-orifice epidural catheter should be threaded into the epidural space. Anesth Analg 1995; 81:301. 91
11. Mackie K, Lam A: Epinephrine-containing test dose during betablockade. J Clin Monit 1991; 7: 213
12. Moore D, Batra M: The components of an effective test dose prior to epidural block. Anesthesiology 1981;55:693
13. Guinard J, Mulroy M, Carpenter R et al: Test doses: Optimal epinephrine content with and without acute beta-adrenergic blockade. Anesthesiology 1990;73:386
14. Christopher M. Bernards. Epidural and Spinal Anesthesia. In: Paul G. Barash, Bruce F. Cullen, Robert K. Stoelting, Michael K. Cahalan, M. Christine Stock, ed. Clinical Anesthesia, 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2009. p.942
15. Bernadette T. Veering and Michael J. cousins. Epidural neural blockade. In: Michael J. cousins, Daniel B. Carr, Terese T. Horlocker, Phillip O. Bridenbaugh,ed. Cousins and Bridenbaugh’s neural blockade in clinical anaesthesia and pain; 4th ed. Lippincott Williams & Wilkins, Wolter Kluwer health; 2009. p.257.