Abstract
Background: Alpha 2 agonists are being used as adjuvants in epidural analgesia as they lead to analgesia, anxiolysis and sedation.
Aim: This study aims to evaluate the post operative analgesic effects of epidural dexmedetomidine and clonidine with 0.125%levobupivacaine
Methods: A comparative study was done to assess the efficacy and clinical profile of two α2 adrenergic agonists – clonidine and dexmedetomidine administered epidurally in combination with intrathecal 0.125%levobupivacaine. The study was conducted for 1 year. Sixty adult patients ASA-PS Class I and II undergoing pelvis and lower limb orthopaedic surgery were randomly assigned into two groups, to receive either epidural dexmedetomidine (1μg/kg) or clonidine (2 μg/kg) with 0.125% isobaric levobupivacaine.
Results: Dexmedetomidine provided a prolonged analgesia, as evidenced by the distribution of VAS scores and requirement rescue analgesic among two groups.
Keywords: Epidural analgesia, 0.125%Levobupivacaine, Dexmedetomidine, Clonidine.
References
- Rawal N, Schollin J, Wesström G. Epidural versus combined spinal epidural block for cesarean section. Acta Anaesthesiol Scand. 1988;32:61–6.
- Yousef AA, Atef AM, Awais WM. Comparison of fentanyl versus meperidine as supplements to epidural clonidine-bupivacaine in patients with lower limb orthopedic surgery under combined spinal epidural anesthesia. BMC Anesthesiol. 2015;15:146.
- Tummala V, Rao LN, Vallury MK, Sanapala A. A comparative study-efficacy and safety of combined spinal epidural anesthesia versus spinal anesthesia in high-risk geriatric patients for surgeries around the hip joint.Anesth Essays Res. 2015;9:185–8.
- Xiao F, Xu WP, Zhang YF, Liu L, Liu X, Wang LZ. The dose-response of intrathecalropivacaine co-administered with sufentanil for cesarean delivery under combined spinal-epidural anesthesia in patients with scarred uterus. Chin Med J (Engl) 2015;128:2577–82.
- Sessler CN, Grap MJ, Ramsay MA. Evaluating and monitoring analgesia and sedation in the Intensive Care Unit. Crit Care. 2008;12(Suppl 3):S2.
- Hjermstad MJ, Fayers PM, Haugen DF, Caraceni A, Hanks GW, Loge JH, et al. Studies comparing Numerical Rating Scales, Verbal Rating Scales, and Visual Analogue Scales for assessment of pain intensity in adults: A systematic literature review. J Pain Symptom Manage. 2011;41:1073–93.
- Bajwa SJ, Kaur J. Clinical profile of levobupivacaine in regional anesthesia: A systematic review. J Anaesthesiol Clin Pharmacol. 2013;29:530–9.
- Leone S, Di Cianni S, Casati A, Fanelli G. Pharmacology, toxicology, and clinical use of new long acting local anesthetics, ropivacaine and levobupivacaine. Acta Biomed. 2008;79:92–105.
- Burlacu CL, Buggy DJ. Update on local anesthetics: Focus on levobupivacaine. Ther Clin Risk Manag. 2008;4:381–92.
- Afonso J, Reis F. Dexmedetomidine: Current role in anesthesia and intensive care. Rev Bras Anestesiol. 2012;62:118–33.
- Bajwa SJ, Bajwa SK, Kaur J, Singh G, Arora V, Gupta S, et al. Dexmedetomidine and clonidine in epidural anaesthesia: A comparative evaluation. Indian J Anaesth. 2011;55:116–2
- Liu N, Bonnet F, Delaunay L, Kermarec N, D’Honneur G. Partial reversal of the effects of extradural clonidine by oral yohimbine in postoperative patients. Br J Anaesth. 1993;70:515–8.
- MacDonald E, Kobilka BK, Scheinin M. Gene targeting – Homing in on alpha 2-adrenoceptor-subtype function. Trends Pharmacol Sci. 1997;18:211–9.
- Ruokonen E, Parviainen I, Jakob SM, Nunes S, Kaukonen M, Shepherd ST, et al. Dexmedetomidine versus propofol/ midazolam for long-term sedation during mechanical ventilation. Intensive Care Med. 2009;35:282–90.
- Guinter JR, Kristeller JL. Prolonged infusions of dexmedetomidine in critically ill patients. Am J Health Syst Pharm. 2010;67:1246–53.
- Gerlach AT, Murphy CV, Dasta JF. An updated focused review of dexmedetomidine in adults. Ann Pharmacother. 2009;43:2064–74.
- Arunkumar S, Hemanth Kumar VR, Krishnaveni N, Ravishankar M, Jaya V, Aruloli M. Comparison of dexmedetomidine and clonidine as an adjuvant to ropivacaine for epidural anesthesia in lower abdominal and lower limb surgeries. Saudi J Anaesth. 2015;9:404–8.
- Jain D, Khan RM, Kumar D, Kumar N. Perioperative effect of epidural dexmedetomidine with intrathecal bupivacaine on haemodynamic parameters and quality of analgesia. South Afr J AnaesthAnalg. 2012;18:105–9.
- Fukushima K, Nishini Y, Mori K, Takeda J. Effect of epidurally administered dexmedetomidine on sympathetic activity and postoperative pain in man. Anesth Analg. 1996;82:S121.
- Salgado PF, Sabbag AT, Silva PC, Brienze SL, Dalto HP, Módolo NS, et al. Synergistic effect between dexmedetomidine and 0.75% ropivacaine in epidural anesthesia. Rev Assoc Med Bras. 2008;54:110–5.
- Ishii H, Kohno T, Yamakura T, Ikoma M, Baba H. Action of dexmedetomidine on the substantiagelatinosa neurons of the rat spinal cord. Eur J Neurosci. 2008;27: 3182–90.
- Langer SZ, Duval N, Massingham R. Pharmacologic and therapeutic significance of alpha-adrenoceptor subtypes. J Cardiovasc Pharmacol. 1985;7 (Suppl 8):S1–8.
Corresponding Author
Dr Amutha Rani R MD
Prof & HOD, Department of Anaesthesiology, Tirunelveli Medical College