Epidural anesthesia with ropivacaine with or without clonidine and postoperative pain in hemorrhoidectomies

Baptista, João Florêncio de Abreu; Gomez, Renato Santiago; Paulo, Danilo Nagib Salomão; Carraretto, Antônio Roberto; Brocco, Marcos Célio; Silva, José Jorge

doi:10.1590/s0102-86502014000300009

Cited by 9 publications

(5 citation statements)

References 33 publications

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“…The results of the present study suggest that clonidine, like epinephrine, is able to increase and prolong the efficacy of lidocaine anesthesia in inferior alveolar nerve block. Several studies have been carried out using different concentrations of clonidine for the enhancement of epidural anesthesia,[6] brachial plexus anesthesia,[7] and anesthesia of peripheral nerves. [8] Brkovic et al [9] mentions that clonidine (15 μg/ml) added to 2% lidocaine produces an onset, duration, and intensity of intraoral block anesthesia similar to those gained by a solution of 2% lidocaine with epinephrine (12.5 μg/ml).…”

Section: Discussionmentioning

confidence: 99%

Clonidine: An adjuvant to adrenaline in local anesthesia for third molar surgery

Alam

Krishna

Kumaran

et al. 2019

Ann Maxillofac Surg

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Purpose:The aim of the study is to compare the efficacy of anesthesia and hemodynamic parameters of clonidine and epinephrine in lignocaine for lower third molar surgery.Materials and Methods:Thirty healthy controls with impacted mandibular third molar were randomly selected from both sexes between the age group of 20–47 years. Patients were divided equally into two groups: Group I (Adrenaline group) and Group II (Clonidine group). Patients received 2.5 ml of 2% lignocaine with adrenaline (12.5 μg/ml) in Adrenaline group and 2.5 ml of 2% lignocaine with clonidine (15 μg/ml) in Clonidine group. Hemodynamic parameters (heart rate, systolic blood pressure [SBP], diastolic blood pressure [DBP], and mean arterial pressure [MAP]) were recorded preoperatively, intraoperatively, and postoperatively. The onset of anesthesia and duration of anesthesia were recorded using pinprick test for both groups. Postoperatively, patients were evaluated for pain experience by the visual analog scale and verbal rating scale.Results:Lignocaine with clonidine intraoperatively and postoperatively decreases SBP and DBP and MAP compared to lignocaine with adrenaline. There was no significant difference in the onset and duration of anesthesia in both the groups. There was a statistically significant difference seen in the visual analog scale, but no statistically significant difference was seen in the verbal rating scale.Conclusion:Clonidine has similar efficacy as that of adrenaline with better hemodynamic parameters and can be used as an alternative to adrenaline for third molar surgeries.

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Section: Discussionmentioning

confidence: 99%

Clonidine: An adjuvant to adrenaline in local anesthesia for third molar surgery

Alam

Krishna

Kumaran

et al. 2019

Ann Maxillofac Surg

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“…[ 14 ] used 15 μg and 30 μg clonidine as adjuvant in 1% ropivacaine (12 mg), they found significant prolongation of sensory and motor block with higher dose of clonidine in their respective studies. Kawaraguchi et al .,[ 15 ] Baptista et al .,[ 16 ] Gupta et al . [ 17 ] also found similar results.…”

Section: Discussionmentioning

confidence: 99%

A comparative study for the analgesic efficacy and safety profile of fentanyl versus clonidine as an adjuvant to epidural ropivacaine 0.75% in lower abdominal surgeries

et al. 2017

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Context:Different adjuvants are coadministered with local anesthetics to improve the speed of onset and duration of analgesia, and to reduce the dose, the selection of which is often left to the choice of an anesthesiologist.Aim:The aim of this study was to compare the analgesic efficacy and safety profile of fentanyl and clonidine as an adjuvant to epidural ropivacaine anesthesia.Setting and Design:With institutional ethical committee clearance, a prospective, randomized, placebo-controlled double-blind clinical study was conducted at Vivekananda Polyclinic and Institute of Medical Sciences, Lucknow.Material and Methods:Two groups with thirty patients each were randomly allocated to receive 15–20 ml of 0.75% ropivacaine with 75 μg clonidine or 15–20 ml of 0.75% ropivacaine with 75 μg fentanyl, respectively. Block characteristics such as onset of analgesia, maximum level of sensory blockade, complete motor blockade, hemodynamic, time to two-segment regressions, time for rescue analgesia, time to complete motor recovery, and side effects were analyzed.Results:Results showed that the onset of blockade is faster when fentanyl is used as additives. Time for two-segment regression was earlier in fentanyl group but time for rescue analgesia was longer in clonidine group.Statistical Analysis:Two groups were compared by Student's t-test and Chi-square test; ANOVA and significance of mean difference bet were done by Newman–Keuls test.Conclusion:Addition of clonidine to epidural ropivacaine provides superior analgesia than the addition of fentanyl to epidural ropivacaine without much difference in side effect profile.

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“…Likewise, multiple pharmacologic means have been employed to combat post-hemorrhoidectomy pain, including bupivacaine injection alone [18] [19], topical glyceryl trinitrate [20] [21], nifedipine [22], diltiazem [23], metronidazole [24] [25], or sucralfate [26], as well as botulinum toxin injection [27], methylene blue injection [28], and intramuscular ketorolac [29]. Systems to deliver analgesic medication over time, such as patient-controlled analgesia pumps and elastomeric infusion pumps [30], have been used, as have transcutaneous electrical nerve stimulation [31] and both epidural [32] and spinal blocks [33]. Historically, anal stretch was proposed by Goligher [34] to reduce post-hemorrhoidectomy pain and lateral internal anal sphincterotomy also has been proposed as an adjunctive pain-relieving measure [35].…”

Section: Discussionmentioning

confidence: 99%

Prolonged Opioid-Sparing Pain Control after Hemorrhoidectomy with Liposome Bupivacaine: Results from a Cohort of 95 Patients

Jetmore¹,

D²

2016

PST

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The objective of this retrospective study was to examine the effects of an intraoperative injection of liposome bupivacaine on the quality and duration of postsurgical pain control, patient satisfaction, and opioid use in a cohort of patients undergoing hemorrhoidectomy in an outpatient setting. Patients underwent ambulatory hemorrhoidectomy conducted by a single surgeon. Liposome bupivacaine 266 mg/20 mL was administered via infiltration at the end of surgery. After discharge, pain-related outcomes were assessed via telephone interviews. Outcomes of interest included first onset of pain after surgery, patient-reported pain intensity (0 = no pain; 10 = worst pain imaginable), time to first use of orally administered opioids after surgery, number of opioid tablets consumed postsurgery, and patient's satisfaction with postsurgical pain control. A total of 95 patients were included; the average number of hemorrhoids excised was 3.0 (median, 2.7) per patient. Mean time to first onset of pain after surgery was 36 hours; mean time to first consumption of postsurgical opioids was 38 hours. Mean pain intensity scores remained <5 through 72 hours after surgery. The average number of opioid analgesic tablets consumed after surgery was 12.4; 13% (12/95) of patients required no postsurgical opioids. Seventy-five percent of patients reported being "very satisfied" or "perfectly satisfied" with their overall pain control. No liposome bupivacaine-related adverse events were observed. A single intraoperative injection of liposome bupivacaine safely facilitated ambulatory hemorrhoidectomy, eliminated the need for intravenous opioids, minimized opioid use, and was associated with high levels of patient satisfaction.

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Epidural anesthesia with ropivacaine with or without clonidine and postoperative pain in hemorrhoidectomies

Cited by 9 publications

References 33 publications

Clonidine: An adjuvant to adrenaline in local anesthesia for third molar surgery

Clonidine: An adjuvant to adrenaline in local anesthesia for third molar surgery

A comparative study for the analgesic efficacy and safety profile of fentanyl versus clonidine as an adjuvant to epidural ropivacaine 0.75% in lower abdominal surgeries

Prolonged Opioid-Sparing Pain Control after Hemorrhoidectomy with Liposome Bupivacaine: Results from a Cohort of 95 Patients

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