A comparative study of the effect of clonidine, fentanyl, and the combination of both as adjuvant to intrathecal bupivacaine for postoperative analgesia in total abdominal hysterectomy

Ahmed, Firoz; Khandelwal, Mamta; Sharma, Anil

doi:10.4103/0970-9185.202194

Cited by 10 publications

(4 citation statements)

References 15 publications

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“…Although opioids are associated with many side effects such as respiratory depression, nausea and vomiting, pruritus, urinary retention, and hemodynamic instability, 5 they do not delay motor recovery. 6 It has less risk of delayed respiratory depression. 7 Magnesium is a N methyl D aspartate (NMDA) antagonist.…”

Section: Introductionmentioning

confidence: 99%

Effect of addition of intrathecal preservative free magnesium sulfate with 0.5% bupivacaine heavy and fentanyl with 0.5% bupivacaine heavy on post-operative pain relief in patients undergoing hysterectomy

Gupta

Tandon

Jain³

et al. 2023

Asian J Med Sci

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Background: Spinal anesthesia is the most common neuraxial anesthesia for infraumblical surgeries. The use of various adjuvants has become popular in today’s scenario to enhance its quality. Aims and Objectives: The aim of this study was to evaluate the onset, duration of sensory and motor block, hemodynamic effects (if any), duration of post-operative analgesia, and adverse effects of fentanyl or magnesium given intrathecally with 0.5% bupivacaine heavy in patients undergoing hysterectomy. Materials and Methods: This prospective randomized double-blinded study was conducted in total sixty patients undergoing hysterectomy, divided into two groups of 30 patients each. Group F received 25 μg fentanyl with 3 mL 0.5% bupivacaine heavy and Group M received 100 mg magnesium sulfate with 3 mL 0.5% bupivacaine heavy. The onset and duration of sensory and motor blockade, duration of analgesia, hemodyamics, and side effects were assessed. Results: The mean time of onset of sensory and motor block was less in fentanyl (P<0.001). Duration of sensory, motor block, and duration of analgesia was more in fentanyl group (P<0.001), whereas incidence of side effects such as bradycardia, hypotension, and shivering was less in magnesium. Conclusion: Our study concluded that addition of fentanyl as adjuvant effectively augmented the quality of spinal anesthesia, but magnesium provided stable hemodynamics and lesser side effects as compared to fentanyl.

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Section: Introductionmentioning

confidence: 99%

Effect of addition of intrathecal preservative free magnesium sulfate with 0.5% bupivacaine heavy and fentanyl with 0.5% bupivacaine heavy on post-operative pain relief in patients undergoing hysterectomy

Gupta

Tandon

Jain³

et al. 2023

Asian J Med Sci

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“…4 Successful management of post-operative pain increases patient satisfaction, leads to earlier recovery, shortens hospital stay, and consequently reduces treatment costs. 5 Post-operative pain management is becoming more vital than ever to anesthesiologists and surgeons with increasing scope of ambulatory surgery. Multimodal analgesic approaches with non-steroidal anti-inflammatory drugs, opioids, peripheral nerve blocks, and wound infiltration with local anesthetics are preferred practice for postoperative pain relief.…”

Section: Introductionmentioning

confidence: 99%

A study to evaluate the efficacy of instillation of ropivacaine with fentanyl, dexmedetomidine, or morphine through surgical drain for post-operative analgesia in patients undergoing modified radical mastectomy

Sumit Das,

Pritam Yadav,

Sanjay Johar

et al. 2023

Asian J Med Sci

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Background: Local anesthetics have become vital part of multimodal analgesia approach. Instillation of local anesthetics through surgical drain is easier and safer method than conventional nerve blocks. Various local anesthetic drugs and adjuvants have been used for post-operative pain management through surgical drains. Aims and Objectives: This study was conducted to evaluate the efficacy of instillation of ropivacaine with fentanyl, dexmedetomidine or morphine through surgical drain for post-operative analgesia and patient satisfaction in patients undergoing modified radical mastectomy. Materials and Methods: A prospective, randomized, and double-blind study was conducted dividing 75 female patients aged 30–70 years who underwent modified radical mastectomy into three groups: Group (RM) received 40 ml 0.25% ropivacaine with 4.5 mg morphine, group (RD) 40 ml 0.25% ropivacaine with 1 mg/kg dexmedetomidine and group (RF) 40 ml 0.25% ropivacaine with 50 microgram fentanyl, instilled through surgical drains. Results: Visual analog score for pain at rest and movement was significantly lower in group RM as compared to group RD and RF with no significant difference among group RD and RF at different time intervals postoperatively. Patient satisfaction at 24-h postoperatively was significantly better in group RM as compared to group RD and RF (P=0.01) with no significant difference among group RD and group RF. Conclusion: Instillation of ropivacaine with morphine provides good pain relief, prolonged duration of analgesia, and good patient satisfaction in the post-operative period as compared to ropivacaine with dexmedetomidine or fentanyl.

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“…For example, the addition of an adrenergic drug such as epinephrine or clonidine significantly reduces the amount of morphine required and its frequency of administration in the peri-and post-operative periods for a wide range of different types of surgeries [20][21][22][23][24][25][26][27][28][29]. The combination significantly decreases the need for intra-operative opiates [27,30], increases the duration of operative analgesia into the post-operative period [20][21][22][23][24]27,30,31]. These effects can be produced even when the delivery of the drugs is accomplished by separate routes at separate times [32,33].…”

Section: Introductionmentioning

confidence: 99%

Biased, Bitopic, Opioid–Adrenergic Tethered Compounds May Improve Specificity, Lower Dosage and Enhance Agonist or Antagonist Function with Reduced Risk of Tolerance and Addiction

Root‐Bernstein

2022

Pharmaceuticals

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This paper proposes the design of combination opioid–adrenergic tethered compounds to enhance efficacy and specificity, lower dosage, increase duration of activity, decrease side effects, and reduce risk of developing tolerance and/or addiction. Combinations of adrenergic and opioid drugs are sometimes used to improve analgesia, decrease opioid doses required to achieve analgesia, and to prolong the duration of analgesia. Recent mechanistic research suggests that these enhanced functions result from an allosteric adrenergic binding site on opioid receptors and, conversely, an allosteric opioid binding site on adrenergic receptors. Dual occupancy of the receptors maintains the receptors in their high affinity, most active states; drops the concentration of ligand required for full activity; and prevents downregulation and internalization of the receptors, thus inhibiting tolerance to the drugs. Activation of both opioid and adrenergic receptors also enhances heterodimerization of the receptors, additionally improving each drug’s efficacy. Tethering adrenergic drugs to opioids could produce new drug candidates with highly desirable features. Constraints—such as the locations of the opioid binding sites on adrenergic receptors and adrenergic binding sites on opioid receptors, length of tethers that must govern the design of such novel compounds, and types of tethers—are described and examples of possible structures provided.

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A comparative study of the effect of clonidine, fentanyl, and the combination of both as adjuvant to intrathecal bupivacaine for postoperative analgesia in total abdominal hysterectomy

Cited by 10 publications

References 15 publications

Effect of addition of intrathecal preservative free magnesium sulfate with 0.5% bupivacaine heavy and fentanyl with 0.5% bupivacaine heavy on post-operative pain relief in patients undergoing hysterectomy

Effect of addition of intrathecal preservative free magnesium sulfate with 0.5% bupivacaine heavy and fentanyl with 0.5% bupivacaine heavy on post-operative pain relief in patients undergoing hysterectomy

A study to evaluate the efficacy of instillation of ropivacaine with fentanyl, dexmedetomidine, or morphine through surgical drain for post-operative analgesia in patients undergoing modified radical mastectomy

Biased, Bitopic, Opioid–Adrenergic Tethered Compounds May Improve Specificity, Lower Dosage and Enhance Agonist or Antagonist Function with Reduced Risk of Tolerance and Addiction

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