Co-injection of Clonidine Prolongs the Anesthetic Effect of Lidocaine Skin Infiltration by a Peripheral Action

Pratap, Jayant Nick; Shankar, Rajesh K.; Goroszeniuk, Teodor

doi:10.1213/01.ane.0000257949.46444.a8

Cited by 24 publications

(16 citation statements)

References 13 publications

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“…Use of α2 agonists is associated with prolongation of effects of local anesthetics, mechanisms postulated being peripheral,[1011] spinal[1213141516] and supra-spinal[1718] in location. Supraspinal effects are a result of inhibition of locus ceruleus in brainstem resulting in disinhibition of noradrenergic nuclei and descending inhibitory effect on nociception in the spinal cord.…”

Section: Discussionmentioning

confidence: 99%

Comparison of block characteristics of spinal anesthesia following intravenous dexmedetomidine and clonidine

Agrawal

Payal

2016

J Anaesthesiol Clin Pharmacol

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Background and Aims:Different routes of administration of α2 adrenergic receptor agonists have been found to prolong the duration of spinal block.Material and Methods:One hundred and twenty patients, aged 18-60 years, of ASA physical status I or II posted for elective fixation of fractures of lower limb under spinal anesthesia were selected. Spinal anesthesia was administered with 2.5 ml of 0.5% bupivacaine mixed with 10 μg fentanyl. The patients were randomized to receive intravenous (IV) dexmedetomidine 1 μg/kg/h for 15 min followed by infusion of 0.3 μg/kg/h (Group I), IV Clonidine 2 μg/kg/h for 15 min followed by infusion of 0.5 μg kg/h (Group II) or 15 ml of normal saline for 15 min followed by infusion at 50 ml/h (Group III). Motor and sensory blockade was evaluated using bromage score and pin prick method respectively.Results:The median block height in all groups was T8. Time to achieve block height was fastest in Group I. Time of regression of sensory block to T12/L1 dermatome was 230.75 ± 21.25 min (Group I), 196.25 ± 20.27 min (Group II) and 163.88 ± 15.46 min (Group III) respectively. Regression of motor blocks to Bromage 0/1 was 274 ± 21.25 min, 234.25 ± 32.41 min and 130.12 ± 20.70 min in Groups I, II and III respectively. Bradycardia was seen in one patient in Group I and two patients in Group II. Hypotension was seen in five patients in Group I and seven patients in Group II. First requirement for postoperative analgesic was after 353.13 ± 39.60 min, 314.38 ± 30.64 min and 193.25 ± 17.74 min in Groups I, II and III respectively.Conclusion:IV α2 agonists are useful adjuvants for prolongation of the duration of spinal block. IV dexmedetomidine produces a better clinical profile compared to clonidine.

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Section: Discussionmentioning

confidence: 99%

Comparison of block characteristics of spinal anesthesia following intravenous dexmedetomidine and clonidine

Agrawal

Payal

2016

J Anaesthesiol Clin Pharmacol

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“…In a study done on 20 volunteers by Pratap et al [13] infiltration of 10 lg of clonidine with lidocaine abolished normal sensation at the site for up till 6 h, compared with plain lidocaine. The authors support the view that there is the existence of a peripheral site of action of clonidine in prolonging local anaesthetic action in humans, independent of any neuraxial or systemic mechanisms.…”

Section: Discussionmentioning

confidence: 94%

Use of Clonidine as an Adjuvant to Infiltration Anaesthesia in Tympanoplasty: A Randomized Double Blind Study

Raghuwanshi¹,

Chakravarty

Asati

et al. 2013

Indian J Otolaryngol Head Neck Surg

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This prospective double blind randomized study evaluated the effect of clonidine when used as an adjuvant to local anaesthetic agents for infiltration block and measured its impact on the quality of anaesthesia, intraoperative bleeding and post-operative pain. We recruited 60 patients needing tympanoplasty, which were randomized them into two groups; group A patients received local infiltration of 12 ml 2 % xylocaine with adrenaline (1:200,000 dilution), while group B received 12 ml 2 % xylocaine with adrenaline with 30 lg of clonidine. Duration of block was significantly prolonged in group B (group A 53.66 ± 7.7 vs. group B 177.13 ± 48.9, p \ 0.005). Mean pain scores were significantly lower in group B during the first hour following the block (3.43 in group A vs. 1.2 in group B, p \ 0.005). Total number of analgesic doses over 24 h showed no significant difference (3.1 in group B vs. 3.26 in group A, p [ 0.05). 93.3 % patients in group A required sedation with midazolam, compared to 10 % in group B. Grade of bleeding was significantly lower in group B. Patient and surgeon satisfaction scores were better in group B. It could be concluded that 30 lg clonidine added to lidocaine 2 % has a significant impact in decreasing the bleeding in the operative field and improving the quality of intraoperative anesthesia as well as prolonging the duration of postoperative analgesia without significant side effects.

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“…(14) have found similar effects from intramuscular and caudal administration of clonidine with regard to caudal blockade in children. The contributing effect of systemic uptake of clonidine in the context of peripheral nerve blocks is still not properly delineated, but adult clinical data support a mainly peripheral mode of action (15–17), although conflicting results have also been published (18). With regard to DEX, animal data have shown the effect to be peripherally mediated (19) as well as dose‐dependent (20).…”

Section: Since There Are No Alpha‐2 Adrenoceptors On Peripheral Nervementioning

confidence: 99%

Alpha‐2 adrenoceptor agonists as adjuncts to Peripheral Nerve Blocks in Children – is there a mechanism of action and should we use them?

Lönnqvist

2012

Pediatric Anesthesia

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Co-injection of Clonidine Prolongs the Anesthetic Effect of Lidocaine Skin Infiltration by a Peripheral Action

Abstract: Clonidine has a significant peripheral action in enhancing duration of local anesthesia on superficial co-infiltration with lidocaine.

Cited by 24 publications

References 13 publications

Comparison of block characteristics of spinal anesthesia following intravenous dexmedetomidine and clonidine

Comparison of block characteristics of spinal anesthesia following intravenous dexmedetomidine and clonidine

Use of Clonidine as an Adjuvant to Infiltration Anaesthesia in Tympanoplasty: A Randomized Double Blind Study

Alpha‐2 adrenoceptor agonists as adjuncts to Peripheral Nerve Blocks in Children – is there a mechanism of action and should we use them?

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