Comparative analgesic efficacy of buprenorphine or clonidine with bupivacaine in the caesarean section

Abstract

The need for early ambulation for caring of the neonate by mothers makes postoperative pain management after cesarean delivery unique. Favorable results have been observed with buprenorphine, clonidine and bupivacaine as epidural analgesics. This prospective, randomised triple blind control study was carried out among 112 lower segment caesarean segment (LSCS) patients, divided into three groups, to assess the analgesic efficacy and side effects of epidural analgesia, with an intermittent top up of (i) bupivacaine (0.125%) and buprenorphine (0.075 mg) (ii) bupivacaine (0.125%) and clonidine (37.5 microgram) and (iii) bupivacaine (0.125%) alone, in LSCS cases. The demographic characteristics (age, weight and height) of the three groups were comparable and the differences were not statistically significant. The mean duration of the analgesia was significantly longer in the group one patients receiving buprenorphine plus bupivacaine (690 ± 35 minutes) and it was lowest in group three patients receiving bupivacaine (170 ± 31 minutes) alone. The mean highest pain score (VAS scale) was significantly lower (3.4 ± 0.6) in group one patients and it was highest in group three (6.7 ± 0.8) patients. Requirement of continuation of epidural analgesia after 15 hours of operation and requirement of diclonfenac injections as well as incidence of itching and pruritus was significantly lower in group one patients. Incidence of nausea and vomiting was the lowest in group one patients. Incidence of respiratory depression, sedation and hypotension were nil in all three group of patients. Epidural buprenorphine combined with bupivacaine produced significantly longer duration and better quality of analgesia than bupivacaine combined with clonidine or bupivacaine alone, and it was safe in LSCS patients, for post-operative analgesia.

A Comparative Analgesic Efficacy of Buprenorphine or Clonidine with Bupivacaine in the Caesarean Delivery

“…Thus confirming the fact that a combination of an opioid and an anaesthetic augments the onset and prolongs the duration of analgesia when compared to opioid or anaesthetic alone. [1,5] Abboud et al used higher doses of buprenorphine (1 to 4 mg) alone, epidurally, found complete pain relief in 22 ± 2.4 minutes, and prolonged duration of post-operative analgesia than our combination group. [6] Studies have shown varying durations of analgesia (2.5 to 9 hours) after adminstration buprenorphine (1 to 4 mg) alone epidurally.…”

“…This is in accordance with that of Agarwal et al (170 minutes). [1,7] We found that buprenorphine showed a improved quality of analgesia regarding VAS scale. This is in accordance with that of Agarwal et al Abboud et al also found a significantly improved quality of analgesia in patients who recieved epidural bupivacaine with buprenorphine than with bupivacaine alone.…”

“…This is in accordance with that of Agarwal et al Abboud et al also found a significantly improved quality of analgesia in patients who recieved epidural bupivacaine with buprenorphine than with bupivacaine alone. [1,6] Shrestha et al showed that 2 mg of epidural buprenorphine added to a lower concentration of bupivacaine (0.1%) gave an improved quality of labour analgesia in terms of incidence of motor blockade than 0.25% bupivacaine alone. [8] Nelson et al demonstrated that analgesia provided by buprenorphine has a significant correlation with the affective domain, with greater reduction in affective magnitude than in pain intensity.…”

“…Buprenorphine has given an encouraging result in analgesic potential. [1,2] Buprenorphine has a high affinity at both Mu (µ) and kappa (κ) opiate receptors and is an effectual analgesic, like morphine, in about all-clinical conditions. It can be given intrathecally, as it is compatible with the cerebrospinal fluid (CSF), without any adverse reactions.…”

Comparison of Effect of Intrathecal Buprenorphine vs Clonidine as an Adjuvant to Hyperbaric Bupivacaine on Subarachnoid Block Characteristics

“…Intrathecal buprenorphine in doses of 75 µg induces rapid onset of analgesia and lacks the side effects that can be attributed to higher doses. 10 Dixit et al stated that 60 µg buprenorphine given intrathecally to pregnant patients prolonged the duration of analgesia with negligible sideeffects. 11 Clonidine prolongs the duration of intrathecally administered local anesthetics and has potent antinociceptive properties.…”