Comparison of intrathecal clonidine and fentanyl as adjuvant to hyperbaric bupivacaine in subarachnoid block for lower limb orthopedic surgery

Routray, Sidharth Sraban; Raut, Khageswar; Pradhan, Amit Kumar; Dash, Abhilash; Soren, Mina

doi:10.4103/aer.aer_91_17

Cited by 14 publications

(17 citation statements)

References 23 publications

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“…One group (group C) received intra-thecal hyperbaric bupivacaine (2.5 ml) and 50 μg clonidine (diluted to 0.5 ml) while other group (group F) received intra-thecal hyperbaric bupivacaine (2.5 ml) and fentanyl 25 μg (diluted to 0.5 ml). They found out that duration of sensory and motor block was significantly prolonged in Group C compared to Group F [9].…”

Section: Discussionmentioning

confidence: 95%

Comparative Evaluation of the Efficacy of Intrathecal Fentanyl, Clonidine and Fentanyl-Clonidine Combination as an Adjuvant to Bupivacaine for Infra-Umblical Surgery

Rana¹,

Sp²,

Asad³

et al. 2018

JCR

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Background: The aim of this study was to evaluate the level of sensory block, onset and duration of motor block, post-operative analgesia, and adverse effects of combination of clonidine and fentanyl given intra-thecally with hyperbaric bupivacaine. Material and Methods: Ninety patients were randomized into three groups of group BC (n=30): hyperbaric 0.5% bupivacaine, clonidine, and 0.9% NaCl intra-thecally; group BF (n=30): hyperbaric 0.5% bupivacaine, fentanyl, and 0.9% NaCl intra-thecally; group BFC (n=30): hyperbaric 0.5% bupivacaine, 0.3 ml of clonidine, and fentanyl intra-thecally. Results: Either adjuvant, fentanyl or clonidine when added to intra-thecal bupivacaine prolongs the motor block and decreases the requirement of rescue analgesic in 24 hours but time to first rescue analgesic request is more prolonged in clonidine as compared to fentanyl. Clonidine is superior to fentanyl in prolonging the sensory block. Combination of intrathecal fentanyl and clonidine as compared to fentanyl alone, as adjuvant to bupivacaine, is superior in prolonging the sensory block, motor block and time to first rescue analgesic request. Combination of intra-thecal fentanyl and clonidine as compared to clonidine alone, as adjuvant to bupivacaine, produces similar sensory block but is superior in prolonging the motor block and time to first rescue analgesic request. Conclusion: The combination of fentanyl and clonidine, as adjuvant to intra-thecal bupivacaine, is superior for surgical procedures of long duration and those procedures which mandate muscle relaxation.

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Section: Discussionmentioning

confidence: 95%

Comparative Evaluation of the Efficacy of Intrathecal Fentanyl, Clonidine and Fentanyl-Clonidine Combination as an Adjuvant to Bupivacaine for Infra-Umblical Surgery

Rana¹,

Sp²,

Asad³

et al. 2018

JCR

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“…Furthermore, there was no significant difference in heart rate and MAP between the groups. The vital signs showed no significant changes in previous studies by adding fentanyl, midazolam, or clonidine to bupivacaine to our journey 1,15,19 . One of the limitations of this study was the type of orthopedic injury severity in patients was not the same and this could be effective at the onset of the patient's pain and distort the results.…”

Section: Discussionmentioning

confidence: 51%

“…They used 20 µg of fentanyl and 2 mg of midazolam, which could not account for the difference in the results of the two studies 3 .Routray et al also reported that adding clonidine to fentanyl in the intrathecal anesthesia could increase the duration of post-operative analgesia. Although the type of medications used in these two studies was completely different, it was concluded that the addition of another drug to fentanyl could enhance its effects and even be useful in controlling post-operative pain 15 .Singh et al also compared the addition of two different doses of fentanyl, and clonidine to bupivacaine, in intrathecal anesthesia and reported that both doses could reduce the duration of anesthesia better than that of the control group, and increases the duration of sensory nerve block, motor block, and analgesia following surgery 16 . Moreover, Tucker et al used a combination of 2 mg of midazolam and 10 µg of fentanyl to control labor pain and reported that the given method could more effectively control pain.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of intrathecal midazolam on enhancing analgesic effect of fentanyl in patients undergoing lower limb surgery

2018

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Background: Co-administration of drugs with synergistic effects is considered as one of the methods to increase the effectiveness of intrathecal anesthesia and to reduce the need for injectable analgesics. The purpose of this study was to investigate the efficacy of intrathecal midazolam on enhancing the analgesic effect of fentanyl in patients undergoing lower limb surgery. Materials: The present double-blinded clinical trial was conducted on 90 candidate patients undergoing lower limb orthopedic surgery in 2017 at Khatam-Al-Anbiya Hospital in the city of Zahedan, Iran. To this end, the patients were selected via convenience sampling method and then randomly divided into three groups. Afterwards, 3 cc of 0.5% hyperbaric Marcaine was injected intrathecally in the first group, 3 cc of Marcaine + 25 ug of fentanyl was administered to the second group, and 3 cc of Marcaine + 25 ug of fentanyl + 1 mg of midazolam was administered to the third group (the final volume of all three syringes was brought up to 3.7 cc with normal saline). The duration of sensory nerve block and those of motor block and analgesia, as well as changes in vital signs, were then measured in these groups. Moreover, the data were analyzed using SPSS Statistics (Version 22.0) through Chi-square test and one-way analysis of variance (ANOVA). Results: The mean age and gender distribution of the patients in the three study groups did not differ significantly. The mean duration of sensory nerve block was equal to 98.6+/-11.1 min in the first group, 142.2+/-12.4 min in the second group, and 174.3+/-10.9 min in the third group; all showed a statistically significant difference (P=0.0001, P=0.001, P=0.000).The mean duration of analgesia was also reported to be 204.43+/-0.3 min in the first group, 323.62+/-7.4 min in the second group, and 526.22+/-0.9 min in the third group, indicating a statistically significant difference between the three study groups (P=0.0001, P=0.000, P=000). Conclusion: The results of this study demonstrated that adding midazolam to intrathecal fentanyl could significantly increase the duration of sensory nerve block and that of post-operative analgesia.

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“…Juitaet al, [13] also reported a significantly prolonged anaesthesia time with bromage score 2 for clonidine groups compared to sufentanil groups in gynaecological surgery. Routray et al, [14] had also reported a increased duration of motor block in clonidine group as compared to fentanyl group when administerd intrathecallywith hyperbaric bupivacaine in lower limb orthopaedic surgeries. The fact that present study demonstrates the motor block enhancing effect of clonidine in doses as low as 30μg is also of importance as a majority of earlier studies have showed this effect only at doses greater than 50μg; therefore it is important to realize that even low doses of intrathecal clonidine can cause a undesirably high motor block.…”

Section: Discussionmentioning

confidence: 95%

Intrathecal Low Dose Bupivacaine with Fentanyl or Clonidine in TURP Surgery: A Prospective Randomized Double Blind Study

Raiger

Sharma

Jain³

et al. 2019

AAN

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Background: Present study was designed to compare the effect of intrathecal clonidine and fentanyl in combination with low doses of bupivacaine in TURP surgery on the hemodynamics, quality of sensory and motor block as well as the duration of analgesia and motor block. Subjects and Methods: 120 patients scheduled to undergo TURP surgery were randomized into four groups. Group I and II received hyperbaric bupivacaine 5 mg and 7.5 mg respectively with fentanyl 25 μg whereas Group III and IV received Bupivacaine 5 mg and 7.5 mg respectively with clonidine 30 μg in subarachnoid space. Hemodynamic parameters (heart rate, systolic blood pressure, diastolic blood pressure) were recorded at regular intervals. Intensity of motor block was recorded at L2 to S1 myotomes and a myotome score was calculated for each limb. Measurement of level of pinprick analgesia and intensity of motor block were recorded at 0,2,4,8 and 10 minutes. Time to return of pain sensation and complete motor recovery was also noted. Results: There was statistically significant difference in occurance of bradycardia from baseline in group I at 10 and 20 minutes (p<0.05,p<0.001). In group IV there was significant fall in heart rate at 10, 20 and 30 minutes (p<0.05,p<0.05,p<0.001). In group II and III there was no significant fall in heart rate. In group I there is significant fall in SBP at 10, 20 and 30 minutes (p<0.05). In group II there is significant fall in SBP at 10 and 20 minute (p<0.05). In group III and IV, there is significant fall in SBP at 10, 20 and 30 minutes (p<0.05,p<0.05,p<0.001). The maximum level of sensory block was comparable in all the groups (T10.21±0.99, T10.30±0.75, T10.33±1.12, T10.13±1.11 in groups I,II,III and IV respectively). There is no statistical significant difference in achieving level of motor block on comparing group I/II and group III/IV but there is highly significant (p<0.001) difference in group I/III, group I/IV, group II/III, group II/IV at 10 minutes after onset of block. There was no statistical significant difference in return of pain sensation in all groups (91.60±18.95, 86.07±10.84, 85.37±17.39, 85.50±22.22 in groups I,II,III and IV respectively). Complete return of motor power (modified Bromage score =0) was seen at 158.17±18.17 min, 154 ± 18.50 min, 146.53 ± 16.54 min and 154.83 ± 21.27 min in group I,II,III and IV respectively. There is significant difference (p<0.05) in return of motor power on comparing group I with III, otherwise all groups are comparable. Conclusion: The addition of fentanyl or clonidine to intrathecal bupivacaine for TURP does not result in any significant difference in the quality and intensity of sensory block. Clonidine causes a greater degree of motor block when compared to fentanyl. Both clonidine and fentanyl causes bradycardia and hypotension although the degree and duration of hypotension is greater with clonidine.

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Comparison of intrathecal clonidine and fentanyl as adjuvant to hyperbaric bupivacaine in subarachnoid block for lower limb orthopedic surgery

Cited by 14 publications

References 23 publications

Comparative Evaluation of the Efficacy of Intrathecal Fentanyl, Clonidine and Fentanyl-Clonidine Combination as an Adjuvant to Bupivacaine for Infra-Umblical Surgery

Comparative Evaluation of the Efficacy of Intrathecal Fentanyl, Clonidine and Fentanyl-Clonidine Combination as an Adjuvant to Bupivacaine for Infra-Umblical Surgery

Efficacy of intrathecal midazolam on enhancing analgesic effect of fentanyl in patients undergoing lower limb surgery

Intrathecal Low Dose Bupivacaine with Fentanyl or Clonidine in TURP Surgery: A Prospective Randomized Double Blind Study

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