Intrathecal Clonidine Added to a Bupivacaine-Morphine Spinal Anesthetic Improves Postoperative Analgesia for Total Knee Arthroplasty

Sites, Brian D.; Beach, Michael L.; Biggs, Russell; Rohan, Christopher; Wiley, Christopher W.; Rassias, Athos J.; Gregory, Janice M.; Fanciullo, Gilbert J.

doi:10.1213/01.ane.0000055651.24073.59

Cited by 82 publications

(50 citation statements)

References 15 publications

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“…Seven trials (9 comparisons) tested morphine 0.05 to 1 mg added to bupivacaine and reported on cumulative 24-h morphine consumption [4,30,38,41,56,61,74] (Supplemental Data 2). In controls, the median of the mean 24-h cumulative morphine consumption was 23 mg (range 4 to 47 mg).…”

Section: Cumulative 24-h Morphine Consumptionmentioning

confidence: 99%

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Opioids added to local anesthetics for single-shot intrathecal anesthesia in patients undergoing minor surgery: A meta-analysis of randomized trials

Pöpping

Elia

Marret

et al. 2012

Pain

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a b s t r a c tOpioids are widely used as additives to local anesthetics for intrathecal anesthesia. Benefit and risk remain unclear. We systematically searched databases and bibliographies to February 2011 for full reports of randomized comparisons of any opioid added to any intrathecal local anesthetic with the local anesthetic alone in adults undergoing surgery (except cesarean section) and receiving single-shot intrathecal anesthesia without general anesthesia. We included 65 trials (3338 patients, 1932 of whom received opioids) published between 1983 and 2010. Morphine (0.05-2 mg) and fentanyl (10-50 lg) added to bupivacaine were the most frequently tested. Duration of postoperative analgesia was prolonged with morphine (weighted mean difference 503 min; 95% confidence interval [CI] 315 to 641) and fentanyl (weighted mean difference 114 min; 95% CI 60 to 168). Morphine decreased the number of patients needing opioid analgesia after surgery and decreased pain intensity to the 12th postoperative hour. Morphine increased the risk of nausea (number needed to harm [NNH] 9.9), vomiting (NNH 10), urinary retention (NNH 6.5), and pruritus (NNH 4.4). Fentanyl increased the risk of pruritus (NNH 3.3). With morphine 0.05 to 0.5 mg, the NNH for respiratory depression varied between 38 and 59 depending on the definition of respiratory depression chosen. With fentanyl 10 to 40 lg, the risk of respiratory depression was not significantly increased. For none of these effects, beneficial or harmful, was there evidence of dose-responsiveness. Consequently, minimal effective doses of intrathecal morphine and fentanyl should be sought. For intrathecal buprenorphine, diamorphine, hydromorphone, meperidine, methadone, pentazocine, sufentanil, and tramadol, there were not enough data to allow for meaningful conclusions.Ó

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Section: Cumulative 24-h Morphine Consumptionmentioning

confidence: 99%

“…Seventeen trials (21 comparisons) tested morphine 0.05 to 1 mg added to bupivacaine and reported on the incidence of postoperative pruritus [4,21,30,34,[37][38][39][41][42][43]46,56,61,69,74,75,79] (Table 2; Supplemental Data 6). The average incidence of pruritus with bupivacaine alone was 4.4%.…”

Section: Pruritusmentioning

confidence: 99%

Opioids added to local anesthetics for single-shot intrathecal anesthesia in patients undergoing minor surgery: A meta-analysis of randomized trials

Pöpping

Elia

Marret

et al. 2012

Pain

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“…We also found that the duration of analgesia was prolonged with the addition of clonidine when compared to that by neostigmine. The mechanism of action of clonidine is thought due to prolonging the motor blockade produced by local anaesthetic agents and also by bringing local vasoconstriction by acting on vascular smooth muscle (α-receptors), thereby decreasing the absorption of local anaesthetics from sub-arachnoid space leading to an increase in the duration of action [15,16]. According to Liu et al, neostigmine increases spinal levels of acetylcholine, thereby augmenting motor block [17].…”

Section: Discussionmentioning

confidence: 99%

A Comparative Study between Intrathecal Clonidine And Neostigmine With Intrathecal Bupivacaine For Lower Abdominal Surgeries

Reddy¹,

Aasim²,

K³

et al. 2017

APJHS

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Background: Limited duration of time has been one of the main drawback of spinal anesthesia.To avoid this. adjuvants have been added to the local anesthetic agent and has proven benefits when used intrathecally. Aims and Objectives: To compare the effect of intrathecal clonidine 75 µg or neostigmine 50 µg added to intrathecal hyperbaric bupivacaine, with respect to sensory characteristics, motor characteristics, haemodynamic stability and side effects. Materials and Methods: Our prospective study included 60 patients who were admitted for lower abdominal surgeries. The patients were randomly divided into 2 groups, with 30 in each group. Group A patients received neostigmine 50 µg with 2.5 ml of intrathecal 0.5% hyperbaric bupivacaine and group B patients received intrathecal clonidine 75 µg and 2.5 ml of intrathecal 0.5% hyperbaric bupivacaine. The parameters for comparison of 2 groups included sensory characteristics, motor characteristics, haemodynamic stability and side effects. Results: In Group B patients, there was a significantly enhanced onset of sensory and motor block and well maintained haemodynamics. Group A patients had prolonged analgesia. Perioperatively no serious adverse effects were noted in both the groups. Conclusion: Intrathecal clonidine with hyperbaric bupivacaine produces prolonged postoperative analgesia and intrathecal neostigmine with bupivacaine produces a good sensory and motor blockade for lower abdominal surgeries.

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“…In addition, clonidine have synergistic action when used as adjuvant to local anesthetic resulting in postoperative analgesic requirement. (19,20) The use of dexmedetomidine, an alpha-2 agonist got FDA approval only for sedation in intensive care.…”

Section: Mechanism Of Actionmentioning

confidence: 99%

Comparative Study of Epidural Ropivacaine With Dexmedetomidine , Ropivacaine With Clonidine and Ropivacaine Alone for Perioperative Analgesia in Abdominal Hysterectomy

Satheedevi¹,

Rasikapriya²,

Chithra³

2015

jemds

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Regional anesthesia is widely used for abdominal hysterectomies. It is divided into spinal and epidural anaesthesia. Epidural anesthesia has got the advantage of extending the period of anesthesia to post-operative analgesia. We can use various pharmacological agents as adjuvants, which prolong the duration of action of local anesthetics. They include opiods, alpha 2 agonists like clonidine and dexmedetomidine. In this we studied the efficacy of local anesthetic agent -ropivacaine alone, ropivacaine with clonidine and ropivacaine with dexmedetomidine for epidural block. Present study showed that Epidural Dexmedetomidine and clonidine have synergistic action in combination with epidural ropivacaine resulting in smooth and prolonged postoperative analgesia and sedation. Group RD (Ropivacaine and Dexmedetomidine) had significant difference in comparison of postoperative block characteristics, such as time of two segment regression, time to Bromage scale 1, time of regression to S1 dermatome and time of first epidural top up than group RC and R. (Ropivacaine with clonidine and Ropivacaine alone). Thus epidural dexmedetomidine is a better neuraxial adjuvant in combination with epidural ropivacaine in producing prolonged analgesia and better sedation for abdominal hysterectomy.

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Intrathecal Clonidine Added to a Bupivacaine-Morphine Spinal Anesthetic Improves Postoperative Analgesia for Total Knee Arthroplasty

Cited by 82 publications

References 15 publications

Opioids added to local anesthetics for single-shot intrathecal anesthesia in patients undergoing minor surgery: A meta-analysis of randomized trials

Opioids added to local anesthetics for single-shot intrathecal anesthesia in patients undergoing minor surgery: A meta-analysis of randomized trials

A Comparative Study between Intrathecal Clonidine And Neostigmine With Intrathecal Bupivacaine For Lower Abdominal Surgeries

Comparative Study of Epidural Ropivacaine With Dexmedetomidine , Ropivacaine With Clonidine and Ropivacaine Alone for Perioperative Analgesia in Abdominal Hysterectomy

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