Oral Clonidine Prolongs Lidocaine Spinal Anesthesia in Human Volunteers

Liu, Spencer Md; Chiu, Andrew A.; Neal, Joseph M.; Carpenter, Randall L.; Bainton, Bruce G.; Gerancher, J. C.

doi:10.1097/00000542-199506000-00005

Cited by 72 publications

(44 citation statements)

References 34 publications

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“…Such prolongation of the effects of local anesthetics has been reported with oral. (4) IV (5) and intrathecal clonidine. (6,7) However, unlike spinal opioids, clonidine does not produce pruritus, urinary retention, respiratory depression, vomiting with no or minimum CNS depression.…”

Section: Introductionmentioning

confidence: 99%

Effect of Intrathecal Clonidine on Duration of Spinal Analgesia

Shrivastava¹,

Sinha²,

Shrivastava³

2015

jemds

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BACKGROUND:Clonidine is an α2 adrenoreceptor agonist that has been shown to effectively prolong the duration of analgesia when administered intrathecally or in the epidural space along with local anaesthetic. AIMS AND OBJECTIVE: This study was designed to evaluate the effect of two different doses of intrathecal clonidine (37.5 µg and 75 µg) on the duration of analgesia and side effects produced by hyperbaric bupivacaine 0.5%. MATERIALS AND METHODS: A prospective hospital based, randomized and double blind study. Selected 75 patients who was scheduled for elective below umbilical surgeries were randomly allocated to one of three groups. Group I (n=25, control group) received 3ml hyperbaric bupivacaine, Group II (n=25) 3ml hyperbaric bupivacaine + 37.5 µg clonidine and Group III (n=25) 3 ml hyperbaric bupivacaine + 75μg clonidine intrathecally. Total volume (4ml) remained constant by adding sterile water. Data were analyzed by using SPSS software ver.18. RESULTS: The (mean ±SD) duration of analgesia was found to be 171.3±6.37 mins in Group I, 217.7±7.01 mins in Group II and 257.1±6.50 mins in Group III (p<0.05). It shows that 37.5g & 75g intrathecal clonidine increases the duration of analgesia of 15mg hyperbaric bupivacaine by about 46 mins & 86 mins respectively. The addition of intrathecal clonidine upto 75 µg does not cause any significant major side effect except mild sedation, without an increase in incidence of hypotension, bradycardia and respiratory depression. CONCLUSION: Intrathecal clonidine (37.5g & 75g) as an adjuvant to hyperbaric bupivacaine 0.5% prolong the duration of analgesia in a dose dependent manner without increase in incidence of significant side effects. KEYWORDS: hyperbaric bupivacaine, intrathecal clonidine, spinal anaesthesia. INTRODUCTION:Spinal anaesthesia is a well-established technique. It is easy to perform, to provide fast onset and effective sensory and motor block. Now a days bupivacaine is a commonly used local anaesthetic drug in spinal anaesthesia. However duration of spinal analgesia by bupivacaine is limited upto 75-150 min. Therefore various additives like clonidine, opioids, neostigmine, ketamine and epinephrine separate or in combination were used along with bupivacaine for prolongation of the effect, to improve the quality of analgesia and to minimize the requirement for postoperative analgesics.Clonidine is an α2 adrenoreceptor agonist that has been shown to effectively prolong the duration of analgesia when administered intrathecally or in the epidural space. (1,2,3) The α2 adrenergic agonist clonidine has a variety of different actions including the ability to potentiate the effects of local anaesthetics. Such prolongation of the effects of local anesthetics has been reported with oral. (4) IV (5) and intrathecal clonidine. (6,7) However, unlike spinal opioids, clonidine does not produce pruritus, urinary retention, respiratory depression, vomiting with no or minimum CNS depression. However, intrathecal clonidine at high doses is associated with brady...

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Section: Introductionmentioning

confidence: 99%

Effect of Intrathecal Clonidine on Duration of Spinal Analgesia

Shrivastava¹,

Sinha²,

Shrivastava³

2015

jemds

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“…9 In our study, the changes in systolic as well as diastolic blood pressures with or without premedication were minimal. Since clonidine is an antihypertensive, we anticipated low prespinal blood pressures than control group.…”

Section: Discussionmentioning

confidence: 44%

Effect of Oral Clonidine Premedication on the Onset and Duration of Spinal Anesthesia With Hyperbaric Bupivacaine

Jayaram¹,

Kulkarni²,

Hegde³

2014

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BACKGROUND:Spinal anesthesia is the most common technique used for lower abdominal surgeries. Hyperbaric Bupivacaine has limited duration of action. Clonidine has been used to prolong the duration of local anaesthetic. Hence in our study, we studied the effects of oral clonidine premedication on spinal anaesthesia with hyperbaric Bupivacaine with reference to sedation, onset and duration of sensory and motor blockade including its effects on hemodynamic status. METHODS: Prospective randomized, double -blinded placebo, control study, two groups of thirty patients each were selected. One group (Group C) received 150μg clonidine tablets and the other group (Group B) received placebo, 90 minutes before anesthesia. Primary outcome were sedation, onset and duration of sensory and motor blockade. Hemodynamic and other effects of the study drug were the secondary outcomes. RESULT: It was observed that clonidine premedication resulted in higher incidence of moderate sedation, hastens the onset of sensory block but has no effect on the onset of motor blockade. It prolonged the duration of sensory and motor blockade. Clonidine at a dose of 150μg is not associated with any greater change in heart rate and blood pressure following spinal anesthesia. CONCLUSION: We conclude that oral clonidine premedication,in patients with hyperbaric bupivacaine hastesns the onset of sensory block and prolongs the duration of sensory and motor anesthesia with moderate sedation.

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“…[16][17][18][19] Clonidine prolongs the time span of intrathecally managed local anesthetics and has robustantinociceptive properties. [20][21][22][23][24][25] Although such prolongation of the effects of local anesthetics has been described for oral and IV Clonidine administration, the intrathecal route is more effective in prolonging Bupivacaine spinal anesthesia. 23,[25][26][27][28] In our study we compared the duration of sensory and motor block in the three groups of patients, Group B was given Intrathecal Bupivacaine alone, Group C was given intrathecal Bupivacaine plus Clonidine and group D was given intrathecal Bupivacaine plus Dexmedetomidine.…”

Section: Discussionmentioning

confidence: 99%

Duration of analgesia, sensory and motor blockade and intra operative hemodynamic changes caused by intrathecal bupivacaine, bupivacaine plus clonidine and bupivacaine plus dexmedetomidine in spinal anesthesia: prospective, comparative study

Sankaranand¹,

Prasad²

2018

Int J Res Med Sci

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Background: This is comparative study to differentiate the effects of Dexmedetomidine and clonidine on duration of analgesia, motor and sensory blockade and the intraoperative hemodynamic profile when mixed with Bupivacaine.Methods: Patients aged 15-45 years having ASA 1 and ASA 2 scheduled for elective orthopedic surgeries under spinal anaesthesia were included and divided into 3 groups equally (50 patients each)’ i.e. Group B received only 3.0 ml of 0.5% Bupivacaine (Heavy); Group C received 3.0ml of 0.5% Bupivacaine (Heavy) mixed with Clonidine 30 µg; and Group D administered with 3.0 ml of 0.5% Bupivacaine (Heavy) mixed with 5µg Dexmedetomidine.Results: Majority of the cases enrolled in the study were knee disorders and the rest being fracture femur, tibia. At preoperative interval mean systolic blood pressure and diastolic blood pressure of Group B was slightly higher than Group C and Group D. At the time when spinal anaesthesia was given, a slight fall in DBP of patients was observed in all Group B, Group C and Group D. Mean heart rate of patients at preoperative interval in patients of Group B, Group C and Group D respectively, with Group C and Group D showing slightly lower mean heart rate as compared with that of the mean heart rate of Group B but the values were not statistically significant. There were no any significant changes in the hemodynamic status.Conclusions: Both of used combinations provide prolonged sensory and motor blockade, hemodynamic stability, minimal side effects, and excellent intraoperative and postoperative analgesia.

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Oral Clonidine Prolongs Lidocaine Spinal Anesthesia in Human Volunteers

Abstract: Premedication with oral clonidine prolonged sensory and motor block from lidocaine spinal anesthesia. The exact mechanism whereby oral clonidine prolongs spinal anesthesia remains to be determined.

Cited by 72 publications

References 34 publications

Effect of Intrathecal Clonidine on Duration of Spinal Analgesia

Effect of Intrathecal Clonidine on Duration of Spinal Analgesia

Effect of Oral Clonidine Premedication on the Onset and Duration of Spinal Anesthesia With Hyperbaric Bupivacaine

Duration of analgesia, sensory and motor blockade and intra operative hemodynamic changes caused by intrathecal bupivacaine, bupivacaine plus clonidine and bupivacaine plus dexmedetomidine in spinal anesthesia: prospective, comparative study

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