Small-Dose Clonidine Prolongs Postoperative Analgesia After Sciatic-Femoral Nerve Block with 0.75% Ropivacaine for Foot Surgery

Casati, Andrea; Magistris, L.; Fanelli, Guido; Beccaria, Paolo; Cappelleri, Gianluca; Aldegheri, Giorgio; Torri, G.

doi:10.1097/00000539-200008000-00029

Cited by 58 publications

(51 citation statements)

References 17 publications

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“…The large diameter of the sciatic nerve may lead to a less foreseeable blockade onset time, as compared to other peripheral blocks, although this pharmacological effect is primarily influenced by chemical properties of the anesthetic drug. In our investigation, mean onset time was 6 minutes, relatively lower than previous studies using other anesthetics by different routes, such as ropivacaine (10 to 25 minutes) 13,14,[24][25][26] and bupivacaine (20 to 30 minutes) 27 . It has to be stressed that no patient needed analgesic complementation during surgery, differently from what has been reported by other authors 14 .…”

Section: Discussioncontrasting

confidence: 66%

“…Nesta investigação, observou-se latência média de 6 minutos, relativamente menor que estudos prévios que utilizaram outros anestésicos por diferente vias, como a ropivacaí-na, cuja latência média foi de 10 a 25 minutos 13,14,[24][25][26] , e bupivacaína de 20 a 30 minutos 27 . Ressalta-se a observação que nenhum paciente necessitou complementação analgésica durante a cirurgia, diferentemente referido por outros autores 14 .…”

Section: Resultsunclassified

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Abordagem simplificada do nervo ciático por via posterior, no ponto médio do sulco glúteo-femoral, com uso de neuroestimulador

Fonseca¹,

Ferreira²,

Ruzi³

et al. 2002

Rev. Bras. Anestesiol.

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RESUMO Background and Objectives -The sciatic nerve may be blocked by several routes, all of them with advantages and disadvantages. It is the largest human nerve in diameter and length, being the prolongation of the upper sacral plexus fascicle (L 4 ,L 5 ,S 2 and S 3 ). It leaves the pelvis through the foramen ischiadicum majus, passing below the piriform muscle and going down between the greater trochanter and the ischial tuberosity, continuing along the femoral dorsum, anterior to biceps femoris and semitendinous muscles, to the lower femoral third, where it is divided in two major

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Section: Discussioncontrasting

confidence: 66%

Section: Resultsunclassified

Abordagem simplificada do nervo ciático por via posterior, no ponto médio do sulco glúteo-femoral, com uso de neuroestimulador

Fonseca¹,

Ferreira²,

Ruzi³

et al. 2002

Rev. Bras. Anestesiol.

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“…The first one is epinephrine, which prolongs the duration of block for local anesthetics of intermediate duration of action (mepivacaine, lidocaine), and which also serves as a marker for intravascular injection. The second useful adjuvant is clonidine which also prolongs the duration of most types of peripheral nerve block [37][38][39][40][41][42][43] The presence and clinical significance of peripheral opioid receptors that may be migratory and activated by inflammatory states, is widely debated. Candido et al [44,45] showed that buprenorphine added to a local anesthetic mixture (mepivacaine 1%, tetracaine 0.2% and epinephrine 1:200,000) significantly prolonged analgesia in both axillary and subclavian perivascular brachial plexus blocks, by up to 30 hours.…”

Section: Local Anesthetics and Additivesmentioning

confidence: 99%

Anesthesia for Shoulder Surgery: A Review of the Interscalene Block and a Discussion of Regional vs. General Anesthesia

Ghaleb¹,

Dilley²

2012

TOATJ

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A review of the literature regarding anesthesia for shoulder surgery was performed. Current anesthetic techniques available include regional, general, or a combination of regional and general. We discuss each of these techniques, with an emphasis on regional (specifically interscalene block), in detail. Current evidence supports both regional and general anesthesia to be safe and efficient techniques. The interscalene block is considered by most to provide the best surgical anesthesia and is the most commonly performed block for shoulder surgery. This paper aims to review the performance of the interscalene block and to discuss alternative choices for shoulder surgery, namely general anesthesia and a combined general/regional technique. We also aim to provide considerations to aid in the performance of a safely administered anesthetic.

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“…12,18,24 Low dose clonidine is also reported to prolong postoperative analgesia with no clinically relevant side effects. 9 Clonidine may act as a central or peripheral sympatholytic agent, resolving sympathetically mediated pain. 25 In lower doses as used here, the sedative and hypotensive effects of clonidine are attenuated and act to offset the stimulating effects of ketamine.…”

Section: Statisticsmentioning

confidence: 99%

“…Several drugs, including clonidine, ketamine, magnesium, lidocaine, ketorolac, and steroids have all been shown to be analgesic. [6][7][8][9][10][11] Combining these drugs may potentiate analgesia by separate actions and decrease the risk of side effects by lowering the effective dose for each agent. 12,13 The purpose of this study was to compare fentanyl analgesia with a combination of non-opioid drugs for gastric bypass surgery.…”

mentioning

confidence: 99%

Non-opioid analgesia improves pain relief and decreases sedation after gastric bypass surgery

Feld

Laurito

Beckerman

et al. 2003

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : Several non-opioid drugs have been shown to provide analgesia during and after surgery. We compared sevoflurane anesthesia with fentanyl analgesia to sevoflurane and non-opioid drug treatment for gastric bypass surgery and recovery.M Me et th ho od ds s: : Thirty obese patients (body mass index > 50 kg·m -2 ) undergoing gastric bypass were randomized to receive sevoflurane anesthesia with either fentanyl or a non-opioid regimen including ketorolac, clonidine, lidocaine, ketamine, magnesium sulfate, and methylprednisolone. Morphine use by patient-controlled analgesia (PCA) pump and pain score measured by visual analogue scale were determined in the postanesthesia care unit (PACU) and for the first 16 hr after surgery. Sedation was evaluated in the PACU. Investigators assessing patient outcomes were blinded to the study group.R Re es su ul lt ts s: : Fentanyl treated patients were more sedated in the PACU compared to the non-opioid group. Non-opioid treated patients required 5.2 ± 2.6 mg·hr -1 morphine by PCA during their stay in the PACU while patients anesthetized with fentanyl used 7.8 ± 3.3 mg·hr -1 (P < 0.05). Fentanyl and non-opioid treated patients showed no difference in pain score one or 16 hr after surgery.C Co on nc cl lu us si io on n: : Our results show that non-opioid analgesia produced pain relief and less sedation during recovery from gastric bypass surgery compared to fentanyl. Objectif : On reconnaît à certains médicaments non-opioïdes des Résultats : La sédation, notée à la SDR, était plus importante chez les patients traités au fentanyl, comparés à ceux traités avec un médicament non-opioïde. Les patients traités aux non-opioïdes ont demandé 5,2 ± 2,6 mg·h -1 de morphine en AAC pendant leur séjour en SDR tandis que les patients anesthésiés au fentanyl en ont utilisé 7,8 ± 3,3 mg·h -1 (P < 0,05). Les scores de douleurs des patients des deux groupes n'ont présenté aucune différence, une ou 16 h après l'opération. Conclusion : L'analgésie avec des non opioïdes, comparé au fentanyl, a mieux soulagé la douleur et provoqué moins de sédation pendant la récupération qui suit un pontage gastrique.HE body mass index (BMI), calculated as the weight in kilograms divided by the height in metres squared, has been used in clinical and epidemiological studies as a predictor of health risk. 1 A BMI of 25 kg·m -2 is considered normal, > 30 kg·m -2 obese, > 35 kg·m -2 morbidly obese and > 55 kg·m -2 super morbidly obese. Respiratory problems are associated with morbid obesity, including obstructive apnea during sleep, decreased functional residual capacity and lung compliance and increased work of breathing. 2,3 Obese patients may be sensitive to the respiratory depressant effect of opioid analgesic drugs and more likely to require postoperative ventilation to avoid hypoxic episodes.

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Small-Dose Clonidine Prolongs Postoperative Analgesia After Sciatic-Femoral Nerve Block with 0.75% Ropivacaine for Foot Surgery

Cited by 58 publications

References 17 publications

Abordagem simplificada do nervo ciático por via posterior, no ponto médio do sulco glúteo-femoral, com uso de neuroestimulador

Abordagem simplificada do nervo ciático por via posterior, no ponto médio do sulco glúteo-femoral, com uso de neuroestimulador

Anesthesia for Shoulder Surgery: A Review of the Interscalene Block and a Discussion of Regional vs. General Anesthesia

Non-opioid analgesia improves pain relief and decreases sedation after gastric bypass surgery

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