Evaluación de la combinación bupivacaína-clonidina para raquia unilateral en cirugía ortopédica por debajo de la rodilla
Evaluation of bupivacaine-clonidine combination for unilateral spinal anesthesia in lower limb below-knee orthopedic surgery.
Sapate M, Sahu P, Shah B, Suryawanshi C, Kulkarni A, Panditrao MM.
Saudi J Anaesth. 2014 Jul;8(3):384-7. doi: 10.4103/1658-354X.136626.
Abstract
BACKGROUND AND OBJECTIVES: The purposes of this study were to evaluate the onset, quality and duration of sensory and motor blockade between hyperbaric bupivacaine and clonidine combination with bupivacaine alone when administered intrathecally for unilateral spinal anesthesia in below-knee orthopedic surgery, efficacy of clonidine for post-operative analgesia and side-effects of clonidine, if any. METHODS:Sixty ASA I and ASA II patients scheduled for elective surgery with time duration up to 90 min were studied. Patients were randomised in two equal groups by the lottery method. Group A (control group) was given Inj. bupivacaine (hyperbaric) 0.5% - 12.5 mg (2.5 ml) + 0.5 ml of normal saline intrathecally. Group B (clonidine group) was given Inj. bupivacaine (hyperbaric) 0.5% - 12.5 mg (2.5 ml) + 50 mcg clonidine in 0.5 ml volume intrathecally. RESULTS: The mean peak sensory block was earlier in Group B (4.7±1.23 min) as compared with Group A (6.27±1.51 min). The mean peak motor block was earlier in Group B (6.17±1.20 min) as compared with Group A (8.63±1.71 min). The two-segment regression of sensory block was longer in Group B (106.23±9.17 min) as compared with Group A (104.43±17.75 min), which is clinically significant. Requirement of rescue analgesia was considerably prolonged in Group B (450.33±95.10 min) as compared with Group A (220±36.36 min), which was also clinically highly significant. CONCLUSION: Intrathecal clonidine potentiates bupivacaine induced spinal sensory block and, motor block and reduces the analgesic requirement in the early post-operative period in nilateral spinal anesthesia for lower limb below knee surgery.
KEYWORDS:Below-knee surgery; bupivacaine; clonidine; intrathecal
http://www.saudija.org/downloadpdf.asp?issn=1658-354X;year=2014;volume=8;issue=3;spage=384;epage=387;aulast=Sapate;type=2
Clonidina como adyuvante de bupivacaína hiperbárica en raquia para viejos sometidos a cirugía ortopédica de extremidades inferiores
Clonidine as an adjuvant to hyperbaric bupivacaine for spinal anesthesia in elderly patients undergoing lower limb orthopedic surgeries.
Agarwal D, Chopra M, Mohta M, Sethi AK.
Saudi J Anaesth. 2014 Apr;8(2):209-14. doi: 10.4103/1658-354X.130720.
Abstract
BACKGROUND: In elderly patients, use of adjuvant with small doses of local anesthetics is a preferred technique for spinal anesthesia for lower limb surgeries. This study tested the hypothesis that addition of small doses of clonidine augments the spinal block levels produced by hyperbaric bupivacaine in elderly without affecting the side-effects if any of clonidine in these patients. MATERIALS AND METHODS: This was a prospective, randomized, double-blind study. Above 60 years male patients were allocated to three equal groups. Group C received 9 mg hyperbaric bupivacaine without clonidine while Group C15 and Group C30 received 15 μg and 30 μg clonidine with hyperbaric bupivacaine respectively for spinal anesthesia. Effect of clonidine on sensory block levels was the primary study outcome measure. Motor blockade and hemodynamic parameters were also studied. RESULTS: A significantly higher median block levels were achieved in Group C15 (P < 0.001) and Group C30 (P = 0.015) than Group C. Highest median sensory block level, the mean times for sensory regression to T12 level and motor block regression were statistically significant between Groups C15 and C and between Groups C30 and C. On comparison of fall in systolic blood pressure trends, there was no significant difference in theclonidine groups as compared with the control group. CONCLUSIONS: In elderly patients, clonidine when used intrathecally in doses of 15 μg or 30 μg with bupivacaine, significantly potentiated the sensory block levels and duration of analgesia without affecting the trend of systolic blood pressure as compared to bupivacaine alone. Clonidine in doses of 30 μg however facilitated the ascent of sensory level block to unexpectedly higher dermatomes for a longer time.
KEYWORDS: Clonidine; elderly; spinal anesthesia
http://www.saudija.org/downloadpdf.asp?issn=1658-354X;year=2014;volume=8;issue=2;spage=209;epage=214;aulast=Agarwal;type=2
Comparación de dexmedetomidina, clonidina y fentanil intratecales como adyuvantes de bupivacaína espinal para cirugía de extremidad inferior
A comparison of intrathecal dexmedetomidine, clonidine, and fentanyl as adjuvants to hyperbaric bupivacainefor lower limb surgery: A double blind controlled study.
Mahendru V, Tewari A, Katyal S, Grewal A, Singh MR, Katyal R.
J Anaesthesiol Clin Pharmacol. 2013 Oct;29(4):496-502. doi: 10.4103/0970-9185.119151.
Abstract
BACKGROUND: Various adjuvants are being used with local anesthetics for prolongation of intraoperative and postoperative analgesia. Dexmedetomidine, the highly selective 2 adrenergic agonist is a new neuraxial adjuvant gaining popularity. SETTINGS AND DESIGN: The study was conducted in prospective, double blind manner. It included 120 American Society of Anesthesiology (ASA) class I and II patients undergoing lower limb surgery under spinal anesthesia after approval from hospital ethics committee with written and informed consent of patients. MATERIALS AND METHODS: The patients were randomly allocated into four groups (30 patients each). Group BS received 12.5 mg hyperbaricbupivacaine with normal saline, group BF received 12.5 mg bupivacaine with 25 g fentanyl, group BC received 12.5 mg of bupivacaine supplemented 30 g clonidine, and group BD received 12.5 mg bupivacaine plus 5 g dexmedetomidine. The onset time to reach peak sensory and motor level, the regression time of sensory and motor block, hemodynamic changes, and side effects were recorded. RESULTS: Patients in Group BD had significantly longer sensory and motor block times than patients in Groups BC, BF, and BS with Groups BC and BF having comparable duration of sensory and motor block. The mean time of two segment sensory block regression was 147 ± 21 min in Group BD, 117 ± 22 in Group BC, 119 ± 23 in Group BF, and 102 ± 17 in Group BS (P > 0.0001). The regression time of motor block to reach modified Bromage zero (0) was 275 ± 25, 199 ± 26, 196 ± 27, 161 ± 20 in Group BD, BC, BF, and BS, respectively (P > 0.0001). The onset times to reach T8 dermatome and modified Bromage 3 motor block were not significantly different between the groups. Dexmedetomidine group showed significantly less and delayed requirement of rescue analgesic. CONCLUSIONS: Intrathecal dexmedetomidine is associated with prolonged motor and sensory block, hemodynamic stability, and reduced demand of rescue analgesics in 24 h as compared to clonidine, fentanyl, or lone bupivacaine. KEYWORDS: adrenoreceptor agonist; bupivacaine; clonidine; dexmedetomidine; fentanyl; spinal anesthesia; α2
http://www.joacp.org/downloadpdf.asp?issn=0970-9185;year=2013;volume=29;issue=4;spage=496;epage=502;aulast=Mahendru;type=2
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Evaluation of bupivacaine-clonidine combination for unilateral spinal anesthesia in lower limb below-knee orthopedic surgery.
Sapate M, Sahu P, Shah B, Suryawanshi C, Kulkarni A, Panditrao MM.
Saudi J Anaesth. 2014 Jul;8(3):384-7. doi: 10.4103/1658-354X.136626.
Abstract
BACKGROUND AND OBJECTIVES: The purposes of this study were to evaluate the onset, quality and duration of sensory and motor blockade between hyperbaric bupivacaine and clonidine combination with bupivacaine alone when administered intrathecally for unilateral spinal anesthesia in below-knee orthopedic surgery, efficacy of clonidine for post-operative analgesia and side-effects of clonidine, if any. METHODS:Sixty ASA I and ASA II patients scheduled for elective surgery with time duration up to 90 min were studied. Patients were randomised in two equal groups by the lottery method. Group A (control group) was given Inj. bupivacaine (hyperbaric) 0.5% - 12.5 mg (2.5 ml) + 0.5 ml of normal saline intrathecally. Group B (clonidine group) was given Inj. bupivacaine (hyperbaric) 0.5% - 12.5 mg (2.5 ml) + 50 mcg clonidine in 0.5 ml volume intrathecally. RESULTS: The mean peak sensory block was earlier in Group B (4.7±1.23 min) as compared with Group A (6.27±1.51 min). The mean peak motor block was earlier in Group B (6.17±1.20 min) as compared with Group A (8.63±1.71 min). The two-segment regression of sensory block was longer in Group B (106.23±9.17 min) as compared with Group A (104.43±17.75 min), which is clinically significant. Requirement of rescue analgesia was considerably prolonged in Group B (450.33±95.10 min) as compared with Group A (220±36.36 min), which was also clinically highly significant. CONCLUSION: Intrathecal clonidine potentiates bupivacaine induced spinal sensory block and, motor block and reduces the analgesic requirement in the early post-operative period in nilateral spinal anesthesia for lower limb below knee surgery.
KEYWORDS:Below-knee surgery; bupivacaine; clonidine; intrathecal
http://www.saudija.org/downloadpdf.asp?issn=1658-354X;year=2014;volume=8;issue=3;spage=384;epage=387;aulast=Sapate;type=2
Clonidina como adyuvante de bupivacaína hiperbárica en raquia para viejos sometidos a cirugía ortopédica de extremidades inferiores
Clonidine as an adjuvant to hyperbaric bupivacaine for spinal anesthesia in elderly patients undergoing lower limb orthopedic surgeries.
Agarwal D, Chopra M, Mohta M, Sethi AK.
Saudi J Anaesth. 2014 Apr;8(2):209-14. doi: 10.4103/1658-354X.130720.
Abstract
BACKGROUND: In elderly patients, use of adjuvant with small doses of local anesthetics is a preferred technique for spinal anesthesia for lower limb surgeries. This study tested the hypothesis that addition of small doses of clonidine augments the spinal block levels produced by hyperbaric bupivacaine in elderly without affecting the side-effects if any of clonidine in these patients. MATERIALS AND METHODS: This was a prospective, randomized, double-blind study. Above 60 years male patients were allocated to three equal groups. Group C received 9 mg hyperbaric bupivacaine without clonidine while Group C15 and Group C30 received 15 μg and 30 μg clonidine with hyperbaric bupivacaine respectively for spinal anesthesia. Effect of clonidine on sensory block levels was the primary study outcome measure. Motor blockade and hemodynamic parameters were also studied. RESULTS: A significantly higher median block levels were achieved in Group C15 (P < 0.001) and Group C30 (P = 0.015) than Group C. Highest median sensory block level, the mean times for sensory regression to T12 level and motor block regression were statistically significant between Groups C15 and C and between Groups C30 and C. On comparison of fall in systolic blood pressure trends, there was no significant difference in theclonidine groups as compared with the control group. CONCLUSIONS: In elderly patients, clonidine when used intrathecally in doses of 15 μg or 30 μg with bupivacaine, significantly potentiated the sensory block levels and duration of analgesia without affecting the trend of systolic blood pressure as compared to bupivacaine alone. Clonidine in doses of 30 μg however facilitated the ascent of sensory level block to unexpectedly higher dermatomes for a longer time.
KEYWORDS: Clonidine; elderly; spinal anesthesia
http://www.saudija.org/downloadpdf.asp?issn=1658-354X;year=2014;volume=8;issue=2;spage=209;epage=214;aulast=Agarwal;type=2
Comparación de dexmedetomidina, clonidina y fentanil intratecales como adyuvantes de bupivacaína espinal para cirugía de extremidad inferior
A comparison of intrathecal dexmedetomidine, clonidine, and fentanyl as adjuvants to hyperbaric bupivacainefor lower limb surgery: A double blind controlled study.
Mahendru V, Tewari A, Katyal S, Grewal A, Singh MR, Katyal R.
J Anaesthesiol Clin Pharmacol. 2013 Oct;29(4):496-502. doi: 10.4103/0970-9185.119151.
Abstract
BACKGROUND: Various adjuvants are being used with local anesthetics for prolongation of intraoperative and postoperative analgesia. Dexmedetomidine, the highly selective 2 adrenergic agonist is a new neuraxial adjuvant gaining popularity. SETTINGS AND DESIGN: The study was conducted in prospective, double blind manner. It included 120 American Society of Anesthesiology (ASA) class I and II patients undergoing lower limb surgery under spinal anesthesia after approval from hospital ethics committee with written and informed consent of patients. MATERIALS AND METHODS: The patients were randomly allocated into four groups (30 patients each). Group BS received 12.5 mg hyperbaricbupivacaine with normal saline, group BF received 12.5 mg bupivacaine with 25 g fentanyl, group BC received 12.5 mg of bupivacaine supplemented 30 g clonidine, and group BD received 12.5 mg bupivacaine plus 5 g dexmedetomidine. The onset time to reach peak sensory and motor level, the regression time of sensory and motor block, hemodynamic changes, and side effects were recorded. RESULTS: Patients in Group BD had significantly longer sensory and motor block times than patients in Groups BC, BF, and BS with Groups BC and BF having comparable duration of sensory and motor block. The mean time of two segment sensory block regression was 147 ± 21 min in Group BD, 117 ± 22 in Group BC, 119 ± 23 in Group BF, and 102 ± 17 in Group BS (P > 0.0001). The regression time of motor block to reach modified Bromage zero (0) was 275 ± 25, 199 ± 26, 196 ± 27, 161 ± 20 in Group BD, BC, BF, and BS, respectively (P > 0.0001). The onset times to reach T8 dermatome and modified Bromage 3 motor block were not significantly different between the groups. Dexmedetomidine group showed significantly less and delayed requirement of rescue analgesic. CONCLUSIONS: Intrathecal dexmedetomidine is associated with prolonged motor and sensory block, hemodynamic stability, and reduced demand of rescue analgesics in 24 h as compared to clonidine, fentanyl, or lone bupivacaine. KEYWORDS: adrenoreceptor agonist; bupivacaine; clonidine; dexmedetomidine; fentanyl; spinal anesthesia; α2
http://www.joacp.org/downloadpdf.asp?issn=0970-9185;year=2013;volume=29;issue=4;spage=496;epage=502;aulast=Mahendru;type=2
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
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