Prevención de hipotensión y prolongación de analgesia postoperatoria en cesárea urgente: Estudio randomizado con clonidina intratecal
Prevention of hypotension and prolongation of postoperative analgesia in emergency cesarean sections: A randomized study with intrathecal clonidine.
Bajwa SJ, Bajwa SK, Kaur J, Singh A, Singh A, Parmar SS.
Department of Anesthesiology and Intensive Care Medicine, Gian Sagar Medical College and Hospital, Banur, Punjab, India.
Int J Crit Illn Inj Sci. 2012 May;2(2):63-9. doi: 10.4103/2229-5151.97269.
Abstract
BACKGROUND AND CONTEXT: Different adjuvants been tried out for neuraxial anesthesia in emergency caesarean section so that the dose of the local anesthetic can be reduced and hypotension thereby prevented. AIMS AND OBJECTIVES:The present study was carried out in patients presenting for emergency lower segment caesarean section (LSCS) to establish the dose of intrathecal clonidine that would allow reduction of the dose of local anesthetic (thereby reducing the incidence and magnitude of hypotension) while at the same time providing clinically relevant prolongation of spinal anesthesia without significant side effects.
MATERIALS AND METHODS: This randomized clinical study was carried out in our institution among 100 pregnant females who underwent emergency caesarean section. The participants were divided randomly into four groups: A, B, C, and D, each comprising 25 parturients. Subarachnoid block was performed using a 26G Quincke needle, with 12 mg of hyperbaric bupivacaine (LA) in group A, 9 mg of LA + 30 μg ofclonidine in group B, LA + 37.5 μg of clonidine in group C, and LA + 45 μg of clonidine in group D. The solution was uniformly made up to 2.2 mL with normal saline in all the groups. Onset of analgesia at T(10) level, sensory and motor blockade levels, maternal heart rate and blood pressure, neonatal Apgar scores, postoperative block characteristics, and adverse events were looked for and recorded. Statistical analysis was carried out with SPSS(®) version 10.0 for Windows(®), using the ANOVA test with post hoc significance, the Chi-square test, and the Mann-Whitney U test. P<.05 was considered significant and P<.0001 as highly significant. RESULTS: One hundred patients were enrolled for this study. The four groups were comparable with regard to demographic data and neonatal Apgar scores. Onset and establishment of sensory and motor analgesia was significantly shorter in groups C and D, while hypotension (and the use of vasopressors) was significantly higher in groups A and D. Perioperative shivering, nausea, and vomiting were significantly higher in groups A and D, while incidence of dry mouth was significantly higher in group D. CONCLUSIONS:The addition of 45 μg, 37.5 μg, and 30 μg of clonidine to hyperbaric bupivacaine results in more prolonged complete and effective analgesia, allowing reduction of up to 18% of the total dose of hyperbaric bupivacaine. From the results of this study, 37.5 μg of clonidine seems to be the optimal dose.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3401819/
Efecto de clonidina intratecal agregada a bupivacaína hiperbárica sobre el dolor postoperatorio después de cesárea. Estudio randomizado controlado
The effect of addition of intrathecal clonidine to hyperbaric bupivacaine on postoperative pain after lower segment caesarean section: A randomized control trial.
Singh R, Gupta D, Jain A.
Department of Anaesthesiology and Critical Care, Lady Hardinge Medical College and Shrimati Sucheta Kriplani Hospital, New Delhi, India.
Saudi J Anaesth. 2013 Jul;7(3):283-90. doi: 10.4103/1658-354X.115360.
Abstract
BACKGROUND:Intrathecal clonidine prolongs spinal anesthesia but the optimum dose to be used in cesarean delivery is not yet known. We evaluated the effect of addition of intrathecal clonidine to hyperbaric bupivacaine on postoperative pain after lower segment caesarean section. METHODS:A total of 105 parturients carrying a singleton fetus at term, scheduled to undergo elective LSCS under spinal anesthesia were randomized in a double blind fashion to one of the three groups. Group BF (n=35) received 2 ml of 0.5% hyperbaric bupivacaine+25 μg fentanyl, Group BC50 (n=35) received 2 ml of 0.5% hyperbaric bupivacaine+50 μg clonidine, Group BC75 (n=35) received 2 ml of 0.5% hyperbaric bupivacaine+75 μg clonidine. RESULTS:The duration of postoperative analgesia was 184.73±68.64 min in group BF, 360.71±86.51 min in group BC50 and 760.50±284.03 min in group BC75, P<0.001. The incidence of hypotension was comparable, P=0.932, whereas the incidence of nausea and pruritis was significantly lower in groups BC50 and BC75 as compared to group BF, P<0.001. No other side effects of intrathecal clonidine were detected. Neonatal outcome was similar in all the three groups. CONCLUSIONS:Addition of 75 μg clonidine to hyperbaric bupivacaine in spinal anesthesia for LSCS significantly prolongs the duration of postoperative analgesia without any increase in maternal side effects. There was no difference in neonatal outcome.
KEYWORDS:Caesarean section, clonidine, intrathecal, postoperative pain
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3757801/
http://www.saudija.org/downloadpdf.asp?issn=1658-354X;year=2013;volume=7;issue=3;spage=283;epage=290;aulast=Singh;type=2
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Prevention of hypotension and prolongation of postoperative analgesia in emergency cesarean sections: A randomized study with intrathecal clonidine.
Bajwa SJ, Bajwa SK, Kaur J, Singh A, Singh A, Parmar SS.
Department of Anesthesiology and Intensive Care Medicine, Gian Sagar Medical College and Hospital, Banur, Punjab, India.
Int J Crit Illn Inj Sci. 2012 May;2(2):63-9. doi: 10.4103/2229-5151.97269.
Abstract
BACKGROUND AND CONTEXT: Different adjuvants been tried out for neuraxial anesthesia in emergency caesarean section so that the dose of the local anesthetic can be reduced and hypotension thereby prevented. AIMS AND OBJECTIVES:The present study was carried out in patients presenting for emergency lower segment caesarean section (LSCS) to establish the dose of intrathecal clonidine that would allow reduction of the dose of local anesthetic (thereby reducing the incidence and magnitude of hypotension) while at the same time providing clinically relevant prolongation of spinal anesthesia without significant side effects.
MATERIALS AND METHODS: This randomized clinical study was carried out in our institution among 100 pregnant females who underwent emergency caesarean section. The participants were divided randomly into four groups: A, B, C, and D, each comprising 25 parturients. Subarachnoid block was performed using a 26G Quincke needle, with 12 mg of hyperbaric bupivacaine (LA) in group A, 9 mg of LA + 30 μg ofclonidine in group B, LA + 37.5 μg of clonidine in group C, and LA + 45 μg of clonidine in group D. The solution was uniformly made up to 2.2 mL with normal saline in all the groups. Onset of analgesia at T(10) level, sensory and motor blockade levels, maternal heart rate and blood pressure, neonatal Apgar scores, postoperative block characteristics, and adverse events were looked for and recorded. Statistical analysis was carried out with SPSS(®) version 10.0 for Windows(®), using the ANOVA test with post hoc significance, the Chi-square test, and the Mann-Whitney U test. P<.05 was considered significant and P<.0001 as highly significant. RESULTS: One hundred patients were enrolled for this study. The four groups were comparable with regard to demographic data and neonatal Apgar scores. Onset and establishment of sensory and motor analgesia was significantly shorter in groups C and D, while hypotension (and the use of vasopressors) was significantly higher in groups A and D. Perioperative shivering, nausea, and vomiting were significantly higher in groups A and D, while incidence of dry mouth was significantly higher in group D. CONCLUSIONS:The addition of 45 μg, 37.5 μg, and 30 μg of clonidine to hyperbaric bupivacaine results in more prolonged complete and effective analgesia, allowing reduction of up to 18% of the total dose of hyperbaric bupivacaine. From the results of this study, 37.5 μg of clonidine seems to be the optimal dose.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3401819/
Efecto de clonidina intratecal agregada a bupivacaína hiperbárica sobre el dolor postoperatorio después de cesárea. Estudio randomizado controlado
The effect of addition of intrathecal clonidine to hyperbaric bupivacaine on postoperative pain after lower segment caesarean section: A randomized control trial.
Singh R, Gupta D, Jain A.
Department of Anaesthesiology and Critical Care, Lady Hardinge Medical College and Shrimati Sucheta Kriplani Hospital, New Delhi, India.
Saudi J Anaesth. 2013 Jul;7(3):283-90. doi: 10.4103/1658-354X.115360.
Abstract
BACKGROUND:Intrathecal clonidine prolongs spinal anesthesia but the optimum dose to be used in cesarean delivery is not yet known. We evaluated the effect of addition of intrathecal clonidine to hyperbaric bupivacaine on postoperative pain after lower segment caesarean section. METHODS:A total of 105 parturients carrying a singleton fetus at term, scheduled to undergo elective LSCS under spinal anesthesia were randomized in a double blind fashion to one of the three groups. Group BF (n=35) received 2 ml of 0.5% hyperbaric bupivacaine+25 μg fentanyl, Group BC50 (n=35) received 2 ml of 0.5% hyperbaric bupivacaine+50 μg clonidine, Group BC75 (n=35) received 2 ml of 0.5% hyperbaric bupivacaine+75 μg clonidine. RESULTS:The duration of postoperative analgesia was 184.73±68.64 min in group BF, 360.71±86.51 min in group BC50 and 760.50±284.03 min in group BC75, P<0.001. The incidence of hypotension was comparable, P=0.932, whereas the incidence of nausea and pruritis was significantly lower in groups BC50 and BC75 as compared to group BF, P<0.001. No other side effects of intrathecal clonidine were detected. Neonatal outcome was similar in all the three groups. CONCLUSIONS:Addition of 75 μg clonidine to hyperbaric bupivacaine in spinal anesthesia for LSCS significantly prolongs the duration of postoperative analgesia without any increase in maternal side effects. There was no difference in neonatal outcome.
KEYWORDS:Caesarean section, clonidine, intrathecal, postoperative pain
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3757801/
http://www.saudija.org/downloadpdf.asp?issn=1658-354X;year=2013;volume=7;issue=3;spage=283;epage=290;aulast=Singh;type=2
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
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