DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20162337

Clonidine versus fentanyl as adjuvant to 0.75% ropivacaine for epidural anesthesia for lower limb surgeries: a comparative evaluation

Salony Agarwal, Kumkum Gupta, Prashant K. Gupta, Manoranjan Bansal, Raaghav Sharma, Aqsa Buchh

Abstract


Background: Epidural adjuvants to local anaesthetic are used to enhance the quality and duration of surgical anaesthesia. The present study was aimed to compare the clinical efficacy of clonidine with fentanyl as adjuvant to epidural ropivacaine for block characteristics and hemodynamic changes during lower limb surgeries.

Methods: Sixty adult consenting patients of both gender of ASA physical status I and II scheduled for lower limb surgeries under epidural anaesthesia, were randomized into   two groups of 30 patients each to receive either 15 ml of 0.75% ropivacaine with 1 ml of clonidine, 50 µg (Group RC) or with 1 ml of fentanyl 50 µg (Group RF). All patients were assessed for onset and duration of sensory and motor blockade and time to first rescue analgesia as primary end points. The hemodynamic variations, sedation, pruritus, respiratory depression or any other adverse events were recorded as secondary end points.

Results: Onset of sensory block to T10 was comparable between the groups. Time to achieve maximum sensory level at T6-7 and maximum motor block was faster when fentanyl was used as compared to clonidine with statistically significant difference between the group (p<0.05). Duration of sensory analgesia was enhanced with epidural clonidine, delaying the need for rescue analgesia. In clonidine group, side effects of sedation, bradycardia and hypotension were also observed. Only 5 patients of fentanyl group suffered from pruritus.

Conclusions: Clonidine was more effective than fentanyl as epidural adjuvant to 0.75% ropivacaine for prolonging the duration of analgesia with fewer manageable side effects.

 


Keywords


Clonidine, Epidural anesthesia, Fentanyl, Ropivacaine

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References


Liu S, Carpenter RL, Neal JM. Epidural anesthesia and analgesia-Their role in postoperative outcome. Anesthesiology. 1995;82:1474-506.

Stewart J, Kellert N, Castro D. The central nervous system and cardiovascular effects of levobupivacaine and ropivacaine in healthy volunteers. Anesth Anal. 2003;97:412-6.

Eledjam JJ, Ripart J, Viel E. Clinical application of ropivacaine for the lower extremity. Curr Top Med Chem. 2001;1:227-31.

Cherng CH, Yang CP, Wong CS. Epidural fentanyl speeds the onset of sensory and motor blocks during epidural ropivacaine anesthesia. Anesth Anal. 2005;101:1834-7.

Reid J. The clinical pharmacology of clonidine and related central antihypertensive agents. Br J Clin Pharmacol. 1981;12:295-302.

Bromage PR. Epidural Analgesia. Philadelphia: WB Saunders. 1978;pp: 144.

Ramsay MA, Savege TM, Simpson BR, Goodwin R. Controlled sedation with alphaxalone–alphadolone. Br Med J. 1974;2:656-9.

McClellan KJ, Faulds D. Ropivacaine: An update of its use in regional anesthesia. Drugs. 2000;60:1065-93.

Agarwal A, Verma RK, Shrivastava S. Ropivacaine- The latest local anesthetic in the Indian market. J Anesth Clin Pharmacol. 2010;26:22-8.

Peduto Va, Baroncini S, Montanini S, Proietti R, Rosignoli L, Tufano R, et al. A prospective, randomized, double-blind comparison of epidural levobupivacaine 0.5% with epidural ropivacaine 0.75% for lower limb procedures. Eur J Anesthesiol. 2003; 20: 979-83.

Fields HL, Emson PC, Leigh BK, Gilbert RFT, . Iversen LL et al. Multiple opiate receptor sites on primary fibres. Nature. 1980;284:351-3.

Filos KS, Goudas LC, Patroni O, Polyzou V. Intrathecal clonidine as a sole analgesic for pain relief after caesarean section. Anesthesiology. 1992;77:267-74.

Bajwa SJ, Bajwa SK, Kaur J, Singh A, Bakshi G, Singh K, Panda A. Admixture of clonidine and fentanyl to ropivacaine in epidural anesthesia for lower abdominal surgery. Anesth Essays Res. 2010;4:9-14.

Bajwa SJ, Bajwa SK, Kaur J. Comparison of epidural ropivacaine and ropivacaine-clonidine combination for elective caesarean sections. Saudi J Anesthesia 2010;4:47-54.

Topcu I, Erincler T, Tekin S, Karear O, Isik, Sakarya M. The comparison of ropivacaine and addition of fentanyl or clonidine in patient controlled epidural analgesia for labour. The Internet Journal of Anesthsiology. 2007;11(2):1-7.