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 |
Dr. Paul Blass
martes, 28 de octubre de 2014
Clonidina como adyuvante de bupivacaína hiperbárica en raquia para viejos sometidos a cirugía ortopédica de extremidades inferiores
Evaluación de la combinación bupivacaína-clonidina para raquia unilateral en cirugía ortopédica por debajo de la rodilla
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 |
Suscribirse a:
Entradas (Atom)