Title: Comparative study of epidural ropivacaine with dexmeditomidine and ropivacaine with clonidine in patients undergoing lower abdominal surgeries
Authors: Dr Sundeep S.Matteda, Dr Pradeep S. Indurkar
DOI: https://dx.doi.org/10.18535/jmscr/v7i11.164
Abstract
Regional Anaesthesia is an excellent choice which provides effective intra &post operative analgesia with a single technique which is being possible due to the availability of long acting amide local anaesthetics like Ropivacaine and by the addition of adjuvants like clonidine and Dexmedetomidine. A good adjuvant must improve the speed of onset, the quality and/ or duration of analgesia with desirable sedation.
Method: 50 patients divided in two groups were studied. Group RC received 19ml of 0.75%Ropivacaine with Inj. clonidine 2μg/kg (made to 1 ml) and Group RD received 19 ml of 0.75% Ropivacaine with inj. Dexmedetomidine 1.5 μg/kg (made to 1 ml) epidurally. The two groups were compared for onset and duration of sensory and motor block, sedation score and haemodynamic stability.
Results: Onset of sensory block was early in dexmeditomidine group. Duration of sensory block and duration of analgesia was prolonged significantly in Dexmeditomidine group as compared to clonidine group. Sedation score was also high in Dexmeditomidine group. There were no significant haemodynamic changes in both the group
Conclusion: Dexmeditomidine with Ropivacaine is a better adjuvant as compared to clonidine with Ropivacaine in respect to early onset and prolonged duration of motor and sensory blockade, haemodynamic stability and satisfactory sedation score.
Keywords: Ropivacaine, Dexmeditomidine, Clonidine, sensory block, motor block, sedation score.
References
- Nemethy M, Paroli L, Williams-Russo PC, Blanck TJ. Assessing sedation with regional anaesthesia: Inter-rater agreement on a modified Wilson Sedation Scale. Anesth Analg 2002;94:723-8.
- Gupta S, Raval D, Patel M, Patel N, Shah N. Addition of epidural Clonidine enhances postoperative analgesia: A double-blind study in total knee replacement surgeries. Anaesthesia, essays and researches. 2010 Jul;4(2):70.
- Kamibayashi T, Maze M. Clinical uses of alpha-adrenergic agonists. Anaesthesiology 2000; 93:1345-9.
- HohenerDr Blumenthal S. Borgeal A. Sedation and regional anaesthesia in the adult patient. Br J Anaesth2008; 100:8-16.
- Helgeson LE. Sedation during regional anaesthesia: Inhalational versus intravenous. CurrOpinAnaesthesiol2005; 18:534-9.
- Scafati A. Analgesia and alpha agonists 2.Medens Rev 2004; 4-7.
- Gabriel JS. Gordin V. Alpha 2 agonists in regional anaesthesia and analgesia. CurrOpinAnaesthesiol2001;14:751-3.
- Grewal A. Dexmedetomidine: New avenues. J Anaesth Clin Pharmacol 2011; 27:297-302
- Salgado PF, Nascimento P, Módolo NSP, Sabbag ATR et al. Adding Dexmedetomidine to Ropivacaine 0.75% for Epidural Anaesthesia. Does It Improve the Quality of the Anaesthesia. Anaesthesiology 2005; 103: A974
- Salgado PF, Sabbag AT, Silva PC, Brienze SL, Dalto HP, Módolo NS, Braz JR, Nascimento P Jr.Synergistic effect between dexmedetomidine and 0.75% ropivacaine in epidural Anaesthesia. Rev Assoc Med Bras. 2008;54(2):110-5.
- Bajwa SJ, Bajwa SK, Kaur J, Singh G, Arora V, Gupta S, Kulshrestha A, Singh A, Parmar SS, Singh A, Goraya SP. Dexmedetomidine and clonidine in epidural anaesthesia: A comparative evaluation. Indian journal of anaesthesia. 2011 Mar;55(2):116.
- Shaikh SI, Mahesh SB. The efficacy and safety of epidural dexmedetomidine and clonidine with bupivacaine in patients undergoing lower limb orthopaedic surgeries. J Anaesthesiol Clin Pharmacol 2016;32:203-9
- Saravana Babu MS, Verma AK, Agarwal A, Tyagi CM, Upadhaya M, Tripathi S.A comparative study in the post-operative spine surgeries: Epidural ropivacaine with dexmedetomidine and ropivacaine with clonidine for post –operative analgesia. Indian J Anaesth2013;57:371-6
- Kaur S, Attri JP, Kaur G, Singh TP. Comparative evaluation of ropivacaine versus dexmedetomidine and ropivacaine in epidural anaesthesia in lower limb orthopaedic surgeries. Saudi J Anaesth2014;8:463-9.
- Bajwa SJ, Arora V, Kaur J, Singh A, Parmar SS. Comparative evaluation of dexmedetomidine and fentanyl for epidural analgesia in lower limb orthopaedic surgeries. Saudi journal of anaesthesia. 2011 Oct;5(4):365.
- Shailesh k, raval dl, kumari a, dhas sk. A comparative study of epidural ropivacaine (0.75%) plus clonidine with ropivacaine (0.75%) plus dexmedetomidine for lower abdominal and lower limb surgeries. Jemds, 2017 jul 6;6(54):4076-81.
- Arunkumar S, Kumar VH, Krishnaveni N, Ravishankar M, Jaya V, Aruloli M. Comparison of dexmedetomidine and clonidine as an adjuvant to ropivacaine for epidural anaesthesia in lower abdominal and lower limb surgeries. Saudi journal of anaesthesia. 2015 Oct;9(4):404.
- Alves TC, Braz JR. Clinical evaluation of clonidine associated to ropivacaine for epidural anaesthesia. Revistabrasileira de anestesiologia. 2002 Jul;52 (4):410-9.