A comparative study for the analgesic efficacy and safety profile of fentanyl versus clonidine as an adjuvant to epidural ropivacaine 0.75% in lower abdominal surgeries

Nigam, Shuchi; Rastogi, Shivani; Tyagi, Amit; Bhandari, Rajlakshmi

doi:10.4103/aer.aer_254_16

Cited by 3 publications

(1 citation statement)

References 27 publications

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“…Fentanyl a synthetic opioid used as an adjunct to local anesthetics for epidural analgesia provides a dose-sparing effect of local anesthetics and superior analgesia. 5,6 There is an increased chance of side effects such as nausea, vomiting, pruritus, urinary retention, and respiratory depression. 7,8 Nalbuphine an agonist-antagonist opioid acts as an antagonist at the μ-receptor and an agonist at the κ-receptor.…”

Section: Introductionmentioning

confidence: 99%

A randomized comparative study of epidural ropivacaine 0.2% with adjuvant fentanyl or nalbuphine for post-operative analgesia in lower limb surgeries

Harichandan,

Khuntia,

Sahu

et al. 2024

Asian J Med Sci

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Background: Opioid analgesics with local anesthetics in an epidural route are extremely safe, effective, and reliable methods of post-operative pain relief. Aims and Objectives: The primary objective is to compare the duration of analgesia and pain scoring by visual analog scale. The secondary objective is to monitor sedation, hemodynamic changes, and side effects such as nausea, vomiting, shivering, and pruritus. Materials and Methods: A prospective randomized comparative study of 0.2% ropivacaine with nalbuphine and 0.2% ropivacaine with fentanyl in epidural route for post-operative analgesia in elective lower limb surgeries under spinal anesthesia was carried out in a population of 80 patients. After 1½ h of surgery under spinal anesthesia, patients in group RF received 10 mL of 0.2% ropivacaine with 25 mcg of fentanyl and those in group RN received 10 mL of 0.2% ropivacaine with 2.5 mg of nalbuphine and were observed for the study parameters over time. Results: The mean duration of analgesia was longer in group RN than in group RF (398.45 vs. 222.88 min). The hemodynamic parameters such as heart rate, mean arterial pressure, and respiratory ratewere statistically significant from 240 to 480 min which is 4–6 h in group RF and 6–8 h in group RN. 27.5% of patients in group RN attained sedation whereas 7.5% of subjects in group RF had a sedation score of 2 and above at 30 min. The subjects in group RN had a lower visual analog score than group RF. 12% and 4% of patients had vomiting in group RN and group RF, respectively. Conclusion: Epidural nalbuphine in a dose of 2.5 mg with 0.2% ropivacaine provided a longer duration of analgesia with better pain score and more sedation which was advantageous for post-operative patient compliance and satisfaction as compared to 25 mcg of fentanyl with 0.2% ropivacaine.

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Section: Introductionmentioning

confidence: 99%

A randomized comparative study of epidural ropivacaine 0.2% with adjuvant fentanyl or nalbuphine for post-operative analgesia in lower limb surgeries

Harichandan,

Khuntia,

Sahu

et al. 2024

Asian J Med Sci

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Maximization of Non-opioid Multimodal Therapy in Ambulatory Surgery Centers

Fuller

Bordelon

Candal

et al. 2021

Pain Control in Ambulatory Surgery Centers

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Comparison of the Effects of Epidural Clonidine and Fentanyl on Spinal Anaesthesia in Lower Abdominal and Lower Limb Surgeries – A Randomised Controlled Study from Delhi, India

Chungkrang¹,

Kaur²,

Singh³

2021

jemds

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BACKGROUND Addition of epidural adjuvants like opioids or α2-adrenoreceptor agonists can enhance the effectiveness of local anaesthetics for surgical procedures on lower abdomen, pelvis, and lower limbs, by intensifying the block and prolonging the duration of analgesia. We wanted to compare the duration of spinal blockade (sensory and motor) and the degree of analgesia between epidural clonidine and fentanyl before giving spinal anaesthesia. METHODS A prospective double blind randomized comparative study was conducted among 100 patients (18 - 65 years) scheduled for elective lower abdomen and lower limb surgeries. Patients were divided into two groups. For C group – clonidine 0.75ug / kg epidural given with spinal anaesthesia (5 % bupivacaine), in Group F fentanyl was given 1.5 ug / kg epidural with 5 % bupivacaine. The outcome measures were time of onset of sensory blockade, duration and level of sensory blockade, time to achieve highest blockade level, duration of motor blockade, vital parameters, and time of first rescue analgesia. All data was entered in MS excel and analysed. P value < 0.05 was considered significant. RESULTS The demographic data (age, gender) were comparable in both the groups. The preoperative blood pressure, pulse rate, SpO2 were comparable. Clonidine group had significantly lesser mean time of onset of sensory block and motor block (P < 0.001), higher duration of motor blockade (P < .0001) and higher time for first rescue analgesia (P < .0001) as compared to fentanyl group. The incidence of hypotension and bradycardia was more with clonidine group than with fentanyl group. CONCLUSIONS Clonidine 0.75 ug / kg is a better epidural adjuvant than fentanyl 1.5ug / kg when given by intrathecal route with 5 % bupivacaine in terms of mean time of onset and duration for both sensory and motor blockade. It also has better analgesic effect postoperatively. Whereas fentanyl is found to be safer in view of haemodynamic stability. KEY WORDS Clonidine, Fentanyl, Spinal Anaesthesia

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A comparative study for the analgesic efficacy and safety profile of fentanyl versus clonidine as an adjuvant to epidural ropivacaine 0.75% in lower abdominal surgeries

Cited by 3 publications

References 27 publications

A randomized comparative study of epidural ropivacaine 0.2% with adjuvant fentanyl or nalbuphine for post-operative analgesia in lower limb surgeries

A randomized comparative study of epidural ropivacaine 0.2% with adjuvant fentanyl or nalbuphine for post-operative analgesia in lower limb surgeries

Maximization of Non-opioid Multimodal Therapy in Ambulatory Surgery Centers

Comparison of the Effects of Epidural Clonidine and Fentanyl on Spinal Anaesthesia in Lower Abdominal and Lower Limb Surgeries – A Randomised Controlled Study from Delhi, India

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