Comparative evaluation of dexmedetomidine and clonidine with low dose ropivacaine in cervical epidural anesthesia for modified radical mastectomy: A prospective randomized, double-blind study

Abstract

Context:Alpha-2 adrenergic agonists clonidine and dexmedetomidine, are well known to produce analgesia through an opioid independent mechanism. Alpha-2 agonists are used as an adjuvant to local anesthetic agents to extend the duration of spinal, epidural and brachial plexus blocks.Aims:We compared clonidine and dexmedetomidine as an adjuvant to Ropivacaine in cervical epidural anesthesia (CEA) with respect to onset and duration of sensory block, duration of analgesia and adverse effects.Subjects and Methods:A total 150 American Society of Anesthesiologists Class I or II adult female patients who were scheduled to undergo modified radical mastectomy were randomly allocated to the following two groups to receive CEA: Group D receive 15 mL of 0.375% ropivacaine combined with 1 μg/kg of dexmedetomidine; Group C received 15 mL of 0.375% ropivacaine combined with 1.5 μg/kg of clonidine. The onset of sensory block, duration of analgesia, mean arterial pressure (MAP), heart rate (HR), sedation scores, and the incidences of adverse effects, such as hypotension, bradycardia, and oxygen desaturation were recorded.Results:The addition of dexmedetomidine to ropivacaine (Group D) resulted in faster onset of sensory block time compared with the addition of clonidine to ropivacaine (Group C) (95% confidence interval [CI]: 14.53 ± 2.96 vs. 16.72 ± 4.43 P = 0.032). The duration of analgesia block in Group D was significantly longer than that in Group C (95% CI: 234.65 ± 23.76 vs. 286.76 ± 34.65; P = 0.037). The Ramsay sedation score at in Group D were significantly higher between 20 and 60 min as compared to Group C (P < 0.022). MAP level and HR level in Group D and Group C were comparable.Conclusion:The addition of dexmedetomidine to low dose ropivacaine for CEA could shorten the onset of sensory block and extend the duration of analgesia with optimum sedation without episodes of hypoxemia as compared to addition of clonidine to ropivacaine.

Comparative evaluation of analgesic sparing efficacy between dexmedetomidine and clonidine used as adjuvant to ropivacaine in thoracic paravertebral block for patients undergoing breast cancer surgery: A prospective, randomized, double-blind study

“…Channabasappa et al . [ 31 ] in a comparative study between dexmedetomidine and clonidine as adjuvant in cervical epidural anesthesia found exactly similar results regarding demographic parameters.…”

“…Channabasappa et al . [ 31 ] experienced similar results with epidural dexmedetomidine and clonidine. In our study, bradycardia was more in dexmedetomidine group, but on the contrary, Kumar et al .…”

“…In this prospective study, we have found dexmedetomidine-treated group asked for rescue analgesics much later than clonidine group. Channabasappa et al .,[ 31 ] while performing a comparative study between clonidine and dexmedetomidine as adjuvant in cervical epidural, found similar result showing dexmedetomidine group requiring rescue analgesic (286.76 ± 34.65 min vs. 234.65 ± 23.76 min) in much later period. On the contrary, Kanazi et al .…”

“…Similarly, Channabasappa et al . [ 31 ] in their study found in cervical epidural anesthesia with ropivacaine for breast cancer surgery when administered with dexmedetomidine, produced lesser requirement of ropivacaine than clonidine (48.67 ± 16.98 mg vs. 66.46 ± 18.42 mg).…”

Paravertebral Block Plus Thoracic Wall Block versus Paravertebral Block Alone for Analgesia of Modified Radical Mastectomy: A Retrospective Cohort Study

“…Epidural anesthesia has been used in breast cancer surgery to provide effective surgical anesthesia [5,6]. However, in case of bilateral sympathectomy and intercostal muscle blockade because of high thoracic epidural anesthesia reaching the T1–T5 levels, subsequent hypotension, bradycardia, and respiratory distress might occur [5–7].…”