Comparison of Intravenous and Epidural Clonidine for Postoperative Patient-Controlled Analgesia

Bernard, Jean-Marc; Kick, O.; Bonnet, Francis

doi:10.1097/00000539-199510000-00009

Cited by 58 publications

(23 citation statements)

References 23 publications

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“…13,14,15 in adults and decrease in blood pressure within 5-15 minutes in children, 16 but no adverse hemodynamic effects; bradycardia or hypotension from the drug were seen in the present study.…”

Section: Discussionsupporting

confidence: 45%

Efficacy of Clonidine as an Adjuvant to Bupivacaine for Caudal Block in Children Undergoing Infra - Umbilical Surgery

G¹,

Hiremath²

2015

jemds

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Caudal epidural analgesia with bupivacaine is common in paediatric anaesthesia for providing intra and postoperative analgesia. But duration of analgesia even with bupivacaine; long acting anaesthetic is short only 4-6hrs. Hence, several adjuvants have been tried to prolong the duration of action of bupivacaine. We evaluated the efficacy of clonidine added to bupivacaine in prolonging the analgesic effect provided by caudal bupivacaine in children undergoing infraumbilical surgery. Forty children, aged one to seven years, American Society of Anaesthesiologists (ASA) Grade I/II, undergoing infra-umbilical surgery, were included in prospective randomized double blind study to one of two groups: caudal analgesia with 0.75 ml/kg of 0.25% bupivacaine in normal saline (Group A) or caudal analgesia with 0.75ml/kg of 0.25% bupivacaine with 1 µg/kg of clonidine in normal saline (Group B). Post-operative pain was assessed for 24 hours using the Objective Pain Scale (OPS). The mean duration of analgesia was significantly longer in Group B (10.2 Hrs.) than in Group A (4.2 1Hrs); P<0.05, which was statistically significant. In both the groups, there were no significant changes in the heart rate and mean arterial pressure from the baseline value, in the intraoperative as well as postoperative period (p>0.05). The requirement of rescue medicine was lesser in Group B. Clonidine as an adjunct to bupivacaine prolongs the post-operative pain relief in children and is safe compared to bupivacaine alone in paediatric infra umbilical surgeries.

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Section: Discussionsupporting

confidence: 45%

Efficacy of Clonidine as an Adjuvant to Bupivacaine for Caudal Block in Children Undergoing Infra - Umbilical Surgery

G¹,

Hiremath²

2015

jemds

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“…This observation was consistent with previous studies of clonidine where adverse hemodynamic effects occurred at doses required for sedation. [5]…”

Section: Discussionmentioning

confidence: 99%

“…[567] This unique combination makes them highly beneficial especially in the ICUs. [6] We therefore planned this study to compare sedative, analgesic and cardiovascular effects and safety profile of two α2 agonists, clonidine, and dexmedetomidine for patients requiring short-term sedation in ICU.…”

Section: Introductionmentioning

confidence: 99%

Comparison of clonidine and dexmedetomidine for short-term sedation of intensive care unit patients

Srivastava¹,

Sarkar²,

Kumar³

et al. 2014

Indian Journal of Critical Care Medicine

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Background and Objectives:Patients on mechanical ventilation in intensive care unit (ICU) are often uncomfortable because of anxiety, pain, and endotracheal intubation; therefore, require sedation. Alpha-2 agonists are known to produce sedation. We compared clonidine and dexmedetomidine as sole agents for sedation.Study Design:Prospective, randomized, controlled open-label study.Materials and Methods:A total of 70 patients requiring a minimum of 12 h of mechanical ventilation with concomitant sedation, were randomly allocated into two groups. Group C (n = 35) received intravenous (IV) clonidine (1 μg/kg/h titrated up to 2 μg/kg/h to attain target sedation), and Group D (n = 35) received IV dexmedetomidine for sedation (loading 0.7 μg/kg and maintenance 0.2 μg/kg/h titrated up to 0.7 μg/kg/h to achieve target sedation). A Ramsay Sedation Score of 3-4 was considered as target sedation. Additional sedation with diazepam was given when required to achieve target sedation. The quality of sedation, hemodynamic changes and adverse effects were noted and compared between the two groups.Results:Target sedation was achieved in 86% observations in Group D and 62% in Group C (P = 0.04). Additional sedation was needed by more patients in Group C compared with Group D (14 and 8 in Groups C and D, respectively, P = 0.034), mainly due to concomitant hypotension on increasing the dose of clonidine. Hypotension was the most common side-effect in Group C, occurring in 11/35 patients of Group C and 3/35 patients of Group D (P = 0.02). Rebound hypertension was seen in four patients receiving clonidine, but none in receiving dexmedetomidine.Conclusion:Both clonidine and dexmedetomidine produced effective sedation; however, the hemodynamic stability provided by dexmedetomidine gives it an edge over clonidine for short-term sedation of ICU patients.

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“…23 Some studies. 24,25 report a marked decrease in heart rate after epidural clonidine while others do not. We did not observe any significant bradycardia in our study.…”

Section: Groupmentioning

confidence: 98%

Clinical Evaluation of Clonidine as an Adjunct to Caudal Ropivacaine in Pediatric Infraumbilical Surgeries

Keshari¹,

Awasya²,

Vatsalya³

2015

jemds

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BACKGROUND:The addition of clonidine as an adjuvant has allowed the use of lower concentration of the local anaesthetic for achieving the same level of anaesthesia but with the prolonged duration of analgesia which increases the margin of safety and reduces the incidence of unwanted motor blockades. With these facts in mind we undertook the study to compare the analgesic properties of 0.25% ropivacaine with the addition of clonidine (1µg/kg) to that of ropivacaine 0.25% following caudal administration in children. METHODS: After approval from ethical committee 60 children of age 1-10 yrs of ASA grade I or II undergoing elective sub umbilical surgeries were selected for the study. We gave caudal block with 0.25% ropivacaine 1ml/kg+1ml normal saline for group R or 0.25% ropivacaine 1ml/kg + clonidine 1microgram/kg+1ml normal saline to make volume 1ml for group C. To perform caudal block all patient received IV injection glycopyrolate-0.01mg/kg, IV injection midazolam-0.1mg/kg and IV Injection ketamine-1mg/kg. Hemodynamic parameters were observed before, during and after the surgical procedure. Quality of surgical anesthesia & requirement of supplemental midazolam/ketamine were also noted. Duration of Post-operative analgesia, pain scores, level of sedation and side effects if any were looked for and duly recorded. RESULT: Duration of analgesia in group R was 6.45±0.52 hrs. and in group C was 13.01±0.89hrs i.e. significantly prolonged in group C (P<0.0001). Post-operative pain score and sedation score were also significantly better in group C (P<0.0001). The quality of surgical analgesia was also significantly excellent in group C. Other vital parameters were not statistically significant in both the groups. CONCLUSION: Ropivacaine (0.25%) with clonidine (1μg/kg) in caudal block showed prolong duration of analgesia as well as better quality of surgical anaesthesia than plain ropivacaine (0.25%) in pediatric patients without any significant side effects.

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Comparison of Intravenous and Epidural Clonidine for Postoperative Patient-Controlled Analgesia

Cited by 58 publications

References 23 publications

Efficacy of Clonidine as an Adjuvant to Bupivacaine for Caudal Block in Children Undergoing Infra - Umbilical Surgery

Efficacy of Clonidine as an Adjuvant to Bupivacaine for Caudal Block in Children Undergoing Infra - Umbilical Surgery

Comparison of clonidine and dexmedetomidine for short-term sedation of intensive care unit patients

Clinical Evaluation of Clonidine as an Adjunct to Caudal Ropivacaine in Pediatric Infraumbilical Surgeries

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