Dexmedetomidine and clonidine in epidural anaesthesia: A comparative evaluation

Abstract

Efforts to find a better adjuvant in regional anaesthesia are underway since long. Aims and objectives are to compare the efficacy and clinical profile of two α-2 adrenergic agonists, dexmedetomidine and clonidine, in epidural anaesthesia with special emphasis on their sedative properties and an ability to provide smooth intra-operative and post-operative analgesia. A prospective randomized study was carried out which included 50 adult female patients between the ages of 44 and 65 years of (American Society of Anaesthesiologists) ASAI/II grade who underwent vaginal hysterectomies. The patients were randomly allocated into two groups; ropivacaine + dexmedetomidine (RD) and ropivacaine + clonidine (RC), comprising of 25 patients each. Group RD was administered 17 ml of 0.75% epidural ropivacaine and 1.5 μg/kg of dexmedetomidine, while group RC received admixture of 17 ml of 0.75% ropivacaine and 2 μg/kg of clonidine. Onset of analgesia, sensory and motor block levels, sedation, duration of analgesia and side effects were observed. The data obtained was subjected to statistical computation with analysis of variance and chi-square test using statistical package for social science (SPSS) version 10.0 for windows and value of P < 0.05 was considered significant and P < 0.0001 as highly significant. The demographic profile, initial and post-operative block characteristics and cardio-respiratory parameters were comparable and statistically non-significant in both the groups. However, sedation scores with dexmedetomidine were better than clonidine and turned out to be statistically significant (P < 0.05). The side effect profile was also comparable with a little higher incidence of nausea and dry mouth in both the groups which was again a non-significant entity (P > 0.05). Dexmedetomidine is a better neuraxial adjuvant compared to clonidine for providing early onset of sensory analgesia, adequate sedation and a prolonged post-operative analgesia.

Efficacy of dexmedetomidine on postoperative shivering: a meta-analysis of clinical trials

“…3,9,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] Other control agents included fentanyl, [33][34][35][36] remifentanyl, 37,38 meperidine, 15 midazolam, [39][40][41] propofol, 43,44 ketamine, 45,46 tramadol, 24,47 clonidine, 42 propacetamol, 48 and buprenorphine 49 ( 8 were reported in the 39 included trials, and all studies reported every endpoint mentioned in the Methods section (reporting bias). 8 however, some bias 8 may exist in of the two trials, 27,32 as the length of surgery was not clear.…”

Epidural Dexmedetomidine and Clonidine as a adjunct with Bupivacaine in patients undergoing lower limb orthopedic Surgeries. A Clinical Study.

“…Our data support previous studies that used dexmedetomidine and clonidine as additive to regional anesthetics. [5], [26], [27] We found no statistical significance in the peak levels of analgesia provided by both drugs. Our findings were in concordance with Salgado etal.…”

“…The prolongation of the motor block of local anesthetics may be the result of binding of α-2 adrenoreceptor agonists to the motor neurons in the dorsal horn. [4], [5] Dexmedetomidine is eight times more specific and highly selective α-2 adrenoreceptor agonist compared to clonidine. [20], [25] This study was undertaken to compare the analgesic efficacy, and sedative effects of two α-2 agonists when administered epidurally along with bupivacaine.…”

“…Addition of either 1 μg/kg dexmedetomidine or 2 μg/kg clonidine as adjuvant to epidural bupivacaine leads to early [3], [5], [26], [27] onset of analgesia, faster achievement of maximum sensory level and motor blockade. It not only prolonged the duration of analgesia but also provided a good sedation level during the surgical procedure without significant hemodynamic effects.…”

“…[2], [3], [4] Many a time for achieving desired effect, invariably large volumes of local anesthetics are used with deleterious consequences or DOI: http://dx.doi.org/10.22192/ijarbs.2016.03.11.001 the impulsive use of large doses of sedation or even general anesthesia defeats the novel purpose of regional anesthesia. [5] To overcome these problems there is an ongoing effort to find a better adjuvant in regional anesthesia. Alpha 2-adrenergic receptor agonists have been the focus of interest for their sedative, analgesic, perioperative sympatholytic, anesthetic-sparing, and hemodynamic -stabilizing properties.…”