Epidural infusion of clonidine or clonidine plus ropivacaine for postoperative analgesia in children undergoing major abdominal surgery

Klamt, Jyrson Guilherme; Garcia, L; Stocche, Renato Mestriner; Meinberg, Antonio Carlos

doi:10.1016/j.jclinane.2003.02.005

Cited by 34 publications

(22 citation statements)

References 15 publications

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“…In relation to clonidine, a previous study support our data, because it was found that for the first three hours postoperatively, children receiving caudal clonidine presented lower blood pressure as compared to children with caudal bupivacaine alone (Motsch et al, 1997). On the other hand, Klamt et al (2003) found no changes in diastolic arterial pressure when epidural infusion of clonidine or clonidine plus ropivacaine was done. The changes in diastolic arterial pressure observed in our study associated with epidural clonidine and ketamine administration is most likely explained by two interacting mechanisms.…”

Section: Discussionsupporting

confidence: 87%

“…Sedation with caudal clonidine and bupivacaine did not affect respiration (Motsh et al, 1997). Furthermore, epidural infusion of clonidine alone or clonidine plus ropivacaine did not change respiratory rate and arterial oxygen saturation (Klamt et al, 2003). Taken together, although we found a small degree of respiratory depression, we believe that the association of caudal ketamine and clonidine with bupivacaine tends to cause respiratory depression without clinical relevance.…”

Section: Discussionmentioning

confidence: 45%

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Comparison between S-ketamine and clonidine in caudal analgesia

Ribeiro¹

2011

Afr. J. Pharm. Pharmacol.

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We aimed to compare the analgesic efficacy of the caudal administration of a combination of preservative free S-ketamine or clonidine with bupivacaine in children. The study included 51 children aged between 3 and 8 years old and physical status between I and II according to: American Society of Anesthesiologist. They were randomly divided into three groups: Group B -bupivacaine 0.25%, 0.75 ml/kg without adrenaline; Group C -bupivacaine 0.25%, 0.75 ml/kg without adrenaline and clonidine 1 µg/kg and; Group K -bupivacaine 0.25%, 0.75 ml/kg without adrenaline and S-ketamine 0.5 mg/kg without conservative. In this study, medication was not used before anesthesia. The evaluation of postoperative analgesia was accomplished through the pain scale of Ouch, the motor blockade assessed by modified Bromage scale and the level of sedation through the three-point scale. The combination of caudal S-ketamine and clonidine with bupivacaine prolonged the duration of postoperative analgesia (p < 0.05) compared to bupivacaine alone. Regarding hemodynamic parameters, bupivacaine associated with clonidine (C) and bupivacaine associated with S-ketamine (K) groups presented diastolic blood pressure changes in the postoperative period. Respiratory rate, regardless of group, showed significant differences over time (p <0.05). The studied groups showed non significant changes in the degree of motor blockade and sedation score and we observed no clinical significant side effects. S-ketamine and clonidine associated with bupivacaine prolongs postoperative analgesia without clinically significant side effects.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 45%

Comparison between S-ketamine and clonidine in caudal analgesia

Ribeiro¹

2011

Afr. J. Pharm. Pharmacol.

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“…On proctologic surgeries, especially hemorroidectomy, the clonidine associated with lidocaine and fentanil, on subarachnoid anesthesia, prolonged the time of analgesia, reducing the intensity of pain, with minimum side effects 22 . Both, clonidine and ropivacaine, improved the postoperatory analgesia, when used under different blockages and types of surgery [23][24][25]32 . Some studies, though, claim that this drug does not improve analgesia when also taken by different ways and in different types of surgery [24][25][26] .…”

Section: Discussionmentioning

confidence: 99%

Epidural anesthesia using a 0,75% ropivacaine and subarachnoid anesthesia with a 0,5% bupivacaine associated or not with clonidine in hemorroidectomies

Baptista

Paulo²,

Paulo³

et al. 2008

Acta Cir. Bras.

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PURPOSE: To study the safety and efficiency of two anesthetic blockages in hemorroidectomy and the effect of clonidine on analgesia. METHODS: 80 patients were studied, randomly divided into four groups: l (n=19)- peridural with a 0,75% ropivacaine; 2 (n=21)-peridural with a 0,75% ropivacaine and 150 µg of clonidine; 3 (n=19)- subarachnoid with a 0,5% bupivacaine; 4 (n=21)- subarachnoid with a 0,5% bupivacaine and 50 µg of clonidine. The intensity of pain was evaluated by the visual analogical scale 8, 12 and 24 hours after surgery. The use of vasoconstrictors on the transoperatory and the amount of analgesics within the 24 hours were registered. RESULTS: The intensity of pain, 8 hours after surgery, was lesser on group 4, and much lesser on group 4 comparing with groups 1 and 2, 12 hours (p=0,022; p=0,001) and 24 hours (p=0,03; p=0,003). The frequency of vasoconstrictors usage on the transoperatory and the analgesics on the post-operatory showed no difference among the groups. There were no anesthetic complications. CONCLUSIONS: The subarachnoid anesthesia with a 0,5% bupivacaine with clonidine, showed better analgesia comparing with the peridural anesthesia with a 0,75% ropivacaine with or without clonidine, however all were safe and efficient. The clonidine aided on the decreasing of pain when subarachnoid anesthesia was used.

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“…In addition, it was found that 2 µg/kg fentanyl and 1 mg/kg lidocaine pre-treatment was less effective in reducing the haemodynamic effects of endobronchial intubation than epidural clonidine. Clonidine is known to have analgesic, 2,3 sedative, 10 anaesthetic-sparing, 11 -13 and antishivering and antihypertensive effects. 4 In addition, it is also known to reduce the incidence of myocardial ischaemia in patients who have undergone vascular and cardiac surgery.…”

Section: Discussionmentioning

confidence: 99%

Thoracic Epidural Clonidine Attenuates Haemodynamic Responses Induced by Endobronchial Intubation

et al. 2006

J Int Med Res

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Laryngoscopyand endobronchial intubation usually cause transient hypertension and tachycardia. We investigated whether thoracic epidurally injected 3 µg/kg clonidine attenuates cardiovascular responses to intubation compared with 2 µg/kg fentanyl and 1 mg/kg lidocaine. Epidural catheterization was performed at the T6 -T7 or T7 -T8 intervertebral space, and saline or clonidine in saline was injected 20 min before anaesthetic induction. Anaesthesia was induced using 5 mg/kg thiopental sodium and 0.1 mg/kg vecuronium. Laryngoscopy and endobronchial intubation were performed 2 min later. Mean blood pressure and heart rate were measured throughout anaesthetic induction. In the control group and the fentanyl group, mean blood pressure and heart rate 3 min after endobronchial intubation were elevated significantly compared with baseline. In the clonidine group, however, mean blood pressure and heart rate did not increase compared with baseline. The control group had higher mean blood pressure and heart rate than the clonidine group 3 min after endobronchial intubation. Thoracic epidural clonidine may attenuate the haemodynamic response to endobronchial intubation.

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Epidural infusion of clonidine or clonidine plus ropivacaine for postoperative analgesia in children undergoing major abdominal surgery

Cited by 34 publications

References 15 publications

Comparison between S-ketamine and clonidine in caudal analgesia

Comparison between S-ketamine and clonidine in caudal analgesia

Epidural anesthesia using a 0,75% ropivacaine and subarachnoid anesthesia with a 0,5% bupivacaine associated or not with clonidine in hemorroidectomies

Thoracic Epidural Clonidine Attenuates Haemodynamic Responses Induced by Endobronchial Intubation

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