Intrathecal Buprenorphine, Clonidine and Fentanyl as Adjuvants To 0.5% Hyperbaric Bupivacaine In Lower Abdominal Surgeries: A Prospective, Randomized And Comparative Study.

Krishnakumar, Subramanian; Chandrasekaran, Ayyavu; Nanthaprabu, M

doi:10.9790/0853-150772530

Cited by 2 publications

(2 citation statements)

References 18 publications

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“…Other opioids: Hydromorphone and Buprenorphine: Hydromorphone has been shown be an efficacious adjuvant in both intrathecal and epidural routes at the dosages of 100 μg and 500-600 μg respectively[ 41 , 42 ]. It is preferred in patients with renal insufficiency and had a better adverse effect profile when compared to morphine[ 43 , 44 ].…”

Section: Discussionmentioning

confidence: 99%

Adjuvants to local anesthetics: Current understanding and future trends

Swain

Nag

Sahu

et al. 2017

WJCC

206

138

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Although beneficial in acute and chronic pain management, the use of local anaesthetics is limited by its duration of action and the dose dependent adverse effects on the cardiac and central nervous system. Adjuvants or additives are often used with local anaesthetics for its synergistic effect by prolonging the duration of sensory-motor block and limiting the cumulative dose requirement of local anaesthetics. The armamentarium of local anesthetic adjuvants have evolved over time from classical opioids to a wide array of drugs spanning several groups and varying mechanisms of action. A large array of opioids ranging from morphine, fentanyl and sufentanyl to hydromorphone, buprenorphine and tramadol has been used with varying success. However, their use has been limited by their adverse effect like respiratory depression, nausea, vomiting and pruritus, especially with its neuraxial use. Epinephrine potentiates the local anesthetics by its antinociceptive properties mediated by alpha-2 adrenoreceptor activation along with its vasoconstrictive properties limiting the systemic absorption of local anesthetics. Alpha 2 adrenoreceptor antagonists like clonidine and dexmedetomidine are one of the most widely used class of local anesthetic adjuvants. Other drugs like steroids (dexamethasone), anti-inflammatory agents (parecoxib and lornoxicam), midazolam, ketamine, magnesium sulfate and neostigmine have also been used with mixed success. The concern regarding the safety profile of these adjuvants is due to its potential neurotoxicity and neurological complications which necessitate further research in this direction. Current research is directed towards a search for agents and techniques which would prolong local anaesthetic action without its deleterious effects. This includes novel approaches like use of charged molecules to produce local anaesthetic action (tonicaine and n butyl tetracaine), new age delivery mechanisms for prolonged bioavailability (liposomal, microspheres and cyclodextrin systems) and further studies with other drugs (adenosine, neuromuscular blockers, dextrans).

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Section: Discussionmentioning

confidence: 99%

Adjuvants to local anesthetics: Current understanding and future trends

Swain

Nag

Sahu

et al. 2017

WJCC

206

138

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“…On comparing the three groups with regards to adverse effects like hypotension, bradycardia, nausea, vomiting, respiratory depression and shivering the difference was statistically insignificant. Srinivasagam K et al 7 reported increased incidence of hypotension and bradycardia with 50mcg of clonidine. This difference could be due to the use of lower doses (30mcg) in our study.…”

Section: Rashmimentioning

confidence: 99%

Comparison of Intrathecal Buprenorphine Versus Clonidine as an Adjuvant to 0.5% Hyperbaric Bupivacaine in Lower Abdominal Surgeries

Bafna¹,

Yadav²,

Sharma³

2020

IJMBS

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Introduction: Various adjuvants have been added to bupivacaine to shorten the onset of block and prolong the duration of block. Present study was undertaken to compare the efficacy of intrathecal clonidine or buprenorphine with bupivacaine in lower abdominal surgeries. Methods: 90 ASA I and II patients undergoing lower abdominal surgeries were randomly allocated into three groups(n=30). Group A received 3ml of 0.5% hyperbaric bupivacaine with 1ml normal saline, Group B received 3ml of 0.5% hyperbaric bupivacaine with 60 mcg buprenorphine(1:5 dilution) and Group C received 3ml of 0.5% hyperbaric bupivacaine with 30mcg clonidine(1:5 dilution) respectively (Total volume 4ml). Onset time and duration of sensory and motor block, duration of analgesia, hemodynamics, VAS score, sedation score and side effect were compared. Results: The duration of analgesia was significantly longest in Group C (354.50±38.48min), followed by Group B (277.10±25.47min) and Group A(131.50±20.15min) (p<0.001) Conclusion: Clonidine(30mcg) and buprenorphine(60mcg) when used as adjuvants to 0.5% hyperbaric bupivacaine intrathecally produces significantly longer duration and better quality of postoperative analgesia than bupivacaine alone. On comparing the two drugs, Clonidine appears to be superior in terms of postoperative analgesia. Keywords: clonidine, buprenorphine, intrathecal, postoperative analgesia.

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Intrathecal Buprenorphine, Clonidine and Fentanyl as Adjuvants To 0.5% Hyperbaric Bupivacaine In Lower Abdominal Surgeries: A Prospective, Randomized And Comparative Study.

Cited by 2 publications

References 18 publications

Adjuvants to local anesthetics: Current understanding and future trends

Adjuvants to local anesthetics: Current understanding and future trends

Comparison of Intrathecal Buprenorphine Versus Clonidine as an Adjuvant to 0.5% Hyperbaric Bupivacaine in Lower Abdominal Surgeries

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