Addition of Intrathecal Fentanyl to Bupivacaine Clonidine Mixture Effect on Quality of Subarachnoid Block and Postoperative Analgesia

Overview

Journal Anesth Essays Res

Specialty Anesthesiology

Date 2015 Apr 18

PMID 25885725

Citations 1

Authors

Marilyn Nazareth

Pabitra Ghoshal

Viraj Namshikar

Yogesh Gaude

Affiliations

Soon will be listed here.

Abstract

Context: This study was undertaken in 100 patients scheduled for lower limb orthopaedic surgeries.

Aim: The objective of this study was to study the effect of addition of intrathecal fentanyl to bupivacaine clonidine mixture on the quality of subarachnoid block and compare it with intrathecal bupivacaine clonidine mixture without fentanyl.

Settings And Design: In this prospective and double blind randomized controlled study, one hundred patients, between 20-40 years of age, of either sex, weighing between 40-65 Kg, measuring more than 150 cm in height, of ASA Grade I and II who were undergoing orthopaedic lower limb surgeries were selected in order to study the quality of subarachnoid block and post-operative analgesia produced by a combination of bupivacaine clonidine and fentanyl in comparison with bupivacaine clonidine.

Materials And Methods: The patients were randomly divided in two groups of 50 each: Group BC: 2.4 ml of 0.5% hyperbaric bupivacaine (12 mg) + 0.2 ml (30 μg) clonidine + 0.4 ml of 0.9% NaCl. Group BCF: 2.4 ml of 0.5% hyperbaric bupivacaine (12 mg) + 0.2 ml (30 μg) clonidine + 0.4 ml (20 μg) of fentanyl. The total volume of solution in both the groups was 3.0 ml. The quality of subarachnoid block and post-operative analgesia were studied.

Statistical Analysis Used: The data thus obtained was statistically analysed using the following tests: Unpaired student's t-test. Average % change in data over baseline values to detect trends. A 'P' value of <0.05 was considered to be statistically significant.

Results: There was no significant difference in duration of sensory and motor blockade in group BCF compared to BC. The duration of analgesia as assessed by, either VAS score of >5 or demand of additional analgesia was > 524.6 ± 32.21 mins in group BC and > 774.4 ± 59.59 mins in group BCF. This prolongation of duration of analgesia in group BCF compared to group BC has statistical significance. Blood pressure and heart rate changes were not significantly different among groups, whereas sedation and pruritus were significantly more frequent in Group BCF.

Conclusions: In conclusion, this study has demonstrated that addition of 20 μg fentanyl to intrathecal 30 μg clonidine and 12 mg bupivacaine enhanced the duration of post-operative analgesia with moderately increased sedation and was not associated with hemodynamic instability or other complications.

Citing Articles

Effect of clonidine and/or fentanyl in combination with intrathecal bupivacaine for lower limb surgery.

Singh R, Kundra S, Gupta S, Grewal A, Tewari A J Anaesthesiol Clin Pharmacol. 2015; 31(4):485-90.

PMID: 26702205 PMC: 4676237. DOI: 10.4103/0970-9185.169069.

References

Brandt S, Livingston A . Receptor changes in the spinal cord of sheep associated with exposure to chronic pain. Pain. 1990; 42(3):323-329. DOI: 10.1016/0304-3959(90)91145-9. View

Reddy S, Yaksh T . Spinal noradrenergic terminal system mediates antinociception. Brain Res. 1980; 189(2):391-401. DOI: 10.1016/0006-8993(80)90099-2. View

Benhamou D, Thorin D, Brichant J, Dailland P, Milon D, Schneider M . Intrathecal clonidine and fentanyl with hyperbaric bupivacaine improves analgesia during cesarean section. Anesth Analg. 1998; 87(3):609-13. DOI: 10.1097/00000539-199809000-00022. View

Hocking G, Wildsmith J . Intrathecal drug spread. Br J Anaesth. 2004; 93(4):568-78. DOI: 10.1093/bja/aeh204. View

Juliao M, Lauretti G . Low-dose intrathecal clonidine combined with sufentanil as analgesic drugs in abdominal gynecological surgery. J Clin Anesth. 2000; 12(5):357-62. DOI: 10.1016/s0952-8180(00)00171-9. View

Harada Y, Nishioka K, Kitahata L, Kishikawa K, COLLINS J . Visceral antinociceptive effects of spinal clonidine combined with morphine, [D-Pen2, D-Pen5] enkephalin, or U50,488H. Anesthesiology. 1995; 83(2):344-52. DOI: 10.1097/00000542-199508000-00015. View

Justins D, Francis D, Houlton P, Reynolds F . A controlled trial of extradural fentanyl in labour. Br J Anaesth. 1982; 54(4):409-14. DOI: 10.1093/bja/54.4.409. View

Rust L, Waring R, Hall G, Nelson E . Intrathecal narcotics for obstetric analgesia in a community hospital. Am J Obstet Gynecol. 1994; 170(6):1643-6; discussion 1646-8. View

Elia N, Culebras X, Mazza C, Schiffer E, Tramer M . Clonidine as an adjuvant to intrathecal local anesthetics for surgery: systematic review of randomized trials. Reg Anesth Pain Med. 2008; 33(2):159-67. DOI: 10.1016/j.rapm.2007.10.008. View

10.

Grace D, Bunting H, Milligan K, Fee J . Postoperative analgesia after co-administration of clonidine and morphine by the intrathecal route in patients undergoing hip replacement. Anesth Analg. 1995; 80(1):86-91. DOI: 10.1097/00000539-199501000-00015. View

11.

Sites B, Beach M, Biggs R, Rohan C, Wiley C, Rassias A . Intrathecal clonidine added to a bupivacaine-morphine spinal anesthetic improves postoperative analgesia for total knee arthroplasty. Anesth Analg. 2003; 96(4):1083-1088. DOI: 10.1213/01.ANE.0000055651.24073.59. View

12.

Chiari A, Eisenach J . Spinal anesthesia: mechanisms, agents, methods, and safety. Reg Anesth Pain Med. 1998; 23(4):357-62; discussion 384-7. DOI: 10.1016/s1098-7339(98)90006-2. View

13.

Lirzin J, Jacquinot P, Dailland P, Jorrot J, Jasson J, Talafre M . Controlled trial of extradural bupivacaine with fentanyl, morphine or placebo for pain relief in labour. Br J Anaesth. 1989; 62(6):641-4. DOI: 10.1093/bja/62.6.641. View