A Comparative Study of Two Different Doses of Epidural Clonidine as an Adjuvant for Post Operative Analgesia After Lower Limb Surgeries
Journal Title: IJAR-Indian Journal of Applied Research - Year 2016, Vol 6, Issue 3
Abstract
Background: Severe pain is common after surgeries like TKR (Total Knee Replacement) and can delay early commencement of physiotherapy which is the most important determinant of successful postoperative knee rehabilitation. Attainment of adequate postoperative analgesia in patients who undergo lower limb surgeries is often a challenging task. The current and the most common approach in post operative pain management is multimodal analgesia. Various combinations of epidural clonidine, opioids and local anaesthetics have improved post operative analgesia after lower limb surgeries. This study is done to determine the optimal epidural bolus dose of clonidine, which provides the best analgesia and least side effects. Aim of the study: This study was designed to evaluate the effects of the addition of two different doses of clonidine to epidural morphine and bupivacaine on duration and efficacy of post operative analgesia and side effects after lower limb surgeries Materials and methods: The study included 60 patients, ASA I and II scheduled for lower limb surgeries at ASRAM Medical College and Hospital, Eluru. These patients were randomly allocated into three groups, 20 patients in each group. Group A where patients received 2-mg morphine + 12.5mg Bupivacaine, Group B where patients were given 2-mg morphine + 12.5mg Bupivacaine+75μg of clonidine while patients in Group C received 2-mg morphine + 12.5mgBupivacaine + 100μg of clonidine. Postoperative pain was assessed using Visual Analog Scale (VAS). Demographics, time intervals, and continuous variables (SBP, DBP, heart rate, VAS) were analyzed using the one-way analysis of variance (ANOVA) test. . Categorical data (ASA, sex) were analyzed using chi-square test. In all cases, P < 0.001 was considered statistically significant. Results: Demographic characteristics as well as intraoperative SBP, heart rate and were similar among groups. Epidural administration of combinations of local anesthetic bupivacaine(1mg/ml), opioid morphine(0.2mg/ml), and clonidine(7.5μg/ml in group B and 100μg/ml in group C) resulted in significant improvement of analgesia after lower limb surgeries The total amount of drug consumed in clonidine groups was significantly lower compared with control group (group-A) p<0.001. The clonidine groups (group-B, group-C) compared with control group (group-A) had significantly less pain at 4hr, 12hr and 16hrs as p<0.001. Systolic blood pressure and diastolic blood pressure were low for the clonidine groups (group-B, group-C) compared to control group (group-A) at all sampling intervals. Relative hypotension in group-C who received higher dose of clonidine (435μg over 24 hr period) for diastolic blood pressure were recorded which were statistically significant at 16hr, 20hr and 24hrs though did not require any therapeutic intervention. In this study 10 patients in group-C and 5 patients in group-B have higher (score 2) sedation scores at 4hr and 16hr, scores were statistically significant between clonidine groups and control group at 4hr Conclusion: When added to lumbar epidural mixture of bupivacaine, morphine and clonidine augmented analgesia both in quality and duration after lower limb surgeries in comparison with patients who received bupivacaine and morphine drug combination only. Group with lower concentration of clonidine group-B (7.5μg/ml) produced significant analgesia compared to control group ( group-A with bupivacaine(0.125%) and morphine 0.2mg/ml only) and experienced significantly less side effects of clonidine compared to group-C( with 10μg/ml of clonidine) .
Authors and Affiliations
Dr. P. Harish Gautam
Keywords
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