Clinical efficacy of clonidine versus nalbuphine as intrathecal adjuvants to 0.5% hyperbaric bupivacaine for subarachnoid block during gynaecological procedures: a double blind study
DOI:
https://doi.org/10.18203/2320-6012.ijrms20172444Keywords:
Bupivacaine, Clonidine, Gynecological procedures, Nalbuphine, Subarachnoid blockAbstract
Background: Regional anesthesia techniques for gynaecological procedures are on increasing trends due to their advantage of postoperative analgesia owing to intrathecal adjuvants. The present study was aimed to comparatively evaluate the clinical efficacy of clonidine with nalbuphine when co-administered intrathecally with 0.5% hyperbaric bupivacaine for gynaecological procedures.
Methods: Regional anesthesia techniques for gynaecological procedures are on increasing trends due to their advantage of postoperative analgesia owing to intrathecal adjuvants. The present study was aimed to comparatively evaluate the clinical efficacy of clonidine with nalbuphine when co-administered intrathecally with 0.5% hyperbaric bupivacaine for gynaecological procedures.
Results: The onset of sensory block was earlier in patients of Group BN (3.91±2.25 min vs 4.30±0.87 min, p=0.039). The onset of motor block was also earlier in patients of Group BN (p=0.042). The time to first rescue analgesia in patients receiving intrathecal clonidine was significantly delayed (283±14.18 min vs 231.50±26.18 min, p=0.001). Intraoperative hemodynamic changes were comparable and none of the patient suffered from respiratory depression, shivering, nausea or vomiting.
Conclusions: Intrathecal clonidine as adjuvant to bupivacaine provided was clinically more effective than nalbuphine for prolonging the duration of analgesia for gynaecological procedures.
References
Forster JG, Rosenberg PH. Clinically useful adjuvants in regional anesthesia. Curr Opin anaesthesiol. 2003;16(5):477-86.
Hindle A. Intrathecal opioids in the management of acute postoperative pain. Continuing Education in Anaesthesia, Critical Care and Pain. Br J Anaesth. 2008;8(3):81-5.
Elia N, Culebras X, Mazza C, Schiffner E, Tramer MR. Clonidine as an adjuvant to intrathecal local anesthetics for surgery: systematic review of randomized trials. Reg Anaesth Pain Med. 2008;33(2):159-67.
Yaksh T, Birbach DJ. Intrathecal nalbuphine after caesarean delivery: Are we ready? Anesthesia and analgesia. 2000;91(3):505-8.
Fournier R, Van Gessel E, Macksay M, Gamulin Z. Onset and offset of intrathecal morphine versus nalbuphine for postoperative pain relief after total hip replacement. Acta Anaesthesiol Scand. 2000;44(8):940-5.
Fields HL, Emson PC, Leigh BK, Gilbert RF, Iversen LL. Multiple opiate receptor sites on primary afferent fibres. Nature. 1980;284:351-3.
Gunion MW, Marchionne AM, Anderson TM. Use of the Mixed Agonist-Antagonist Nalbuphine in Opioid Based Analgesia. Acute Pain. 2004;6(1):29-39.
Culebras X, Gaggero G, Zatloukal J, Kern C, Marti RA. Advantages of Intrathecal nalbuphine, compared with intrathecal morphine, after Caesarean delivery: An evaluation of postoperative analgesia and adverse effects. Anesth Analg. 2000;91(3):601-5.
Mukherjee A, Pal A, Agrawal J, Mehrotra A, Dawar N. Intrathecal nalbuphine as an adjuvant to subarachnoid block: What is the most effective dose? Anesth Essays Res. 2011;5(2):171-5.
Strebel S, Gurzeler JA, Schneider MC, Aeschbach A, Kindler CH. Small-dose intrathecal clonidine and isobaric bupivacaine for orthopedic surgery: a dose-response study. Anesth Analg. 2004;99(4):1231-8.
Gecaj-Gashi A, Terziqu H, Pervoefi T, Kryeziu A. Intrathecal clonidine added to small dose bupivacaine prolongs postoperative analgesia in patients undergoing transurethral surgery. Can Urol Assoc J. 2012;6(1):25-9.
Tilkar Y, Bansal SA, Agnihotri GS. A comparative study of intrathecal clonidine and fentanyl as adjuvants to bupivacaine in lower limb orthopedic surgery. Int J Med Sci Public Health. 2015;4(4):458-62.
Gupta K, Jain M, Gupta PK, Agarwal S, Bhatia KS, Singh VP et al. Clonidine versus Butorphanol as adjuvant to 0.5% hyperbaric Bupivacaine to enhance the onset and duration of subarachnoid blockade with postoperative analgesia during orthopedic surgeries-A randomized study. Glob Anaesth Periopr Med. 2015;2:50-3.
Jain PN, Gehdoo RP, Priya V. Study of intrathecal clonidine for postoperative pain relief. Indian J Pain 2003;17(2):1233-36.
Ahmed F, Narula H, Khandelwal M, Dutta D. A comparative study of three different doses of nalbuphine as an adjuvant to intrathecal bupivacaine for postoperative analgesia in abdominal hysterectomy. Indian J Pain. 2016;30(1):23-8.
Sapate M, Sahu P, Thatte W S, Dubey R. A randomized double blind controlled study of the effects of adding Nalbuphine to spinal bupivacaine for lower abdominal surgeries in elderly patients. Anaesthesia Pain and intensive care. 2013;17(2):145-8.