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      Evaluation of the effect of intrathecal clonidine to decrease shoulder tip pain in laparoscopy under spinal anaesthesia

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          Abstract

          Sixty ASA grade I/II patients scheduled for elective short laparoscopic procedures under spinal anaesthesia were divided into two groups of 30 each. The first group (group C) received 3.5 ml of hyperbaric bupivacaine with 30 mcg of clonidine. The second group (group B) received plain bupivacaine 3.5 ml. Till date, the limiting factor for use of spinal anaesthesia for laparoscopy was patient’s discomfort due to shoulder tip pain. From our study it can be concluded that bupivacaine along with clonidine in low doses provides good sedation and analgesia in intraoperative and post-operative period and at the same time abolishes shoulder tip pain during laparoscopic procedures. In addition, no significant changes in haemodynamics occur with the low dose of clonidine used.

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          alpha(2)-adrenergic agonists for regional anesthesia. A clinical review of clonidine (1984-1995).

          Martha M Kock, J Eisenach, W Klimscha (1996)
          Article 0 comments Cited 97 times – based on 0 reviews     Review now
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            Prospective randomized trial of low-pressure pneumoperitoneum for reduction of shoulder-tip pain following laparoscopy.

            L Roncoroni, R Costi, L Sarli … (2000)
            Postoperative shoulder-tip pain occurs frequently following laparoscopic cholecystectomy. The aim of this randomized clinical trial was to evaluate the efficacy of a low-pressure carbon dioxide pneumoperitoneum during laparoscopic surgery in reducing the incidence of postoperative shoulder-tip pain. Ninety consecutive patients undergoing laparoscopic cholecystectomy were randomized prospectively into low-pressure (group A) and normal-pressure (group B) laparoscopic cholecystectomy groups. Patients in group A (n = 46) underwent laparoscopic cholecystectomy with 9 mmHg carbon dioxide pneumoperitoneum during most of the operation, and those in group B (n = 44) had laparoscopic cholecystectomy with 13 mmHg pneumoperitoneum. Shoulder-tip pain was recorded on a visual analogue pain scale 1, 3, 6, 12, 24 and 48 h after operation. The low-pressure pneumoperitoneum did not increase the duration of surgery. There were no significant intraoperative or postoperative complications in either group. Fourteen patients (32 per cent) in group B and five (11 per cent) in group A complained of shoulder pain (P<0.05). Mean shoulder-tip pain scores at 12 and 24 h and postoperative analgesia requirements were also significantly lower in the low-pressure laparoscopic cholecystectomy group (P<0.001). A carbon dioxide pneumoperitoneum pressure lower than that usually utilized to perform laparoscopic surgery reduces both the frequency and intensity of shoulder-tip pain following laparoscopic cholecystectomy.
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              Hemodynamic and analgesic actions of epidurally administered clonidine.

              J Eisenach, Neil D. Detweiler, Elizabeth Hood (1993)
              alpha 2-Adrenergic agonists such as clonidine produce behavioral analgesia and cardiovascular depression in animals, but clonidine's site of action in clinical analgesia and cerebrospinal fluid (CSF) pharmacokinetics have not been defined. Clonidine was administered in the lumbar epidural space to nine volunteers while monitoring blood pressure, heart rate, finger and toe blood flow, and response to cold pain testing, and while sampling CSF and arterial plasma for clonidine analysis. Effects were correlated to plasma and CSF clonidine concentrations. Ten other volunteers received stepped intravenous infusions of the opioid alfentanil with similar testing. Clonidine decreased pain report in the foot but not the hand, and this effect correlated stronger with CSF than with plasma clonidine, suggesting a spinal site for analgesia. Extrapolation of CSF clonidine pharmacokinetics suggests the minimum effective CSF clonidine concentration for postoperative pain relief is 76 +/- 15 ng/ml. Clonidine increased finger and toe blood flow, decreased blood pressure and heart rate, produced sedation, and mildly increased arterial PCO2, in most cases correlating better with plasma than CSF clonidine concentrations, suggesting actions at central sites. In 10 other volunteers, intravenous infusion of the opioid alfentanil produced analgesia of similar intensity to clonidine but was accompanied by significant respiratory depression. These data support previous studies in animals and provide the scientific rationale for this novel analgesic therapy. In comparison to the potent opioid alfentanil, epidural clonidine produces a similar degree of analgesia but less respiratory depression.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Indian J Anaesth
                Journal ID (publisher-id): IJA
                Title: Indian Journal of Anaesthesia
                Publisher: Medknow Publications (India )
                ISSN (Print): 0019-5049
                ISSN (Electronic): 0976-2817
                Publication date (Print): May-Jun 2010
                Volume: 54
                Issue: 3
                Pages: 231-234
                Affiliations
                Lecturer, Department of Anaesthesiology, Shrimati Kashibai Navale Medical College and General Hospital, Narhe, Pune, India
                [1 ]Associate Professor, Department of Anaesthesiology, Shrimati Kashibai Navale Medical College and General Hospital, Narhe, Pune, India
                [2 ]Professor and HOD, Department of Anaesthesiology, Shrimati Kashibai Navale Medical College and General Hospital, Narhe, Pune, India
                Author notes
                Address for correspondence: Dr. Poonam S Ghodki, A 201, Doctor’s Quarters, Shrimati Kashibai Navale Medical College and General Hospital, Narhe, Pune, India. E-mail: drpoonamghodki@ 123456gmail.com
                Article
                Publisher ID: IJA-54-231
                DOI: 10.4103/0019-5049.65370
                PMC ID: 2933482
                PubMed ID: 20885870
                SO-VID: d23a1cf6-b0fa-40c0-b600-d3a42a6364e6
                Copyright © © Indian Journal of Anaesthesia
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Subject: Clinical Investigation

                ScienceOpen disciplines: Anesthesiology & Pain management
                Keywords: laparoscopy,clonidine,shoulder tip pain,intrathecal,bupivacaine
                Data availability:
                ScienceOpen disciplines: Anesthesiology & Pain management
                Keywords: laparoscopy, clonidine, shoulder tip pain, intrathecal, bupivacaine

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