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      Postoperative Analgesia with Epidural Dexmedetomidine Compared with Clonidine following Total Abdominal Hysterectomies: A Prospective Double-blind Randomized Trial

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          Abstract

          Background and Aims:

          Anesthesia for total abdominal hysterectomies is not only concerned with relieving pain during intraoperative period but also during the postoperative period. We compared clonidine and dexmedetomidine as an adjuvant to levobupivacaine for epidural analgesia with respect to onset and duration of sensory block, duration of analgesia, and adverse effects.

          Materials and Methods:

          A total of 80 individuals between the age of 45 and 65 years of American Society of Anesthesiologists (ASA) physical status Classes I and II who underwent total abdominal hysterectomies were randomly allocated into two groups, comprising 40 patients in each group. Group LC received 10 ml of 0.125% levobupivacaine and 2 μg/kg of clonidine while Group LD received 10 ml of 0.125% levobupivacaine and 1 μg/kg of dexmedetomidine through the epidural catheter. Onset of analgesia, time of peak effect, duration of analgesia, cardiorespiratory parameters, side effects, and need of rescue intravenous (IV) analgesics were observed. The data analysis was carried out with Z-test and Chi-square test.

          Results:

          The demographic profile and ASA physical classes were comparable between the groups. Group LD had early onset, early peak effect, prolonged duration, and stable cardiorespiratory parameters when compared with Group LC. Less number of patients (42.5%) in Group LD required IV rescue analgesics when compared to Group LC (70%) and was statistically significant. The side effects’ profile was also comparable.

          Conclusion:

          Dexmedetomidine is a better neuraxial adjuvant compared with clonidine for providing early onset and prolonged postoperative analgesia and stable cardiorespiratory parameters.

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          Most cited references16

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          Clinical uses of alpha2 -adrenergic agonists.

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            Efficacy of postoperative epidural analgesia: a meta-analysis.

            Whether epidural analgesia is a better method than parenteral opioids for postoperative pain control remains controversial. To systematically review the efficacy of postoperative epidural analgesia vs parenteral opioids, the primary alternative technique. Studies were identified primarily by searching the National Library of Medicine's PubMed database (1966 to April 25, 2002) and other sources for studies related to postoperative epidural analgesia. Inclusion criteria were a comparison of epidural therapy vs parenteral opioids for postoperative analgesia, measurement of pain using a visual analog scale (VAS) or numeric rating scale, randomization of patients to either therapy, and adult patients (> or =18 years). A total of 1404 abstracts were identified, 100 of which met all inclusion criteria. Each article was reviewed and data extracted from tables, text, or extrapolated from figures as needed. Weighted mean pain scores, weighted mean differences in pain score, and weighted incidences of complications were determined by using a fixed-effect model. Epidural analgesia provided better postoperative analgesia compared with parenteral opioids (mean [SE], 19.40 mm [0.17] vs 29.40 mm [0.20] on the VAS; P<.001). When analyzed by postoperative day, epidural analgesia was better than parenteral opioids on each postoperative day (P<.001 for each day after surgery). For all types of surgery and pain assessments, all forms of epidural analgesia provided significantly better postoperative analgesia compared with parenteral opioid analgesia (P<.001 for all), with the exception of thoracic epidural analgesia vs opioids for rest pain after thoracic surgery (weighted mean difference, 0.6 mm; 95% confidence interval, -0.3 to 1.5 mm; P =.12). The complication rates were lower than expected for nausea or vomiting and pruritus but comparable with existing data for lower extremity motor block. Epidural analgesia, regardless of analgesic agent, location of catheter placement, and type and time of pain assessment, provided better postoperative analgesia compared with parenteral opioids.
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              Dexmedetomidine and clonidine in epidural anaesthesia: A comparative evaluation

              Efforts to find a better adjuvant in regional anaesthesia are underway since long. Aims and objectives are to compare the efficacy and clinical profile of two α-2 adrenergic agonists, dexmedetomidine and clonidine, in epidural anaesthesia with special emphasis on their sedative properties and an ability to provide smooth intra-operative and post-operative analgesia. A prospective randomized study was carried out which included 50 adult female patients between the ages of 44 and 65 years of (American Society of Anaesthesiologists) ASAI/II grade who underwent vaginal hysterectomies. The patients were randomly allocated into two groups; ropivacaine + dexmedetomidine (RD) and ropivacaine + clonidine (RC), comprising of 25 patients each. Group RD was administered 17 ml of 0.75% epidural ropivacaine and 1.5 μg/kg of dexmedetomidine, while group RC received admixture of 17 ml of 0.75% ropivacaine and 2 μg/kg of clonidine. Onset of analgesia, sensory and motor block levels, sedation, duration of analgesia and side effects were observed. The data obtained was subjected to statistical computation with analysis of variance and chi-square test using statistical package for social science (SPSS) version 10.0 for windows and value of P 0.05). Dexmedetomidine is a better neuraxial adjuvant compared to clonidine for providing early onset of sensory analgesia, adequate sedation and a prolonged post-operative analgesia.
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                Author and article information

                Journal
                Anesth Essays Res
                Anesth Essays Res
                AER
                Anesthesia, Essays and Researches
                Medknow Publications & Media Pvt Ltd (India )
                0259-1162
                2229-7685
                Jan-Mar 2018
                : 12
                : 1
                : 103-108
                Affiliations
                [1]Department of Anaesthesiology and Critical Care, RIMS, Kadapa, Andhra Pradesh, India
                Author notes
                Address for correspondence: Dr. Balaji Donthu, Flat No.: 105, Sri Krishna Sai Appartments, Besides Balireddy Hospital, Co-operative Colony, Kadapa - 516 001, Andhra Pradesh, India. E-mail: drvaasu@ 123456gmail.com
                Article
                AER-12-103
                10.4103/aer.AER_207_17
                5872843
                29628563
                eee4951f-2de1-47fe-ae6b-b86e280f2900
                Copyright: 2018 © Anesthesia: Essays and Researches

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

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                Original Article

                anesthesia technique,clonidine,dexmedetomidine,epidural analgesia,levobupivacaine,total abdominal hysterectomy

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