Volume : 6, Issue : 2, February - 2017

COMPARISON OF EFFECTS OF SPINAL ADDITIVES FENTANYL OR CLONIDINE WITH HYPERBARIC BUPIVACCAINE WITH CONTROL GROUP RECEIVING ONLY HYPERBARIC BUPIVACAINE

V. Philitsen, P. Vijaya Ananth

Abstract :

<p>&nbsp;<b><span style="font-size:12.0pt;mso-bidi-font-size:14.0pt;line-height:&#10;150%;font-family:&quot;Times New Roman&quot;,serif">Background and goals of study</span></b><span style="font-size: 12pt; line-height: 150%; font-family: &quot;Times New Roman&quot;, serif;">: </span><span style="font-size: 12pt; line-height: 150%; font-family: &quot;Times New Roman&quot;, serif;">Bupivacaine&nbsp; is&nbsp; the&nbsp; commonly&nbsp; used&nbsp; local&nbsp; anesthetic&nbsp; in&nbsp; spinal&nbsp; anesthesia&nbsp; and&nbsp; several&nbsp; spinal&nbsp; additives,&nbsp; commonly&nbsp; the&nbsp; opioids&nbsp; are&nbsp; added&nbsp; to&nbsp; enhance&nbsp; the&nbsp; block&nbsp; and&nbsp; duration&nbsp; of&nbsp; spinal anesthesia. Each&nbsp; of&nbsp; the&nbsp; drug&nbsp; added&nbsp; as&nbsp; spinal&nbsp; additive&nbsp; has&nbsp; its&nbsp; own&nbsp; advantages&nbsp; and&nbsp; disadvantages. </span><span lang="EN-IN" style="font-size: 12pt; line-height: 150%; font-family: &quot;Times New Roman&quot;, serif;">This study was designed to&nbsp; compare&nbsp; the&nbsp; effects&nbsp; of&nbsp; intrathecal&nbsp; Fentanyl with</span><span style="font-size: 12pt; line-height: 150%; font-family: &quot;Times New Roman&quot;, serif;"> 0.5 % Hyperbaric&nbsp; Bupivacaine&nbsp; and&nbsp; Clonidine with&nbsp;&nbsp; 0.5% Hyperbaric&nbsp; Bupivacaine&nbsp;&nbsp; with&nbsp; control&nbsp; group of patients&nbsp; who&nbsp; received only&nbsp; 0.5% Hyperbaric&nbsp; Bupivacaine.</span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height:&#10;150%"><b><span style="font-size:12.0pt;mso-bidi-font-size:14.0pt;line-height:&#10;150%;font-family:&quot;Times New Roman&quot;,serif">Methods</span></b><span style="font-size:12.0pt;mso-bidi-font-size:14.0pt;line-height:150%;font-family:&#10;&quot;Times New Roman&quot;,serif">:</span><span style="mso-bidi-font-size:14.0pt;&#10;line-height:150%;font-family:&quot;Times New Roman&quot;,serif"> </span><span lang="EN-IN" style="font-size:12.0pt;mso-bidi-font-size:11.0pt;line-height:150%;font-family:&#10;&quot;Times New Roman&quot;,serif;mso-ansi-language:EN-IN">45 patients were assigned to 3 groups of 15 each.&nbsp; </span><span style="font-size:12.0pt;mso-bidi-font-size:11.0pt;line-height:150%;font-family:&#10;&quot;Times New Roman&quot;,serif">Group A &ndash; 15 mg of 0.5% bupivacaine (H) + 0.5ml of Normal&nbsp; Saline; Group B &ndash; 15 mg of 0.5% bupivacaine (H) + 25 &micro;g of Fentanyl; Group C &ndash; 15 mg of 0.5% bupivacaine (H) + 50 &micro;g of clonidine (corrected to a volume of 0.5ml by adding Normal&nbsp; Saline). Intraoperative hemodynamic parameters, </span><span lang="EN-IN" style="font-size:12.0pt;mso-bidi-font-size:&#10;11.0pt;line-height:150%;font-family:&quot;Times New Roman&quot;,serif;mso-ansi-language:&#10;EN-IN">maximum sensory level&nbsp; blocked&nbsp; (until grade 3), </span><span style="font-size:12.0pt;mso-bidi-font-size:11.0pt;line-height:150%;font-family:&#10;&quot;Times New Roman&quot;,serif">time to achieve maximum sensory&nbsp; level, sensory Regression time&nbsp; to&nbsp; L1&nbsp; (until grade 0), onset of grade 4&nbsp;&nbsp; motor&nbsp; block, regression&nbsp; time&nbsp; to&nbsp; grade&nbsp; 1&nbsp; motor&nbsp; block and sedation&nbsp; score were assessed.</span><span style="font-size:12.0pt;line-height:150%;font-family:&quot;Times New Roman&quot;,serif"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height:&#10;150%"><b><span style="font-size:12.0pt;mso-bidi-font-size:14.0pt;line-height:&#10;150%;font-family:&quot;Times New Roman&quot;,serif">Results</span></b><span style="font-size:12.0pt;mso-bidi-font-size:14.0pt;line-height:150%;font-family:&#10;&quot;Times New Roman&quot;,serif">: </span><span style="font-size:12.0pt;line-height:&#10;150%;font-family:&quot;Times New Roman&quot;,serif">Maximum&nbsp; height of&nbsp; dermatomal&nbsp; block&nbsp; and&nbsp; the&nbsp; time&nbsp; to&nbsp; achieve&nbsp; it were similar</span><span style="font-size:12.0pt;line-height:150%;font-family:&quot;Times New Roman&quot;,serif;&#10;mso-ansi-language:EN-IN"> </span><span style="font-size:12.0pt;line-height:&#10;150%;font-family:&quot;Times New Roman&quot;,serif">in&nbsp; all these&nbsp; groups.</span><span style="font-size:12.0pt;line-height:150%;font-family:&quot;Times New Roman&quot;,serif;&#10;mso-ansi-language:EN-IN"> </span><span style="font-size:12.0pt;line-height:&#10;150%;font-family:&quot;Times New Roman&quot;,serif">Sensory regression to&nbsp; L1&nbsp; is prolonged&nbsp; in the&nbsp; additive&nbsp; groups.</span><span style="font-size:12.0pt;line-height:150%;font-family:&#10;&quot;Times New Roman&quot;,serif;mso-ansi-language:EN-IN"> </span><span style="font-size:12.0pt;line-height:150%;font-family:&quot;Times New Roman&quot;,serif">Onset of&nbsp; grade 4&nbsp; motor&nbsp; block&nbsp; was&nbsp; shorter&nbsp; in&nbsp; group B&nbsp; and&nbsp; C</span><span lang="EN-IN" style="font-size:12.0pt;line-height:150%;font-family:&quot;Times New Roman&quot;,serif;&#10;mso-ansi-language:EN-IN">. </span><span style="font-size:12.0pt;line-height:&#10;150%;font-family:&quot;Times New Roman&quot;,serif">Regression&nbsp; to grade 1 motor block&nbsp; is significantly&nbsp; prolonged</span><span style="font-size:12.0pt;&#10;line-height:150%;font-family:&quot;Times New Roman&quot;,serif;mso-ansi-language:EN-IN"> </span><span style="font-size:12.0pt;line-height:150%;font-family:&quot;Times New Roman&quot;,serif">in Groups B&nbsp; and C;&nbsp; and&nbsp; Group C&nbsp; is&nbsp; longer&nbsp; than Group B.</span><span style="font-size:12.0pt;line-height:150%;&#10;font-family:&quot;Times New Roman&quot;,serif;mso-ansi-language:EN-IN"> </span><span style="font-size:12.0pt;line-height:150%;font-family:&quot;Times New Roman&quot;,serif">Hemodynamic&nbsp; variables&nbsp;&nbsp; were&nbsp; relatively&nbsp; lower&nbsp; in&nbsp; clonidine group.</span><span lang="EN-IN" style="font-size:12.0pt;line-height:150%;font-family:&quot;Times New Roman&quot;,serif;&#10;mso-ansi-language:EN-IN"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height:&#10;150%"><b><span style="font-size:12.0pt;&#10;mso-bidi-font-size:14.0pt;line-height:150%;font-family:&quot;Times New Roman&quot;,serif;&#10;mso-fareast-font-family:Univers-Medium">Conclusion: </span></b><span lang="EN-IN" style="font-size:12.0pt;line-height:150%;font-family:&quot;Times New Roman&quot;,serif;&#10;mso-ansi-language:EN-IN">Clonidine</span><span style="font-size:12.0pt;&#10;line-height:150%;font-family:&quot;Times New Roman&quot;,serif">&nbsp; qualitatively&nbsp; prolongs&nbsp; the&nbsp; duration&nbsp; of both&nbsp; sensory&nbsp; and&nbsp; motor&nbsp; block&nbsp; of&nbsp; spinal&nbsp; anesthesia&nbsp;&nbsp;&nbsp; with&nbsp; insignificant hemodynamic&nbsp; variation&nbsp; which&nbsp; can&nbsp; be&nbsp; easily&nbsp; managed</span><span lang="EN-IN" style="font-size:12.0pt;line-height:150%;font-family:&quot;Times New Roman&quot;,serif;&#10;mso-ansi-language:EN-IN">. F</span><span style="font-size:12.0pt;line-height:&#10;150%;font-family:&quot;Times New Roman&quot;,serif">entanyl&nbsp; also&nbsp; prolongs&nbsp; the spinal</span><span lang="EN-IN" style="font-size:12.0pt;line-height:150%;font-family:&quot;Times New Roman&quot;,serif;&#10;mso-ansi-language:EN-IN">&nbsp; </span><span style="font-size:12.0pt;line-height:150%;font-family:&quot;Times New Roman&quot;,serif">anesthesia,&nbsp;&nbsp; but&nbsp; not&nbsp; to&nbsp; the&nbsp; extent&nbsp; of&nbsp; Clonidine, without&nbsp; any&nbsp; significant&nbsp; hemodynamic&nbsp; changes.<b><o:p></o:p></b></span></p>