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Drug Res (Stuttg) 2015; 65(11): 581-586
DOI: 10.1055/s-0034-1395614
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

A Randomised Controlled Trial to Evaluate the Effectiveness of Intrathecal Bupivacaine Combined with Different Adjuvants (Fentanyl, Clonidine and Dexmedetomidine) in Caesarean Section

Z. Li   *
1   School of Medicine, Shandong University, Jinan, China
2   Department of Anesthesiology, Yantai Yuhuangding Hospital, Affiliated Hospital of Medical College, Qingdao University, Yantai, China
,
M. Tian   *
1   School of Medicine, Shandong University, Jinan, China
2   Department of Anesthesiology, Yantai Yuhuangding Hospital, Affiliated Hospital of Medical College, Qingdao University, Yantai, China
,
C.-Y. Zhang
2   Department of Anesthesiology, Yantai Yuhuangding Hospital, Affiliated Hospital of Medical College, Qingdao University, Yantai, China
,
A.-Z. Li
2   Department of Anesthesiology, Yantai Yuhuangding Hospital, Affiliated Hospital of Medical College, Qingdao University, Yantai, China
,
A.-J. Huang
2   Department of Anesthesiology, Yantai Yuhuangding Hospital, Affiliated Hospital of Medical College, Qingdao University, Yantai, China
,
C.-X. Shi
2   Department of Anesthesiology, Yantai Yuhuangding Hospital, Affiliated Hospital of Medical College, Qingdao University, Yantai, China
,
D.-Q. Xin
2   Department of Anesthesiology, Yantai Yuhuangding Hospital, Affiliated Hospital of Medical College, Qingdao University, Yantai, China
,
J. Qi
2   Department of Anesthesiology, Yantai Yuhuangding Hospital, Affiliated Hospital of Medical College, Qingdao University, Yantai, China
,
K.-Z. Li
1   School of Medicine, Shandong University, Jinan, China
2   Department of Anesthesiology, Yantai Yuhuangding Hospital, Affiliated Hospital of Medical College, Qingdao University, Yantai, China
› Author Affiliations
Further Information

Publication History

received 19 September 2014

accepted 18 October 2014

Publication Date:
11 December 2014 (online)

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Abstract

Purpose: The purpose of this study was to evaluate comparatively, in women undergoing caesarean section under spinal anesthesia, the effectiveness of hyperbaric bupivacaine combined with 3 different adjuvants (fentanyl, clonidine, and dexmedtomidine) on quality of blockade and maternal and neonatal repercussions.

Method: 84 patients undergoing elective surgeries under spinal anesthesia were randomized into 4 groups of 21 each, gB, gBF, gBC and gBD. Patients in groups gb, gBF, gBC and gBD were given bupivacaine alone, bupivacaine plus fentanyl (15.0 µg), bupivacaine plus fentanyl plus clonidine (75 µg), and bupivacaine plus dexmedetomidine (10 µg), respectively. Hemodynamic parameters evaluated were the onset and level of sensory block, perioperative analgesia, degree and recovery time of motor block, duration of analgesia, sedation, and maternal-foetal repercussions.

Results: The onset of blockade was significantly faster in groups with adjuvants clonidine and dexmedetomidine compared with gB and gBF. Patients in Groups gB and gBF reported pain during the perioperative period. Duration of analgesia was significantly higher in Group gBD and was comparable to gBC and time to motor block recovery was significantly higher in Group gBD. Sedation was significant in Group gBD and gBC.

Conclusion: Addition of dexmedetomidine and clonidine as adjuvants to hyperbaric bupivacaine provided adequate anesthesia and postoperative analgesia compared to fentanyl adjuvant without causing any significant side effects.

Key words

spinal anesthesia - bupivacaine - fentanyl - clonidine - dexmedetomidine - sensory block - motor block - caesarean section - labour analgesia

* Zhi Li and Ming Tian contributed equally to this article.


 

  • References

  • 1 Hunt CO. Spinal anesthesia for obstetrics. International Anaesthesiology Clinics 1989; 27: 26-30
    PubMedGoogle Scholar
  • 2 Bajwa SJ, Bajwa SK, Kaur J et al. Prevention of hypotension and prolongation of postoperative analgesia in emergency cesarean sections: A randomized study with intrathecal clonidine. Int J Crit Illn Inj Sci 2012; 2: 63-69
    CrossrefPubMedGoogle Scholar
  • 3 Benhamou D, Thorin D, Brichant JF et al. Intrathecal clonidine and fentanyl with hyperbaric bupivacaine improves analgesia during cesarean section. Anesth Analg 1998; 87: 609-613
    PubMedGoogle Scholar
  • 4 Roelants F. The use of neuraxial adjuvant drugs (neostigmine, clonidine) in obstetrics. Curr Opin Anaesthesiol 2006; 19: 233-237
    CrossrefPubMedGoogle Scholar
  • 5 Kothari N, Bogra J, Chaudhary AK. Evaluation of analgesic effects of intrathecal clonidine along with bupivacaine in cesarean section. Saudi J Anaesth 2011; 5: 31-35
    CrossrefPubMedGoogle Scholar
  • 6 Lav and’homme PM, Roelants F, Waterloos H, Collet V, De Kock MF. An evaluation of the postoperative antihyperalgesic and analgesic effects of intrathecal clonidine administered during elective cesarean delivery. Anesth Analg 2008; 107: 948-955
    CrossrefPubMedGoogle Scholar
  • 7 van Tuijl I, van Klei WA, van der Werff DB et al. The effect of addition of intrathecal clonidine to hyperbaric bupivacaine on postoperative pain and morphine requirements after Caesarean section: a randomized controlled trial. Br J Anaesth 2006; 97: 365-370
    CrossrefPubMedGoogle Scholar
  • 8 Dyer RA, Joubert IA. Low-dose spinal anaesthesia for Caesarean section. Curr Opin Anaesthesiol 2004; 17: 301-308
    CrossrefPubMedGoogle Scholar
  • 9 Hunt CO, Naulty JS, Bader AM et al. Perioperative analgesia with subarachnoid fentanyl– bupivacaine for Cesarean delivery. Anesthesiology 1989; 71: 535-540
    CrossrefPubMedGoogle Scholar
  • 10 Saxena AK, Arava SE. Current concepts in neuraxial administration of opioids and non-opioids: An overview and future perspectives. Indian J Anaesth 2004; 48: 13-24
    PubMedGoogle Scholar
  • 11 Shukry M, Miller JA. Update on dexmedetomidine: use in nonintubated patients requiring sedation for surgical procedures. Ther Clin Risk Manage 2010; 6: 111-121
    PubMedGoogle Scholar
  • 12 Chiari A, Lorber C, Eisenach JC et al. Analgesic and hemodynamic effects of intrathecal clonidine as the sole analgesic agent during first stage of labor: A dose-response study. Anesthesiology 1999; 91: 388-396
    CrossrefPubMedGoogle Scholar
  • 13 Sia AT. Optimal dose of intrathecal clonidine added to sufentanil plus bupivacaine for labour nalgesia. Can J Anesth 2000; 47: 875-880
    CrossrefPubMedGoogle Scholar
  • 14 Julião MC, Lauretti GR. Low dose intrathecal clonidine combined with sufentanil as analgesic drugs in abdominal gynecologicalal surgery. J Clin Anesth 2000; 12: 357-362
    CrossrefPubMedGoogle Scholar
  • 15 Elia N, Culebras X, Mazza C et al. Clonidine as an adjuvant to intrathecal local anesthetics for surgery: Systematic review of randomized trials. Reg Anesth Pain Med 2008; 33: 159-167
    PubMedGoogle Scholar
  • 16 Alves TCA, Braz JRC. Vianna PTG. α2-agonistas em anestesiologia: aspectos clínicos e farmacológicos. Rev Bras Anestesiol 2000; 50: 396-404
    PubMedGoogle Scholar
  • 17 Kalso E, Poyhia R, Rosemberg P. Spinal antinociceptive by dexmedetomidine, a highly selective 2-adrenergic agonist. Pharmacol Toxicol 1991; 68: 140-143
    CrossrefPubMedGoogle Scholar
  • 18 Post C, Gordh T, Minor G et al. Antinociceptive effects and spinal cord tissue concentrations after intrathecal injection of guanfacine or clonidine into rats. Anesth Analg 1987; 66: 317-324
    CrossrefPubMedGoogle Scholar
  • 19 Ishii H, Kohno T, Yamakura T et al. Action of dexmedetomidine on the substantia gelatinosa neurons of the rat spinal cord. Eur J Neurosci 2008; 27: 3182-3190
    CrossrefPubMedGoogle Scholar
  • 20 Liu SS, Strodtbeck WM, Richman JM et al. A comparison of regional versus general anesthesia for ambulatory anesthesia: a meta-analysis of randomized controlled trials. Anesth Analg 2005; 101: 1634-1642
    PubMedGoogle Scholar
  • 21 Akcaboy ZN, Akcaboy EY, Mutlu NM et al. Spinal Anesthesia with Low-Dose Bupivacaine-Fentanyl Combination: a Good Alternative for Day Case Transurethral Resection of Prostrate Surgery in Geriatric Patients. Brazilian Journal of Anesthesiology 2012; 62: 753-761 DOI: 10.1016/S0034-7094(12)70176-9.
    CrossrefPubMedGoogle Scholar
  • 22 Agarwal K, Agarwal N, Agrawal VK et al. (n.d.) Anesthesia: Essays and Researches Efficacy of single dose epidural morphine versus intermittent low-dose epidural morphine along with bupivacaine for postcaesarean section analgesia. DOI: 10.4103/0259-1162.103367
    PubMedGoogle Scholar
  • 23 Goncalves RF, Lauretti GR, Mattos AL. Estudo Comparativo entre bupivacaína a 0,5% e mistura enantiomérica de bupivacaína (S75-R25) a 0,5% em anestesia peridural. Rev Bras Anestesiol 2003; 53: 169-176
    CrossrefPubMedGoogle Scholar
  • 24 Delfino J, Vale NB. Bupivacaína levógira a 0,5% pura versus mistura enantiomérica de bupivacaína (S75-R25) a 0,5% em anestesia peridural para cirurgia de varizes. Rev Bras Anestesiol 2001; 51: 474-482
    CrossrefPubMedGoogle Scholar
  • 25 Cortes CAF, Oliveira AS, Castro LFL et al. Estudo comparativo entre bupivacaina a 0,5%, mistura enantiomérica de bupivacaína (S75-R25) a 0,5% e ropivacaína a 0,75% associadas ao fentanil em anestesia peridural para cesarianas. Rev Bras Anestesiol 2003; 53: 177-187
    CrossrefPubMedGoogle Scholar
  • 26 Cortes CAF, Castro LFL, Serafim MM et al. Estudo comparativo entre bupivacaína racêmica a 0,25% e bupivacaína com excesso enantiomérico de 50% (S75-R25) a 0,25% associadas ao fentanil para analgesia de parto com deambulação da parturiente. Rev Bras Anestesiol 2006; 56: 16-27
    CrossrefPubMedGoogle Scholar
  • 27 Cortes CAF, Sanchez CA, Oliveira AS et al. Analgesia de parto: estudo comparativo entre anestesia combinada raquiperidural versus anestesia peridural continua. Rev Bras Anestesiol 2007; 57: 39-51
    CrossrefPubMedGoogle Scholar
  • 28 Duarte NMC, Caetano AMM, Lima LC et al. Estudo comparativo entre bupivacaína racêmica (S50-R50) a 0,125% e bupivacaína em excesso enantiomérico de 50% (S75-R25) a 0,125% e 0,25% em anestesia peridural para analgesia de parto. Rev Bras Anestesiol 2008; 58: 5-14
    CrossrefPubMedGoogle Scholar
  • 29 Al-ghanem SM, Massad IM, Al-Mustafa MM et al. Effect of adding dexmedetomidine versus fentanyl to intrathecal bupivacaine on spinal block characteristics in gynecological procedures: a double blind controlled study. Am J Appl Sci 2009; 6: 882-887
    CrossrefPubMedGoogle Scholar
  • 30 Kanazi GE, Aouad MT, Jabbour-Khoury SI et al. Effect of low-dose dexmedetomidine or clonidine on the characteristics of bupivacaine spinal block. Acta Anaesth Scand 2006; 50: 222-227
    CrossrefPubMedGoogle Scholar
  • 31 Singh R, Gupta D, Jain A. The effect of addition of intrathecal clonidine to hyperbaric bupivacaine on postoperative pain after lower segment caesarean section: A randomized control trial. Saudi J Anaesth 2013; 7: 283-290
    CrossrefPubMedGoogle Scholar
  • 32 Brandt SA, Livingston A. Receptor changes in spinal cord of sheep associated with exposure to chronic pain. Pain 1990; 42: 323-329
    CrossrefPubMedGoogle Scholar
  • 33 Reddy SVR, Yaksh TL. Spinal noradrenergic terminal system mediates antinociception. Brain Res 1980; 189: 391-401
    CrossrefPubMedGoogle Scholar
  • 34 Tekin M, Kati I, Tomak Y et al. Effect of dexmedetomidine IV on the duration of spinal anesthesia with Prilocaine: A double-blind, prospective study in adult surgical patients. Current Therapeutic Research 2007; 68: 313-324
    CrossrefPubMedGoogle Scholar
  • 35 Dinesh CN, Sai Tej NA, Yatish B et al. Effects of intravenous dexmedetomidine on hyperbaric bupivacaine spinal anesthesia: A randomized study. Saudi J Anaesth 2014; 8: 202-208
    CrossrefPubMedGoogle Scholar
  • 36 Talke P, Tayefeh F, Sessler DI et al. Dexmedetomidine does not alter the sweating threshold, but comparably and linearly decreases the vasoconstriction and shivering thresholds. Anesthesiology 1997; 87: 835-841
    CrossrefPubMedGoogle Scholar
  • 37 Al-Mustafa MM, Badran IZ, Abu Ali HM et al. Intravenous dexmedetomidine prolongs bupivacaine spinal analgesia. Middle East J Anesthesiol 2009; 20: 225-231
    PubMedGoogle Scholar
  • 38 Whizar-Lugo V, Gómez-Ramírez IA, Cisneros-Corral R et al. Intravenous dexmedetomidine vs. Intravenous clonidine to prolong bupivacaine spinal anesthesia. A doublé blind study. Anestesia en Mexico 2007; 19: 143-146
    PubMedGoogle Scholar
  • 39 Braga AFA, Frias JAF, Braga FSS et al. Anestesia espinhal com 10 mg de bupivacaína hiperbárica associada a 5 µg de sufentanil para cesariana. Estudo de diferentes volumes. Rev Bras Anestesiol 2010; 60: 121-129
    PubMedGoogle Scholar
  • 40 Simon L, Boulay G, Ziane AF et al. Effect of injection rate on hypo- tension associated with spinal anesthesia for cesarean section. Int J Obstet Anaesth 2000; 9: 10-14
    CrossrefPubMedGoogle Scholar
  • 41 Braga AFA, Braga FSB, Potério B et al. Sufentanil added to hyper- baric bupivacaine for subarachnoid block in Caesarean section. Eur J Anaesthesiol 2003; 20: 631-635
    CrossrefPubMedGoogle Scholar
  • 42 Inanoglu K, Ozcengiz D, Gunes Y et al. Epidural ropivacaine versus ropivacaine plus tramadol in postoperative analgesia in children undergoing major abdominal surgery: a comparison. Journal of Anesthesia 2010; 24: 700-704 DOI: 10.1007/s00540-010-0979-1.
    CrossrefPubMedGoogle Scholar