Published June 1, 2012 | Version v1
Journal article Open

Comparative study of intrathecal hyperbaric Bupivacaine with Clonidine, Fentanyl and Midazolam for quality of anaesthesia and duration of post operative pain relief in patients undergoing elective caesarean section

Authors/Creators

  • 1. Department of Anaesthesiology, NKP Salve Institute of Medical Sciences & Lata Mangeshkar Hospital, Nagpur

Description

Pain free postoperative period and early ambulation are the need of the day for mothers caring for their neonates.The use of adjuvants in spinal analgesia has gained popularity in recent times. This prospective randomized study was carried out among 120 patients scheduled for elective caesarian section. They were divided into 4 groups. Group A (Control) received Injection Bupivacaine (Hyperbaric) along with 0.9% Normal saline, Group B, C and D received Clonidine 75 µg, Fentanyl 25 µg and Midazolam 2.5 mg along with injection Bupivacaine (H) respectively. The results of the present study showed that intrathecal Clonidine, Fentanyl and Midazolam can be used safely in parturient, provided strict protocol for preloading is followed by vigilant operative and post-operative monitoring by a trained person. Requirement of postoperative analgesics was found to be significantly reduced in all the study groups when compared with the control group. The highest duration of pain relief was found with Clonidine. Adverse effects were minimal and could be easily managed; no adverse foetal effect was noted with the use of any drug in this study

Files

4. Neelakshi Kalita Dr..pdf

Files (83.8 kB)

Name Size Download all
md5:c6a6e39f8a3ed2a0a39dd95b5eb95e3d
83.8 kB Preview Download

Additional details

References

  • 1. Biswas BN, Rudra A, Bose BK, Nath S, Chakrabarty S, Bhattacharjee S: Intrathecal fentanyl with hyperbaric bupivacaine improves analgesia during caesarean delivery and in early postoperative period. Indian Journal Anaesthesia, 2002;46(6):469-472
  • 2. Belzarena S D: Clinical Effects of intrathecally administered fentanyl in patients undergoing cesarean section. Anesthesia and Analgesia, 1992;74(5):653-657.
  • 3. Dobrydnjov I, Axelsson K, Samarütel J, Holmström B: Postoperative pain relief following intrathecal bupivacaine combined with intrathecal or oral clonidine. Acta Anaesthesiologica Scandinavica, 2002;46(7): 806–814.
  • 4. Edwards M, Serrao JM, Gent JP, Goodchild CS: On the mechanism by which midazolam causes spinally mediated analgesia. Anesthesiology, 1990; 73(2): 273- 277
  • 5. Eisenach JC, De Kock M, Klimscha W: Alpha (2)- adrenergic agonists for regional Anaesthesia: A Clinical Review of Clonidine (1984-1995). Anaesthesiology, 1996;85(3):655-674.
  • 6. Hunt CO, Naulty JS, Bader AM, Hauch MA, Vartikar JV, Datta S, Hertwig LM, Ostheimer GW: Perioperative analgesia with subarachnoid fentanyl-bupivacaine for cesarean delivery. Anaesthesiology, 1989; 71(4):274-278
  • 7. Kothari N, Bogra J, Chaudhary AK: Evaluation of analgesic effects of intrathecal clonidine along with bupivacaine in cesarean section. Saudi Journal of Anaesthesia, 2011; 5(1): 31–35.
  • 8. Mohler H, Okada T: Benzodiazepine receptor: demonstration in central nervous system. Science, 1977; 1984(319):849-851.
  • 9. Naguib M, el Gammal M, Elhattab YS, Seraj M: Midazolam for caudal analgesia in children: comparison with caudal bupivacaine. Canadian Journal of Anesthesia, 1995; 42(9): 758-764.
  • 10. Neves JF, Monteiro GA, Almeida JR, Sant'anna RS, Saldanha RM, Moraes JM, Nogueira ES, Coutinho FL, Neves MM, Araujo FP, Nobrega PB: Postoperative analgesia for caesarean section: Does the addition of clonidine to subarachnoid morphine improve the quality of analgesia? Revista Brasileira de Anestesiologia, 2006;56(4):370-376.
  • 11. Ogun CO, Kirgiz EN, Duman A, Ökesli S: The comparison of intrathecal isobaric ropivacaine and comparison of intrathecal isobaric ropivacaine and isobaric ropivacaineclonidine for caesarean delivery. The International Journal of Anesthesiology, 2007;15.
  • 12. Prakash S, Joshi N, Gogia AR, Prakash S, Singh R: Analgesic efficacy of two doses of intrathecal Midazolam with bupivacaine in patients undergoing cesarean delivery. Regional Anesthesia and Pain Medicine, 2006;31(3):221-226.
  • 13. Rolbin SH, Morgan PJ: Anesthesia for postpartum sterilization.In: Snider and Levinson's Anesthesia for Obstetrics. S.C. Hughes, G. Levinson M.A. Rosen (Eds.); 4th Edn.; Lippincott Williams & Wilkins, Philadelphia, 2002;pp: 237-244.
  • 14. Sen A, Rudra A, Sarkar SK, Biswas B: Intrathecal midazolam for postoperative pain relief in caesarean section delivery. Journal of the Indian Medical Association, 2001;99(12):683-686.
  • 15. van Tuijl I, van Klei WA, van der Werff DB, Kalkman CJ: The effect of addition of intrathecal clonidine to hyperbaric bupivacaine on postoperative pain and morphine requirements after Caesarean section: a randomized controlled trial. British Journal of Anesthesia, 2006; 97(3): 365-370.