Philitsen, V (2011) A Comparative study on Effects of Spinal Additives Fentanyl and Clonidine with Hyperbaric Bupivacaine. Masters thesis, Kilpauk Medical College, Chennai.
|
Text
201000411philitsen.pdf Download (710kB) | Preview |
Abstract
INTRODUCTION: The history of spinal anesthesia dates back since August 15, 1898 when Gustav August Bier performed the first spinal anesthesia with cocaine. Then came Arthur E. Barker who determined several factors involved in the spread of local anesthetic in subarachnoid space. It was Rudolph Matas who first used a spinal additive morphine with cocaine to enhance neuraxial anesthesia. Several factors have been determined since the introduction of spinal anesthesia, till date and in evolution that modify the effects, extent or duration of spinal anesthesia. Bupivacaine is the commonly used local anesthetic in spinal anesthesia and several spinal additives, commonly the opioids are added to enhance the block and duration of spinal anesthesia. Each of the drug added as spinal additive has its own advantages and disadvantages. The ease of administering spinal anesthesia and its superior analgesic property has gained popularity over general anesthesia. AIM OF THE STUDY: To compare the effects of intrathecal fentanyl with 0.5 % Hyperbaric Bupivacaine and clonidine with 0.5% Hyperbaric Bupivacaine with control group of patients who received only 0.5% Hyperbaric Bupivacaine. MATERIASL AND METHODS: Study Design: Prospective randomised control study, Ethical committee approval was obtained, Pre – operative assessment done for all cases, Informed consent obtained from all patients. Inclusion Criteria: 1. ASA PS – 1 & 2 patients, 2. Both male and female patients, 3. Age within 20 and 40 years, 4. Patients who have given consent, 5. Elective surgeries. Exclusion Criteria: 1. Contraindication for spinal anesthesia, 2. ASA PS 3, 4 & 5 patients, 3. Patients who have not given consent, 4. Age more than 40 years and less than 20 years. Drugs used: 1. 0.5 % Hyperbaric Bupivaccaine, 2. Preservative free Fentanyl, 3. Preservative free Clonidine, 4. 0.9 % Normal Saline. Groups: 1. A – 15 mg of 0.5% bupivacaine (H) + 0.5ml of Normal Saline, 2. B – 15 mg of 0.5% bupivacaine (H) + 25 μg of Fentanyl, 3. C – 15 mg of 0.5% bupivacaine (H) + 50 μg of clonidine. Corrected to a volume of 0.5ml by adding Normal Saline. Study Methodology: 45 Patients were assigned to 3 groups 15 each Randomisedly and after obtaining informed consents from all patients study was done. Preoperative vitals were recorded and all patients were standardly started with 18G Venflon and preloaded with 500ml of Ringer Lactate fluid 15 minutes before the time of spinal anesthesia. No patients were sedated intra operatively. Table was ensured to be horizontal before spinal anesthesia. Under aseptic precautions spinal anesthesia was given to all patients in right lateral position, with 25G Quincke-Babcocks spinal needle, and in L3-4 space. Hypotension was defined as less than 20% from the basal mean arterial pressure and treated with ephedrine & intravenous fluids and bradycardia less than 60 and treated with atropine. RESULTS: • Onset of grade 4 motor block was shorter in group 2 and 3 with an average of around 5 to 7 minutes. • Regression to grade 1 motor block is significantly prolonged in group 3 and 2 but group 3 is longer than 2. • Sensory regression to L1 is prolonged in the additive groups but not significantly prolonged while comparing these two groups. • Maximum height of dermatomal block was not significant in all these groups and the time to achieve it was also not significant. • Hemodynamic variables were relatively lower in clonidine group. • All the patients in clonidine group were well sedated. CONCLUSION: CLONIDINE when used as a spinal additive to hyperbaric bupivacaine in healthy adults it qualitatively prolongs the duration of both sensory and motor block of spinal anesthesia with insignificant hemodynamic variation which can be easily managed. Whereas fentanyl also prolongs the spinal Anesthesia but not to the extent of Clonidine, without any significant hemodynamic changes. Clonidine has an additional advantage of arousable sedation.
| Item Type: | Thesis (Masters) |
|---|---|
| Uncontrolled Keywords: | Spinal Additives Fentanyl ; Clonidine ; Hyperbaric Bupivacaine ; Comparative study. |
| Subjects: | MEDICAL > Anaesthesiology |
| Depositing User: | Subramani R |
| Date Deposited: | 01 May 2018 01:30 |
| Last Modified: | 01 May 2018 05:57 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/7386 |
Actions (login required)
 |
View Item |
