Ahila, K (2013) Comparative Evaluation of the effects of addition of Intrathecal Fentanyl and Clonidine added to 0.5% Hyperbaric Bupivacaine for Lower Segment Caesarean Section: A Study of 120 Cases. Masters thesis, Tirunelveli Medical College, Tirunelveli.
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Abstract
INTRODUCTION: Relief of Pain is purchased always at a price – Ralph Waters. “For all the happiness mankind can gain is not in pleasure but in rest from pain”. – John Dyrden. The aim of anesthesiology as a science is the removal of pain temporarily started initially with pain relief for surgeries, extending now to post operative pain relief, relief of chronic pain and cancer pain. Spinalanesthesia plays in important role of alleviating pain intraoperatively, extending sometime into postoperative period also. The entry of Corning’s needle in 1885-into the subarachnoid space paved the way for the greatest leap into spinal anaesthesia. His words “Be the density of this observation, what it may have seemed to me on the whole, worth recording. This opened the prologue for the word “spinal anaesthesia”. Cocaine was the drug first used experimentally in dogs. In men the first spinal anaesthesia was conducted by “August Bier” on 16.8.1898 with cocaine 3 ml as 0.5% solution followed by Matas in America and Tuffier in France. Spinal anesthesia for caesarean section has always enjoyed popularity as it eliminates the complication of pulmonary aspiration and avoids the problem of difficult tracheal intubation observed with general anaesthesia. Other advantages of this technique are its simplicity, rapid onset and dependability. The demonstration of opiate receptors in substantia gelatinosa of spinal cord (Yaksh and Rudy 1976) has created interest in the intrathecal administration of opiates. The use of intrathecal morphine for providing postoperative pain relief in caesarean section was started in the year 1988 by EzzazAboulesish et.al. The advantages of neuraxial opioids over neuraxial local anesthetics are that it produces prolonged, intense, selective, segmental analgesia without motor blockade and sympathetic dysfunction. Opiods and local anesthetics administered together have a potent synergistic analgesic effect. Intrathecal opiods enhance analgesia from subtherapeutic dose of local anesthetic and make it possible to achieve successful spinal anaesthesia using otherwise inadequate doses of local anesthetic. The α2 adrenergicmechanism have been exploited for more than 100 yrs. Vetenarians have used α2 agonist for many years for regional analgesia, but the experience with these agents in humans, dates back only slightly more than 10 years. In 1984 Tamsen, Gordh after testing neurotoxicity in animals and then injected a parenteral preparation of α2 agonist clonidine, epidurally intwo patients with chronic pain. Since then the complete toxicologic assessment in animal studies has suggested that clonidine is safe for Intrathecal use. AIM OF THE STUDY: 1. To evaluate the effects of fentanyl and clonidineadded to Bupivacaine, for caesarean section in spinal Anaesthesia 2. To evaluate the duration of analgesia by comparing two groups. 3. To evaluate the hemodynamic effects, post-operative sedation and neonatal outcome between the two groups. MATERIALS AND METHODS: Following approval by the institutions ethical committee, this prospective study was done at Tirunelveli Medical College Hospital, Tirunelveli in 120 patients undergoing elective or emergency caesarean section after getting informed consent from each patient and explaining the procedure. This is a randomized prospective comparative study. Inclusion Exclusion Criteria: Term, parturient, ASA I an ASA IE who were fit to undergo spinal anaesthesia for caesarean section, age between 18-35 yrs., are selected. Patients with medical and obstetrical complications and impaired placental function were excluded; patients who were converted to general Anaesthesia were also excluded from the study. Preoperative Preparation: Preoperatively all patients were seen by the anesthetist. The procedure was explained in detail and informed consent was obtained. No premedication was given. Patients were randomly allocated into 3 groups of 40 each. A- Control Group - Injection (0.5%) Bupivacaine 1.8 ml + 0.4 ml NS, B- Study group 1 inj. (0.5%) Bupivacaine 1.8 ml + Clonidine 30 μg) + 0.2 ml NS, C- Study group 2 Inj (0.5%) Bupivacaine 1.8 ml + Clonidine (30 μg) +fentanyl (10μg). OBSERVATIONS: Statistical Analysis: The Randomization of three groups was done by matching their age, height, and weight of their demographic factors and base Physiological factors such as pulse rate, SBP, respiration rate and SPO2 by ANOVA (Analysis of Variance). The differences between them were interpreted by the Post hoc test of Bonferroni. Similarly, the time for maximum loss of sensation, the 2 segment regression time, pain free time and Apgar score at 1 minute and 5 minutes were compared between groups by ANOVA. The intra and post-operative pulse rate and SBP at different intervals were compared between groups by ANOVA and interpreted the difference by Post hoc test of Bonferroni.The sensation level and sedation score were analyzed and interpreted by χ2 test (Chi- square). The above statistical procedures were performed by the statistical package IBM SPSS statistics 20. The P - values less than 0.05 (P<0.05) were treated as significant in two tail condition. CONCLUSION: The above study bears out the following facts. 1. Intrathecal clonidine and the clonidine fentanyl combination, both improved quality of Intra Operative analgesia. 2. Combination of clonidine with fentanyl increased the intra operative analgesic efficacy and significantly prolonged postoperative analgesia compared with clonidine alone. 3. Stable Intra Operative hemodynamics was obtained. 4. Duration of analgesia was prolonged. 5. The incidence of side effects due to additive effects of the drugs was minimal. 6. Fetal outcome was not altered.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Intrathecal Fentanyl ; Clonidine ; 0.5% Hyperbaric Bupivacaine ; Lower Segment Caesarean Section ; Comparative Evaluation ; Study of 120 Cases. |
| Subjects: | MEDICAL > Anaesthesiology |
| Depositing User: | Subramani R |
| Date Deposited: | 30 Apr 2018 02:56 |
| Last Modified: | 01 May 2018 07:32 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/7346 |
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