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Academia Mexicana de Neurología, A.C.

2011, Number 4

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Rev Mex Neuroci 2011; 12 (4)

Dexmedetomidine plus bupivacaine versus bupivacaine alone in peridural infusion for control of postsurgical pain

Vaca-Damy A, Villaseñor-Santillán L, Ríos-Alatorre AA, Ramírez-Ruiz M, Hernández-Gutiérrez D, Valdez S, Ochoa-Guzmán A, Ruiz-Sandoval JL, Chiquete E

Language: Spanish
References: 18
Page: 181-186
PDF size: 211.93 Kb.


ABSTRACT

Introduction: Postsurgical pain is the main cause of acute pain in hospital settings. Selective α-2 adrenergic agonists such as clonidine and dexmedetomidine administered via peridural infusion have been evaluated in postsurgical pain control, since they act on brain stem, spinal and peripheral receptors, modulating the nociceptive input. In this context, clonidine is the most studied drug, but little information exists with dexmedetomidine. Objective: To evaluate the efficacy of the add-on use of dexmedetomidine in peridural anesthesia, as a strategy aimed to diminish postsurgical pain. Methods: An open-label trial was designed to compare bupivacaine via 24-h peridural infusion (n = 15) versus the combination of bupivacaine and dexmedetomidine (Bupi/Dexme, n = 21) in women who underwent abdominal hysterectomy. The main study outcome was the magnitude of postsurgical pain (as reflected in a visual analog scale) and the need for rescue analgesia during 24 h of peridural infusion after surgery. We also evaluated the impact on heart rate (HR) and mean arterial pressure (MAP) during the same period. Results: We observed significant differences with respect to the subjective patients’ pain scoring, from the first 4 h after infusion initiation, favoring Bupi/Dexme group (p ‹ 0.05). Moreover, time to rescue analgesia and mean cumulative analgesic load were lower in Bupi/Dexme group, as compared with bupivacaine alone (in both, p ‹ 0.05). HR and MAP were significantly lower in the Bupi/Dexme group at 4, 8, 12 and 24 h after infusion initiation, but without important hemodynamic repercussion. Conclusions: The administration of bupivacaine and dexmedetomidine via peridural infusion is a useful strategy in management of postsurgical pain, without clinically meaningful hemodynamic impact.


REFERENCES

  1. Aldrete A. Texto de anestesiología teórico práctico. 1a. Ed. México: Editorial Salvat; 1998, p. 1690-2.

  2. Morgan E. Anestesiología clínica. 1a. Ed. México: Editorial Manual Moderno; 1995, p. 330-2.

  3. Quiroga OJ. Estudio comparativo entre bupivacaína-morfina contra bupivacaína-morfina-clonidina por vía peridural en la analgesia postoperatoria de pacientes sometidos a cesáreas. Revista de la Sociedad Española de Dolor 2003; 10: 135-44.

  4. Guevara U, Roa L. Dolor perioperatorio. Medicina del dolor y paliativa. México; Corporativo Intermédica, S.A de C.V.; 2002, p. 246-53.

  5. Dewandre PY, Decurninge V, Bonhomme V, Hans P, Brichant JF. Side effects of the addition of clonidine 75 microg or sufentanil 5 microg to 0.2% ropivacaine for labour epidural analgesia. Int J Obstet Anesth 2010; 19: 149-54.

  6. Wallet F, Clement HJ, Bouret C, Lopez F, Broisin F, Pignal C, Schoeffler M, et al. Effects of a continuous low-dose clonidine epidural regimen on pain, satisfaction and adverse events during labour: a randomized, double-blind, placebo-controlled trial. Eur J Anaesthesiol 2010; 27: 441-7.

  7. Grosu I, Lavand‘homme P. Use of dexmedetomidine for pain control. F1000 Med Rep 2010; 2: 90.

  8. Rygnestad T, Borchgrewinck PC, Eide E. Postoperative epidural infusion of morphine and bupivacaine is safe on surgical wards. Acta Anaesthesiol Scand 1997; 41: 868-76.

  9. Gall O, Murat I. Estrategia para la analgesia postoperatoria en el niño. París: Encyclopédie Médico-Chirurgicale; 2001, p. 1-11.

  10. Jankovic D, De Andrés J. Coadyuvantes utilizados junto a los anestésicos locales en bloqueos neuroaxiales. Técnicas de anestesia y analgesia regional. 2a. Ed. México: Editorial Prado; 2003, p. 307-12.

  11. Angst M, Ramaswamy B, Davies MF, Maze M. Comparative analgesic and mental effects of increasing plasma concentrations of dexmedetomidine and alfentanyl in humans. Anesthesiology 2004; 101: 744-52.

  12. Ebert T, Maze M. Dexmedetomidine: Another arrow for the clinician’s quiver. Anesthesiology 2004; 101: 568-70.

  13. Cedillo-Maguey, Cárdenas-Jurado. Dexmedetomidina, bupivacaína y fentanyl vs bupivacaína y fentanyl. Analgesia extradural continua en cirugía de extremidad inferior. Revista Mexicana de Anestesiología 2006; 29: 152-8.

  14. Congedo E, Sgreccia M, De Cosmo G. New drugs for epidural analgesia. Curr Drug Targets 2009 Aug; 10: 696-706.

  15. Obayah GM, Refaie A, Aboushanab O, Ibraheem N, Abdelazees M. Addition of dexmedetomidine to bupivacaine for greater palatine nerve block prolongs postoperative analgesia after cleft palate repair. Eur J Anaesthesiol 2010; 3: 280-4.

  16. El-Hennawy AM, Abd-Elwahab AM, Abd-Elmaksoud AM, El-Ozairy HS, Boulis SR. Addition of clonidine or dexmedetomidine to bupivacaine prolongs caudal analgesia in children. Br J Anaesth 2009; 103: 268-74.

  17. Brummett CM, Padda AK, Amodeo FS, Welch KB, Lydic R. Perineural dexmedetomidine added to ropivacaine causes a dose-dependent increase in the duration of thermal antinociception in sciatic nerve block in rat. Anesthesiology 2009; 111: 1111-9.

  18. Ramadhyani U, Park JL, Carollo DS, Waterman RS, Nossaman BD. Dexmedetomidine: clinical application as an adjunct for intravenous regional anesthesia. Anesthesiol Clin 2010; 2: 709-22.




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