Vargas-Trujillo C, Popoca-Mondragón X, Peñuelas-Acuña J, Oriol-López SA, Domínguez-Ramírez FJ

Language: Spanish
References: 23
Page: 86-91
PDF size: 141.57 Kb.

ABSTRACT

Epidural blockade is one of the most commonly used anesthetic techniques because of its many advantages. Epidural administration of alpha-2-agonists produces analgesia by acting on alpha-2 receptors in the dorsal horn of the spinal cord, which inhibit the release of noradrenaline from adrenergic and central nervous endings. Objective: Comparing the use of epidural lidocaine plus clonidine vs lidocaine plus epinephrine to improve the quality and duration of anesthesia in patients undergoing surgery of the lower abdomen and lower limbs, and recording hemodynamic changes. Materials and methods: Prospective, transversal, descriptive, randomized, comparative, parallel groups clinical study, with 90 patients randomized into two groups, 45 patients each. Group I received 5 mg/kg lidocaine 2% with epinephrine 1: 20,000; Group II received 5 mg/kg lidocaine 2% plus 3 µg/kg clonidine. Results: Hemodynamic parameters showed no significant difference among the two groups. Average anesthetic time was 86.8 minutes in Group I vs 112.6 minutes in Group II. Quality of anesthesia in both groups was good. Conclusions: Epidural administration of lidocaine plus clonidine achieves a longer anesthetic time with good anesthetic quality, reducing the need for subsequent doses, with minimal hemodynamic effects.

REFERENCES

1. Bernadette ThV, Stienstra R. Duration of block: drug, dose, and additives. Reg Anesth 1998;23:352-356.

2. Felsby S, Juelsgaard P. Combined spinal and epidural anesthesia. Anesth Analg 1995;80:821-6.

3. Butterworth J. Physiology of spinal anesthesia: what are the implications for management? Reg Anesth 1998;23:370-73.

4. Bromage P. Mechanism of action of extradural analgesia. Br J Anesth 1975;47:199-211.

5. Bromage PR. Epidural Analgesia. 1a. Ed. Philadelphia, W.B. Saunders, 1978.

6. Constant I, Gall O, Gouyet L, Chauvin M, Murat I. Addition of clonidine or fentanyl to local anaesthetics prolongs the duration of surgical analgesia after single shot caudal block in children. Br J Anesth 1998;80:294-8.

7. Eisenach J, Detweiler D, Hood D. Hemodynamic and analgesic actions of epidurally administered clonidide. Anesthesiology 1993;78:277-287.

8. Eisenach J, Hood D, Tuttle R. Computer–controlled epidural infusion to targeted cerebrospinal fluid concentrations in humans. Anesthesiology 1995;83:33-47.

9. Eisenach J, Rauck R, Buzzanell C. Epidural clonidine analgesia for intractable. Cancer Pain: Phase I. Anesthesiology 1989;71:647-652.

10. Ohata H, Lida H. The optimal test dose of epinephrine for epidural injection with lidocaine solution in awake patients premedicated with oral clonidine. Anesth Analg 1998;86:1010-4.

11. Brown DL. Spinal, epidural and caudal anesthesia: anatomy, Physiology and technique. In: Chesnut DH: Obstetric anesthesia principle and practice. 1a Ed. St Louis Mo. Mosby 1994:181-202.

12. Anzai Y, Nishikawa T. Thoracic epidural clonidine and morphine for postoperative pain relief. Can J Anesth 1995;42:292-7.

13. Galindo A, Hernandez J, Benavides O, Ortegon de Muñoz S, Bonica JJ. Quality of spinal extradural anesthesia: the influence of spinal nerve root diameter. Br J Anaesth 1975;47:41-47.

14. Constant I, Gall O, Gouyet L, Chauvin M, Murat I. Addition of clonidine or fentanyl to local anaesthetics prolongs the duration of surgical analgesia after single shot caudal block in children. Br J Anesth 1998;80:294-8.

15. Klimscha W, Chiari A, Krafft P, et al. Hemodynamic and analgesic affects of clonidine added repetitively to continuous epidural and spinal blocks. Anesth Analg 1995;80:322-7.

16. Mogensen T, Eliasen K, Ejlersen E, et al. Epidural clonidine enhances postoperative analgesia from a combined low-dose epidural bupivacaine and morphine regimen. Anesth Analg 1992;75:607-10.

17. Ohata H, Lida H. The optimal test dose of epinephrine for epidural injection with lidocaine solution in awake patients premedicated with oral clonidine. Anesth Analg 1998;86:1010-4.

18. Omote K, Namiki TO, Iwasaki H. Epidural administration and analgesia spread: comparison of injection with catheters and needles. J Anesthesia 1992;6:289-294.

19. Senard M, Ledoux D, Darmon PL. Hemodynamic effects of epinephrine associated to an epidural clonidine-bupivacaine mixture during combined lumbar epidural and general anesthesia. Acta Anaesthesiol Belg 1998;49:167-173.

20. Murga G, Samso E, Valles J, Casanovas P, Puig MM. The effect of clonidine on intra-operative requirements of fentanyl during combined epidural/general anesthesia. Anesthesia 1994; 49:999-1002.

21. Eisenach J, De KocK M, Klimscha W. Alpha sub 2-Adrenergic agonists for regional anesthesia: a clinical review of clonidine (1984-1995). Anesthesiology 1996;85:655-674.

22. Williams S, Tong C, Eisenach J. Neostigmine counteracts spinal clonidine induced hypotension in sheep. Anesthesiology 1993;78:301-307.

23. Fitzgibbon R, Rapp E, Butler H. Rebound hypertension and acute withdrawal associated with discontinuation of an infusion of epidural clonidine. Anesthesiology 1996;84:729-31.