2006, Number 3
<< Back Next >>
Rev Mex Anest 2006; 29 (3)
Dexmedetomidine, bupivacaine and fentanyl vs bupivacaine and fentanyl. Continuous extradural analgesia in lower-extremity surgery
Cedillo-Maguey A, Cárdenas-Jurado J, Juárez-Crescencio O, González-Santillán JM
Language: Spanish
References: 31
Page: 152-158
PDF size: 105.89 Kb.
ABSTRACT
A clinical, comparative trial was carried out to demonstrate whether the extradural infusion of a mixture of dexmedetomidine, bupivacaine and fentanyl had a superior efficacy than the infusion of a mixture of bupivacaine and fentanyl in relieving postoperative pain in patients undergoing orthopedic surgery of the lower limb. One hundred and forty patients, ages 18 to 95, ASA physical status I-III, were randomized into two groups: group 1 (experimental, n = 70), with dexmedetomidine, and group 2 (control, n = 70), without dexmedetomidine. Both groups received the drugs by extradural infusion using a mechanical pumping device. Postoperative analgesia was evaluated using a visual analogue scale; it was considered “satisfactory” when the patients’ score was 0 through 2, and “unsatisfactory” when the score was 3 through 10, in the first 24 hours. There were no statistically significant differences in demographic variables among the two groups. No complications occurred in the perioperative period. Analgesia was considered “unsatisfactory” in one patient (1.5%) in group 1, and in 9 patients (12.8%) in group 2, p ‹ 0.001. We concluded that the dexmedetomidine, plain bupivacaine and fentanyl mixture has a greater efficacy than the plain bupivacaine and fentanyl mixture for the postoperative control of pain in patients undergoing orthopedic surgery of the lower limb.
REFERENCES
Rawal N. Postoperative pain and its treatment. In: Rawal N. Management of acute and chronic pain. London; BMJ, 1998:51-88.
Kehlet H, Dahl J. The value of multimodal or balanced analgesia in postoperative pain treatment. Anesth Analg 1993;83:215-222.
Eledjam JJ, Viel E, Bruelle P, de la Coussaye JE. Farmacología de los anestésicos locales. Encyclopédie Medico-Chirurgicale París. 1999;T136-320-A-10:1-18.
Brodner G, Mertes N, Van A, Pogatski E. Epidural analgesia with local anesthetics after abdominal surgery; earlier motor recovery with 0.2% ropivacaine than 0.75% bupivacaine. Anesth Analg 1999;88:128-133.
Deweeze F, Akbari Z, Carlne E. Pain control after knee arthroplasty: intraarticular versus epidural anesthesia. Clin Orthop Res 2001;392:226-231.
Badner N, Reid P, Liu A. Continuous epidural infusion of ropivacaine for the prevention of postoperative pain after major orthopedia surgery: A dose finding study. Anesthesiology 1994;81:3A (Abst.).
Kampe S, Diefenbach C. Comparison of continuous epidural infusion of ropivacaine and sufentanyl with intravenous patient-controlled analgesia after total hip replacement. Anaesthesia 2001;56:1181-1193.
Murat I. Management of acute pediatric pain. In: Rawal N. Management of acute and chronic pain. London; BMJ, 1998:118-138.
Jamali S, Monín S, Begon C, Dubousset AM, Ecoffey C. Clonidine in pediatric caudal anesthesia. Anesth Analg 1994;78:663-666.
Lee JJ, Robin AP. Comparison of bupivacaine-clonidine mixture with plain bupivacaine for caudal anesthesia in children. Br J Anaesth 1994;72:258-262.
Penon C, Ecoffey C, Cohen SE. Ventilatory response to carbon dioxide after epidural clonidine injection. Anesth Analg 1991;72:761-764.
Bovaziz K, Hewit C, Eisenach JC. Subarachnoid neostigmine potentiation of alpha2-adrenergic agonist analgesia. Reg Anesth 1995;20:121-127.
Klimscha K, Tong C, Eisenach JC. Intrathecal [alpha]2-adrenergic agonist stimulate acethylcholine and noerepinephrine release from the spinal cord dorsal horn in sheep. An in vivo microdyalisis study. Anesthesiology 1997;87:110-116.
Eisenach J, Detweiler O, Hood D. Hemodynamic and analgesic actions of epidurally administered clonidine. Anesthesiology 1993;78:277-287.
Khan ZP, Ferguson SN, Jones RM. Alpha2 and imidazoline receptor agonists: Their pharmacology and therapeutic role. Anaesthesia 1999;54:146-165.
Gordh T, Post C, Olsson Y. Evaluation of the toxicity of subarachnoid clonidine, guanfacine and substance P antagonist on rat spinal cord and nerve roots. Anesth Analg 1986;65:1303-1311.
Lamer TJ. Postoperative analgesia. In: Wedel DJ. Orthopedic anesthesia. New York; Churchill-Livingstone, 1993:363-384.
Cañedo L. Tamaño de la muestra. En: Cañedo L. Investigación clínica. México; Interamericana, 1987:171-183.
Cañedo L. Pruebas de hipótesis y significancia estadística. En: Cañedo L. Investigación clínica. México; Interamericana, 1987:159-170.
Capdevilla X, Barthelet Y, d’Athis F. Anestesia en cirugía ortopédica. Encyclopédie Médico-Chirurgicale París. 1999; T3 E-36-605-A-11:1-14.
Cárdenas JJ, Castellanos VA, Vázquez MI, Cedillo MA, González SJM, Juárez CO. Analgesia postoperatoria por vía extradural en pacientes tratados con cirugía ortopédica de extremidad inferior. Ropivacaína simple más fentanyl vs Bupivacaína simple más fentanyl. Rev Mex Anest 2004;27:86-91.
Rygnestad T, Borchgrewinck PC, Eide E. Postoperative epidural infusion of morphine and bupivacaine is safe on surgical wards. Acta Anaesthesiol Scand 1997;41:868-876.
Gall O, Murat I. Estrategia para la analgesia postoperatoria en el niño. Encyclopédie Médico-Chirurgicale París. 2001;T2 E-36-396-C-10:1-11.
Tamsen A, Gordh T. Epidural clonidine produces analgesia. Lancet 1984;2:231-232.
Bonnet F, Boici O, Rostaing S. Postoperative analgesia with extradural clonidine. Br J Anaesth 1989;63:465-469.
Jankovic D, De Andrés J. Coadyuvantes utilizados junto a los anestésicos locales en bloqueos neuroaxiales. En: Jankovic D, De Andrés J. Técnicas de anestesia y analgesia regional. 2ª México; Editorial Prado, 2003:307-312.
Salonen M, Reid K, Maze M. Synergistic interaction between (alpha)2-adrenergic agonists and benzodiazepines in rats. Anesthesiology 1992;76:1004-1011.
Huan G, Shunji T, Sungsam Ch, Tetsuya H, Shiro T, Koji S. The effects of dexmedetomidine on left ventricular function during hypoxia and reoxygenation in isolated hearts. Anesth Analg 2005;100(3):1-9.
Ebert T, Maze M. Dexmedetomidine: Another arrow for the clinician’s quiver. Anesthesiology 2004;101:568-570.
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;101:744-752.
Cousins JM, Mather LE. Intrathecal and epidural administration of opioids. Anesthesiology 1984;61:276-310.