DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20212952

The effect of clonidine with bupivacaine on perioperative hemodynamics and post-operative analgesia in cesarean section cases

Priti Kumar, Sangeeta Arya, Sushil Kr. Singh, Sunil Kumar

Abstract


Background: Cesarean section is the commonest procedure in Obstetric practice and postoperative pain can be a major factor for wound healing as well as mother and baby bonding. Spinal anesthesia is considered to be safest and easiest modality for cesarean section cases. Bupivacaine is the commonest drug given in spinal anesthesia, but many additive drugs have been introduced to cover post-operative analgesia. Clonidine is an alpha 2 agonist which can be used as an adjunct to heavy bupivacaine to extend analgesic effects.

Methods: A randomized double-blind study was performed in 100 women undergoing elective cesarean section under spinal anaesthesia. After proper informed written consent patient undergoing cesarean section were divided by computerized method into group A (Given 10.0 mg 0.5% hyperbaric Bupivacaine) and Group B (Given 9.0 mg 0.5% hyperbaric bupivacaine and 30 μg clonidine).

Results: Intraoperative hypotension is the most worrisome factor but it is transient and can be managed by ephedrine effectively. Intraoperative nausea and vomiting are slightly higher with clonidine as occurrence of hypotension is more. VAS scoring in post-operative period was better and need of first analgesic dose was much delayed in women been given clonidine with bupivacaine.

Conclusions: Clonidine can be considered as adjunct in spinal anesthesia to extend post-op analgesic cover.

 


Keywords


Spinal anesthesia, Clonidine, Bupivacaine, Intra-operative hypotension

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References


Apfelbaum JL, Chen C, Mehta SS, Gan TJ. Postoperative pain experience: Results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg. 2003;97:534-40.

Rawal N. 10 years of acute pain services: Achievements and challenges. Reg Anesth Pain Med. 1999;24:68-73.

Kehlet H, Holte K. Effect of postoperative analgesia on surgical outcome. Br J Anesth. 2001;87(1):62-72.

Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet. 2006;367(9522):1618-25.

Barletta JF, Asgeirsson T, Senagore AJ. Influence of intravenous opioid dose on postoperative ileus. Ann Pharmacother. 2011;45(7-8):916-23.

Goettsch WG, Sukel MP, Van der Peet DL, Van Riemsdijk MM, Herings RM. In-hospital use of opioids increases rate of coded postoperative paralytic ileus. Pharmacoepidemiol Drug Saf. 2007;16(6):668-74.

Lavand'homme PM, Roelants F, Waterloos H, Collet V, Kock MF. An evaluation of the postoperative antihyperalgesic and analgesic effects of intrathecal clonidine administered during elective cesarean delivery. Anesth Analg. 2008;107:948-55.

Ong CK, Lirk P, Seymour RA, Jenkins BJ. The efficacy of pre-emptive analgesia for acute postoperative pain management: a meta-analysis. Anesth Analg. 2005;100(3):757-73.

Sng BL, Sia AT, Quek K, Woo D, Lim Y. Incidence and risk factors for chronic pain after caesarean section under spinal anaesthesia. Anaesth Intensive Care. 2009;37:748-52.

Braga AA, Frias JAF, Braga FS, Poterio GB, Hirata ES, Torres NA. Spinal anesthesia for caesarean section. Use of hyperbaric bupivacaine (10mg) combined with different adjuvants. Rev Bras Anestesiol. 2012;62:775-87.

Iwasaki H, Collins JG, Saito Y, Uchida H, Kerman-Hinds A. Low-dose clonidine enhances pregnancy-induced analgesia to visceral but not somatic stimuli in rats. Anesth Analg. 1991;72:325-9.

Wolff M, Heugel P., Hempelmann G, Scholz A., Mühling J., Olschewski A. Clonidine reduces the excitability of spinal dorsal horn neurones. Br J Anaesth. 2007;98:353-61.

Saravanan S, Kocarev M, Wilson RC, Watkins E, Columb MO, Lyons G. Equivalent dose of ephedrine and phenylephrine in the prevention of post- spinal hypotension in Caesarean section. Br J Anaesth. 2006;96:95-9.

Shidhaye RV, Shah BB, Joshi SS, Deogaonkar SG, Bhuva AP. Comparison of clonidine and fentanyl as an adjuvant to intrathecal bupivacaine for spinal anaesthesia and postoperative analgesia in patients undergoing caesarian section. Sri Lankan J Anaesthesiol. 2014;22:15-20.

Huntoon M, Eisenach JC, Boese P. Epidural clonidine after cesarean section. Appropriate dose and effect of prior local anesthetic. Anesthesiology. 1992;76:187-93.

Singh R, Gupta D, Jain A. The effect of addition of intrathecal clonidine to hyperbaric bupivacaine on postoperative pain after lower segment caesarean section: a randomized control trial Saudi J Anaesth. 2013;7:283-90.

Eisenach JC, De Kock M, Klimscha W. Alpha (2)-adrenergic agonists for regional anesthesia. A clinical review of clonidine (1984-1995). Anesthesiology. 1996;85:655-74.