low dose intratechal clonidine

8/19/2019 Low Dose Intratechal Clonidine

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LO W DO SE IN TR A TECH A L CLONIDINE A

FEN T A N YL A DDED TO H YPERB A

B UPI V A C A INE PROLONG S A N A LGE SI

G YNECOLOGIC A L S URG

POOJ A CHOPR A , V A ND A N A T A L W A R

DEP A R TEMEN T OF A N A E S THE SI A A ND IN TEN SI VE C

A RE, V A RDHM A N M A H A VIR MEDIC A L COLLEGE A N

S A FD A RJ A NG HO SPI T A L, NE W DELHI, INDI A


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INTRODUCTION

The study !s "#!$$ed t% !s&e't!($ () ! s*!## d%se%) %$(d($e +- *&./ he$ !dded t% ! 0u"(1!&!($e2)e$t!$y# *(3tu'e (*"'%1es s"($!# !$!#.es(!, (th%ut

"'%du&($. s(de e))e&ts, !s &%*"!'ed t% !0u"(1!&!($e2)e$t!$y# %' ! 0u"(1!&!($e2%$(d($e

*(3tu'e4


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H!e*%dy$!*(& "'%)(#eO$set !$d Le1e#

Se$s%'y B#%&5!d

I$t'!%"e'!t(1e !$d

P%st%"e'!t(1e P!($S&%'e

S(de e))e&ts !$

sed!t(%$

Du'!t(%$ %) A$!#.es(!


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MATERIAL AND

METHODS


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O0t!($($. Eth(& A""'%1!#

P'%s"e&t(1e D%u0#e B#($d R!$d%*(6e Study

I$us(%$ !$d e3us(%$ &'(te'(!

P!t(e$ts e'e '!$d%*#y !##%&!ted t% 'e&e(1e e(the' Bu"(1!Fe$t!$y# +G'%u" BF/, Bu"(1!&!($e C#%$(d($e +G'%u" BC/, BuFe$t!$y# C#%$(d($e +G'%u" BFC/


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INCLUSION CRITERIA

78 FEMALE PATIENTS ASA +AMERICAN SOCIETY OF

ANESTHESIOLOGIST/ GRADE I2II, AGED BETWEEN 982:8 YEA

WHO WERE SCHEDULED FOR VAGINAL HYSTERECTOMY WIT

PELVIC FLOOR REPAIR OR NON DESCENT VAGINAL HYSTEREC

UNDER SPINAL ANAESTHESIA4


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E;CLUSION CRITERIA

PATIENT RE


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•GROUP BF= -48> HYPERBARIC BUPIVACAINE +?4 ML/ AND FENTANY

WITH SALINE -4? ML

•GROUP BC = -48> HYPERBARIC BUPIVACAINE +?4 ML/ AND CLON

MCG/ WITH SALINE -4 ML

•GROUP BCF = -48> HYPERBARIC BUPIVACAINE +?4 ML/ AND FENTA

MCG/

AND CLONIDINE +- MCG/ WITH SALINE -4? ML


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P'e*ed(&!t(%$

• O'!# A#"'!6%#!* -4?8 *. +$(.ht!$d ? h%u's "'(%' t% su'.e'y

SAB

• P!t(e$ts e'e '!$d%*#t% %$e %) th'ee .'%u"s

• SAB !s "e')%'*ed ($ tL92L8 ($te's"!&e us($.s"($!# $eed#e ($ the #!t"%s(t(%$


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PATIENT CHARACTERISTIC

G'%u" BF

N?8

G'%u" BC

N?8

G'%u"

N

He(.ht +&*/ @8 9 @89 9 @87

We(.ht +5./ 8- 949 848 4 84:

A.e +ye!'s/ 9:4? 4: 8@4: 4? 948

Su'.e'y du'!t(%$

+*($utes/

@?74 ?847 @@?4 ?:49 @-


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ANALGESIC DATA V!'(!0#es G'%u" BF

N?8

G'%u" BC

N?8

De'*!t%*!# S"'e!d !)te' ($t'!te&h!#

($e&t(%$ +de'*!t%*es 0#%&5ed/

@8 ? @: ?

O$set %) se$s%'y 0#%&5 +*($utes/ @74? 849 @-49 94?

I$t'!%"e'!t(1e "!($ +> %) "!t(e$ts/ 9- +$@-/ @? +$/

Re.'es(%$ t% t% se.*e$t +*($utes/ 78 - 8 8:


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ANALGESIC DATA V!'(!0#es G'%u" BF

N?8

G'%u" BC

N?8

Du'!t(%$ %) se$s%'y 0#%&5 +*($utes/ @9?4? @947 @774 94

Du'!t(%$ %) e))e&t(1e !$!#.es(! +*($utes/ @7: 9-4 ? 48

Nu*0e' %) d(%)e$!& ($e&t(%$ ($ ?9h%u's

?4:: +?2/ @4@: +@2?/


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INTRAOPERATIVE PARAMETERSI$t'!%"e'!t(1e V!'(!0#es G'%u" BF

N?8

G'%u" BC

N?8

Du'!t(%$ %) *%t%' 0#%&5 +*($utes, *e!$

SD/

@9?4? @947 @774 94

N!use! !$d V%*(tt($. +> %) "!t(e$ts/ @7: 9-4 ? 48

Sh(1e'($. +> %) "!t(e$ts/ ?4:: +?2/ @4@: +@2?/

Sed!t(%$ +> %) "!t(e$ts/ @? +$/ +$?/


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DISCUSSION


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CLONIDINE 2 MECHANISM OF ACTIO• PREDOMINANTLY ALPHA ? ADRENERGIC AGONIST ACTIVITY

•DECREASE SYMPATHETIC ACTIVITY, SYSTEMIC VASCULAR RESISTANCE, HEARBLOOD PRESSURE

• ENHANCE PARASYMPATHETIC TONE

• REDUCE CIRCULATING CATHECOLAMINE

•ITS ANALGETIC EFFECT ARE MEDIATED ENTIRELY VIA PRE AND POST SYNAPTIC

ADRENERGIC RESEPTOR THAT BLOC NOCICEPTIVE TRANSMISSION

• ANTIHYPERTENSIVE ACTION OCCURS VIA BINDING TO A NONADRENERGIC

+IMIDAOLINE/ RECEPTORM%'.!$ 8t


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CLONIDINE 2 CLINICAL USES

• ANTIHYPERTENSIVE AGENT

• ADJUNCT FOR EPIDURAL, CAUDAL, PERIPHERAL NERVE BLOC

•USED IN THE MANAGEMENT OF PATIENT WITH CRONIC NEUROPATH

M%'.!$ 8th e


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THE STUDY FOUND THAT =

@4 DERMATOMAL SPREAD TO BE WIDER?4 TIME OF ONSET OF ANALGESIA TO BE SIGNIFICANTLY LESS4 DURATION OF EFFECTIVE ANALGESIA, DURATION OF SENSORY AN

MOTOR BLOC AND TIME TO TWO SEGMENT REGRESSION WERE

SIGNIFICANTLY MORE

94 INCIDENCE OF INTRAOPERATIVE PAIN AND RE


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CONCLUSION


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CRITICAL APPRAISAL

P : 75 female patients ASA grade I-II, aged be

45-65 years, scheduled fr !aginal hysterectwith pel!ic "r repair r nn descent !aginahysterectmy under spinal anaesthesiaI : #yperbaric bupi!acaine $ clnidine $ fent

% : hyperbaric bupi!acaine $ fentanyl andhyperbaricbupi!acaine $ clnidine

& : duratin f analgesic


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THERAPY WORSHEET

A'e the 'esu#ts %) th(s s($.#e "'e1e$t(1e %' the'!"eut(& t'(!# 1!#

W!s the !ss(.$*e$t %) "!t(e$ts t% t'e!t*e$ts

'!$d%*(sed

W!s the '!$d%*(s!t(%$ #(st &%$&e!#ed

Yes

W!s )%##%2u" %) "!t(e$ts su))(&(e$t#y #%$. !$d

&%*"#ete

Yes

We'e !## "!t(e$ts !$!#ysed ($ the .'%u"s t%

h(&h they e'e '!$d%*(sed

Yes

We'e "!t(e$ts !$d ($(&(!$s 5e"t 0#($dK t%t'e!t*e$t

Yes

We'e the .'%u"s t'e!ted eu!##y, !"!'t )'%* the

e3"e'(*e$t!# t'e!t*e$t

Yes

We'e the .'%u"s s(*(#!' !t the st!'t %) the t'(!# Yes


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C!$ y%u !""#y th(s 1!#(d, (*"%'t!$t e1(de$&e !0%ut

the'!"y ($ &!'($. )%' y%u' "!t(e$t

D% these 'esu#ts !""#y t% y%u' "!t(e$t

Is y%u' "!t(e$t s% d())e'e$t )'%* th%se

($ the study th!t (ts 'esu#ts &!$$%t

!""#y

N%

Is the t'e!t*e$t )e!s(0#e ($ y%u'

sett($.

Yes

A'e y%u' "!t(e$tMs 1!#ues !$d "'e)e'e$&es s!t(s)(ed 0y t

'e.(*e$ !$d (ts &%$seLue$&es

D% y%u' "!t(e$t !$d y%u h!1e ! e!'

!ssess*e$t %) the(' 1!#ues !$d

"'e)e'e$&es

Yes

A'e they *et 0y th(s 'e.(*e$ !$d (ts

&%$seue$&es

Yes


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CONC USION

THIS JOURNAL VALID AND

APPLICABLE


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CLONIDINE


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MECHANISM OF ACTION

• PREDOMINANTLY ALPHA ? ADRENERGIC AGONIST ACTIVITY

• DECREASE SYMPATHETIC ACTIVITY, SYSTEMIC VASCULAR RESISTANCE, HEART RATE, BLOOD

• ENHANCE PARASYMPATHETIC TONE

• REDUCE CIRCULATING CATHECOLAMINE

• ITS ANALGETIC EFFECT ARE MEDIATED ENTIRELY VIA PRE AND POST SYNAPTIC ALPHA ? ADRE

RESEPTOR THAT BLOC NOCICEPTIVE TRANSMISSION

• ANTIHYPERTENSIVE ACTION OCCURS VIA BINDING TO A NONADRENERGIC +IMIDAOLINE/ RE

M%'.!$ 8t


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CLINICAL USES

• ANTIHYPERTENSIVE AGENT

• ADJUNCT FOR EPIDURAL, CAUDAL, PERIPHERAL NERVE BLOC

•USED IN THE MANAGEMENT OF PATIENT WITH CRONIC NEUROPATH

M%'.!$ 8th e


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SIDE EFECTS

•SEDATION

•DIINESS

•BRADYCARDIA

•DRY MOUTH

M%'.!$ 8th e


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DOSAGE

• STARTED AT - MCGH IN A MI;TURE WITH AN OPIOID OR A LOCAL ANESTHETIC

• ORAL = -2:- MINUTES ONSET, AND LAST :2@?H

• ACUTE HYPERTENSION = -4@ MGHOUR, MA;IMUM -4:MG, MAINTENANCE DOSE ? ; -4@2-4MG

• METABOLIED BY THE LIVER AND E;CRETED RENALLY

M%'.!$


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DRUGS INTERACTION

low dose intratechal clonidine

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