Analgesic effectiveness of Clonidine vs Fentanyl as adjuvants in intrathecal anesthesia of lower abdomen and trauma surgeries

Abstract

Clonidine, which has been used for more than 15 years in humans, was initially used as an antihypertensive, resuming its usefulness in epidural regional anesthesia since the end of 1996 and is currently part of the anesthesiologist's therapeutic armamentarium due to its analgesic properties and sedatives, offering their maximum benefit in pain control in the intraoperative and postoperative period. Clonidine in combination with opiate drugs and local anesthetics improves the quality of analgesia and reduces the dose of these drugs by up to 50%. The use of intrathecal clonidine as an adjuvant in spinal anesthesia would improve the anesthetic and analgesic quality in relation to the use of fentanyl as an adjuvant, in patients undergoing lower abdominal and lower limb trauma surgeries. Objective: To determine the analgesic and anesthetic effectiveness of clonidine vs. Fentanyl as adjuvants for intrathecal anesthesia

A randomized, prospective, double-blind clinical study was conducted at Hospital Misericordia approved by CIEIS. Total 60 (sixty) patients undergoing lower abdominal and lower limb trauma surgeries with spinal anesthesia, divided into two groups. Group C (n=30) Hyperbaric bupivacaine 0.5% 15 mg of + 1 mcg/kg of clonidine; Group F (n=30) Hyperbaric bupivacaine 0.5% 15 mg of hyperbaric bupivacaine 0.5% + 10 mcg of fentanyl. The guidelines of the Declaration of Helsinki were followed.

Statistically significant differences (p = 0.0001) were observed in the time that elapses between the intrathecal administration of the drugs and the request for the first dose of additional analgesia. Fentanyl 2 hours ± 2.1 compared to clonidine 6 hours ± 2.91. Statistically significant differences are also observed (p = 0.001), with a LEB at the time of requesting the first dose higher for Fentanyl of 4-6 in relation to Clonidine with 1-3.

The bupivacaine-clonidine analgesic scheme prolongs the sensory blockade, managing to reduce intraoperative and postoperative pain, reaching EVN values ​​(verbal numerical scale) 0 at the end of surgery and motor blockade, reducing the need for rescue analgesia. with morphine; all this in a significant way compared to fentanyl.