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A randomized double-blind study to evaluate efficacy and safety of epidural magnesium sulfate and clonidine as adjuvants to bupivacaine for postthoracotomy pain relief.

Mohammad W, Mir SA, Mohammad K, Sofi K - Anesth Essays Res (2015 Jan-Apr)

Bottom Line: Postoperative sedation and other side effects if any were recorded.The duration of analgesia was significantly prolonged in the clonidine group as compared to the control group (P = 0.001).The sedation scores were significantly higher in Group C.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesiology and Critical Care, Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India.

ABSTRACT

Background: The aim of the study was to compare postoperative pain relief in patients undergoing an elective thoracotomy with thoracic epidural analgesia using single shot magnesium and clonidine as adjuvants to bupivacaine.

Methods: In a randomized prospective study, 60 patients of American Society of Anesthesiologists physical status I-III of either sex, between 20 and 60 years undergoing elective unilateral thoracotomy, were allocated to three equal groups of 20 patients. Each patient received thoracic epidural analgesia using bupivacaine alone (Group A) or with magnesium (Group B) or clonidine (Group C) at the end of surgery during skin closure. Postoperatively, pain was measured using a visual analog scale (VAS). Rescue analgesia (50 mg tramadol intravenous) was given at a VAS score of ≥4. Duration of analgesia and total dose of rescue analgesic during 24 h was calculated. Postoperative sedation and other side effects if any were recorded.

Results: All the groups were homogeneous with respect to their demographics. The 24 h cumulative mean VAS score in Groups A, B, and C was 3.12 ± 0.97, 2.86 ± 0.43, and 1.83 ± 0.59, respectively. The duration of analgesia was prolonged in Group C (165 ± 49.15 min), followed by Group B (138 ± 24.6 min), and Group A (118.5 ± 52.8 min). The duration of analgesia was significantly prolonged in the clonidine group as compared to the control group (P = 0.001). The number of rescue analgesia doses were more in Group A (3.3 ± 1.65) followed by Group B (2.35 ± 0.98) and Group C (1.75 ± 0.71). The sedation scores were significantly higher in Group C. However, shivering was seen in Group A (40%) and Group C (20%) and absent in Group B (P = 0.003).

Conclusion: Thoracic epidural analgesia using bupivacaine with clonidine is an efficient therapeutic modality for postthoracotomy pain. Magnesium as an adjuvant provided quality postoperative analgesia decreasing the need for postoperative rescue analgesia and incidence of postoperative shivering without causing sedation.

No MeSH data available.


Related in: MedlinePlus

Patients’ distribution according to the number of requests of rescue analgesia
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Figure 2: Patients’ distribution according to the number of requests of rescue analgesia

Mentions: Mean duration of analgesia in Groups A, B, and C was 118.5 ± 52.84 min, 138 ± 24.62 min, and 165 ± 49.15 min, respectively [Table 4]. The duration of analgesia was significantly prolonged in the clonidine group as compared to the control group (P = 0.001). However, there was no statistical significance in duration of analgesia between clonidine and magnesium groups (P = 0.057) and magnesium and control groups (P = 0.167). Throughout the first 24 h postoperative period, all patients requested rescue analgesia. About 17 patients (28.3%) requested it once, 24 patients (40%) requested it twice, 13 patients (21.7%) requested it thrice, and six patients (10%) requested it >3 times [Figure 2]. The mean number of rescue analgesia doses in Group A, Group B, and Group C were 3.3 ± 1.6, 2.35 ± 0.98, and 1.750 ± 0.71, respectively. The association was significant between magnesium (P = 0.023) and clonidine (P = 0.017) versus control group [Table 5]. The mean rescue analgesia was significantly reduced in Group C (86.7 ± 44.2 mg) and Group B (100 ± 46.3 mg) as compared to control the group (133.3 ± 55.6 mg). Two patients in Group A, one patient each in group B and Group C developed bradycardia (heart rate <60/min) and hypotension which was treated as per protocol. No significant respiratory depression was reported in any patient in this study, and none of the patients had a SpO2 value of <95% on pulse oximetry.


A randomized double-blind study to evaluate efficacy and safety of epidural magnesium sulfate and clonidine as adjuvants to bupivacaine for postthoracotomy pain relief.

Mohammad W, Mir SA, Mohammad K, Sofi K - Anesth Essays Res (2015 Jan-Apr)

Patients’ distribution according to the number of requests of rescue analgesia
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4383119&req=5

Figure 2: Patients’ distribution according to the number of requests of rescue analgesia
Mentions: Mean duration of analgesia in Groups A, B, and C was 118.5 ± 52.84 min, 138 ± 24.62 min, and 165 ± 49.15 min, respectively [Table 4]. The duration of analgesia was significantly prolonged in the clonidine group as compared to the control group (P = 0.001). However, there was no statistical significance in duration of analgesia between clonidine and magnesium groups (P = 0.057) and magnesium and control groups (P = 0.167). Throughout the first 24 h postoperative period, all patients requested rescue analgesia. About 17 patients (28.3%) requested it once, 24 patients (40%) requested it twice, 13 patients (21.7%) requested it thrice, and six patients (10%) requested it >3 times [Figure 2]. The mean number of rescue analgesia doses in Group A, Group B, and Group C were 3.3 ± 1.6, 2.35 ± 0.98, and 1.750 ± 0.71, respectively. The association was significant between magnesium (P = 0.023) and clonidine (P = 0.017) versus control group [Table 5]. The mean rescue analgesia was significantly reduced in Group C (86.7 ± 44.2 mg) and Group B (100 ± 46.3 mg) as compared to control the group (133.3 ± 55.6 mg). Two patients in Group A, one patient each in group B and Group C developed bradycardia (heart rate <60/min) and hypotension which was treated as per protocol. No significant respiratory depression was reported in any patient in this study, and none of the patients had a SpO2 value of <95% on pulse oximetry.

Bottom Line: Postoperative sedation and other side effects if any were recorded.The duration of analgesia was significantly prolonged in the clonidine group as compared to the control group (P = 0.001).The sedation scores were significantly higher in Group C.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesiology and Critical Care, Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India.

ABSTRACT

Background: The aim of the study was to compare postoperative pain relief in patients undergoing an elective thoracotomy with thoracic epidural analgesia using single shot magnesium and clonidine as adjuvants to bupivacaine.

Methods: In a randomized prospective study, 60 patients of American Society of Anesthesiologists physical status I-III of either sex, between 20 and 60 years undergoing elective unilateral thoracotomy, were allocated to three equal groups of 20 patients. Each patient received thoracic epidural analgesia using bupivacaine alone (Group A) or with magnesium (Group B) or clonidine (Group C) at the end of surgery during skin closure. Postoperatively, pain was measured using a visual analog scale (VAS). Rescue analgesia (50 mg tramadol intravenous) was given at a VAS score of ≥4. Duration of analgesia and total dose of rescue analgesic during 24 h was calculated. Postoperative sedation and other side effects if any were recorded.

Results: All the groups were homogeneous with respect to their demographics. The 24 h cumulative mean VAS score in Groups A, B, and C was 3.12 ± 0.97, 2.86 ± 0.43, and 1.83 ± 0.59, respectively. The duration of analgesia was prolonged in Group C (165 ± 49.15 min), followed by Group B (138 ± 24.6 min), and Group A (118.5 ± 52.8 min). The duration of analgesia was significantly prolonged in the clonidine group as compared to the control group (P = 0.001). The number of rescue analgesia doses were more in Group A (3.3 ± 1.65) followed by Group B (2.35 ± 0.98) and Group C (1.75 ± 0.71). The sedation scores were significantly higher in Group C. However, shivering was seen in Group A (40%) and Group C (20%) and absent in Group B (P = 0.003).

Conclusion: Thoracic epidural analgesia using bupivacaine with clonidine is an efficient therapeutic modality for postthoracotomy pain. Magnesium as an adjuvant provided quality postoperative analgesia decreasing the need for postoperative rescue analgesia and incidence of postoperative shivering without causing sedation.

No MeSH data available.


Related in: MedlinePlus