Effectiveness of clonidine and fentanyl addition to bupivacaine in postoperative patient controlled epidural analgesia; [Wirksamkeit von clonidin und fentanyl als zusatz bei der postoperativen patientenkontrollierten epiduralanalgesie mit bupivacain]
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2005
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Abstract
Background and Objectives: The aim of this prospective randomized double-blinded study was to compare the analgesic and side-effects of bupivacaine in combination with clonidine or fentanyl during patient-controlled-epidural analgesia (PCEA) in the postoperative period after abdominal hysterectomy. Methods: 75 patients from 18 to 65 years of age with ASA status I - II were investigated. After preoperative epidural catheterization, the patients were operated in general anesthesia. After surgery, the patients were randomly allocated to 3 PCEA-groups: Group B 0.125% bupivacaine, Group F 0.125% bupivacaine plus 1 μg × ml-1 fentanyl, Group C 0.125% bupivacaine plus 0.75 μg × ml-1 clonidine (10 ml loading dose, 5 ml repetitive bolus dose, 10 min lockout time, 30 ml limit within 4h). During the following 24 hours, hemodynamic parameters, pain score using visual analog scale (VAS), total analgesic consumption, additional analgesic requirements, sedation, satisfaction, nausea scores and probable side-effects were evaluated. Results: Total analgesic consumption was not different between Group F and Group C, but lower than in Group B (p < 0.05). Additional analgesic use was not different between the groups. Group F and Group C had lower VAS-scores in 24 hours than Group B (p < 0.05). Hemodynamic and sedation scores of patients were not different. In Group C, incidence of nausea was lower and satisfaction of patients was higher (p < 0.05). Conclusions: Addition of clonidine or fentanyl to local anesthetics for PCEA can reduce the analgetic demand. Epidural clonidine can reduce postoperative nausea and is connected with higher patients' satisfaction. © Georg Thieme Verlag KG Stuttgart.
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Adolescent , Adrenergic alpha-Agonists , Adult , Aged , Analgesia, Epidural , Analgesia, Patient-Controlled , Analgesics, Opioid , Anesthetics, Local , Bupivacaine , Clonidine , Female , Fentanyl , Hemodynamic Processes , Humans , Hysterectomy , Middle Aged , Pain Measurement , Pain, Postoperative , analgesic agent , bupivacaine , clonidine , fentanyl , lidocaine , thiopental , vecuronium , abdominal hysterectomy , adult , aged , article , clinical trial , controlled clinical trial , controlled study , double blind procedure , drug effect , drug efficacy , drug use , epidural anesthesia , evaluation , female , hemodynamic monitoring , human , intravenous anesthesia , major clinical study , nausea , outcomes research , pain assessment , patient controlled analgesia , patient satisfaction , postoperative pain , prospective study , randomized controlled trial , sedation , visual analog scale