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KMID : 0378020060490110011
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New Medical Journal
2006 Volume.49 No. 11 p.11 ~ p.19
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Analgesic effect of Epidural Clonidine Combined with Bupivacaine, Meperidine, Fentanyl, and Morphine in Cesarean-section
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Bae Sang-Chul
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Abstract
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Background: Although the epidural administration of clonidine and opioids provides pain relief after surgery, the interaction between the two drugs has not been examined formally. This study was proposed to determine whether analgesic efficacy of clonidine reinforce in an additive manner of the epidurally administered bupivacaine or opioids.
Method: Eighty healthy parturients undergoing Cesarean section with general anesthesia were studied. They were randomized to receive either of clonidine 150 ㎍+bupivacaine 12.5 mg (Group CB), clonidine 150 ㎍+meperidine 25 mg (Group CD), clonidine 150 ㎍ +Fentanyl 50 ㎍ (Group CF) or clonidine 150 ㎍+Morphine 3 mg (Group CM) as an initial dose of epidural injection diluted to 10 ml with normal saline while closing the peritoneum and then followed by continuous epidural infusion of clonidine 1800 ㎍ for 2 days. Postoperative analgesia was assessed by recording the VAS (Visual Analogue Scale), PHS (Prince Henry Score) at 1, 2, 3, 6, 12, 24 and 48 postoperative hours. Sedation analogue scale and side effects were also recorded. Heart rate and blood pressure were carefully monitored for 2 days.
Result: There were no statistical significant differences in the VAS and the clinical states of hemodynamic changes, but CD-Group and CF-Group showed to decreasing of the PHS at the postoperative 1, 2 and 3 hours when compared with CB-Group (P<0.05), and also CD-Group showed to reduction of PHS at the postoperative 1 hour when compared with CM-Group (P<0.05).
Conclusion: The epidural clonidine combined with meperidine or fentanyl in the early stage (postoperative 1, 2, 3 hours) more potent than those of bupivacaine or morphine, but all of the groups were similar to relief of pain in the late of stage (3~48 hours).
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KEYWORD
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Pain control, Analgesic technique:continuous epidural, Analgesics:clonidine, opioids, local anesthetics
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