Comparative study between the effects of either dexmedetomidine or clonidine when combined with bupivacaine in thoracic epidural anaesthesia in patient undergoing thoracotomy

ABSTRACT Pain following thoracic surgery has been reported to be among the most intense clinical experiences. Patients experience painful wound incisions that alter chest wall mechanics and ineffective chest expansion may predispose to atelectasis, ventilation/ perfusion mismatching, hypoxemia and infection. The aim of this study is to compare the preemptive use of either dexmedetomidine or clonidine when combined with bupivacaine versus bupivacaine alone in thoracic epidural anaesthesia in patient undergoing thoracotomy. Result: Although dexmedetomidine decrease heart rate and blood pressure but also it gives better analgesia and sedation for longer duration postoperative. The decrease in heart rate and blood pressure not serious and easily reversed by atropine and ephedrine. We concluded that Dexmedetomidine gives better analgesia and sedation for longer duration postoperative when used as adjuvant to bupivacaine in thoracic surgeries compared with clonidine which produce less analgesia and sedation and more haemodynamic instability. REFERENCES Brewer RJ, Walsh GL, Anesthesia for thoracic surgery in the Oncology patient, Anesthesiol Clin North Am, 1998;(16):605- 28. Richardson J, Sabanathan S, Shah R, Post-thoracotomy spirometric lung function: the effect of analgesia, J Cardiovasc Surg, 1999; (40):445- 56. Kruger M, McRae K, Pain management in cardiothoracic Practice, Surg Clin North Am, 1999; (79): 387- 400. Silimon M, Claus T, Huwer H, Interpleural analgesia does not influence postthoracotomy pain, Anesth Analg, 2000; (91):44- 50. Reilly JJ Jr, Preoperative and postoperative care of standard and high-risk surgical patients, Hematol Oncol Clin North Am, 1997; (11):449- 59. Katz J, Jackson M, Kavanagh BP, Acute pain after thoracic surgery predicts long-term post-thoracotomy pain, Clin J Pain , 1996; (12):50–5. Roy G., Eugene S. Fu, acute pain management of patient undergoing thoracotomy, Ann Thorac Surg , 2003; (75):1349 – 57. Wall PD, The prevention of postoperative pain, Pain, 1988; (33): 289- 9. Roy, Eugene S. Fu G. acute pain management of patient undergoing, thoracotomy, Ann Thorac Sur ,, 2003; (75):1349-57. Ferrante FM, Acute postoperative pain management, Morgan GE Jr, 2nd , Mosby, 1998; 2331- 51. Kaukinen S, Kaukinen L, Eerola R. Preoperative and postoperative use of clonidine with neurolept anaesthesia. Acta Anaesthesiol Scand. 1978;23:113- 20. Aantaa R, Scheinin M. Alpha 2 adrenergic agents in Anaesthesia. Acta Anaesthesiol Scand 1993;37:433- 38. Schnaider TB, Vieira AM, Brandao AC. Intraoperative analgesic effect of epidural ketamine, clonidine or dexmedetomidine for upper abdominal surgery. Rev Bras Anestesiol 2005;55:525-31. Mauro VA. Brandão ST. Clonidine and dexmedetomidine through epidural route for post-operative analgesia and sedation in a cholecistectomy. Rev Bras Anestesiol. 2004;4:1-10. El-Hennawy AM, Abd-Elwahab AM, Abd-Elmaksoud AM. Addition of clonidine or dexmedetomidine to bupivacaine prolongs caudal analgesia in children. Br J Anaesth 2009;103:268-74. Kanazi GE, Aouad MT, Jabbour-Khoury SI. Effect of low-dose dexmedetomidine or clonidine on the characteristics of bupivacaine spinal block. Acta Anaesthesiol Scand 2006;50:222-7.Meet Shah, Sumanth Shivaswamy, Sanjay Jain, Sonal Tambwekar, A clinical comparison of pain perception and extent of area anesthetized by Wand and a traditional syringe, Journal of Indian Society of Periodontology .2012;16(2): 207- 12. Ramsay M, Savege T, Simpson BRJ, The Ramsay Scale. Controlled sedation with alphaxalone/alphadolone. BMJ 1974;2:656– 69. Staffan Wahlander, MD, Robert J. Frumento, MS, MPH, Gebhard Wagener, MD, Dexmedetomidine as an Adjunct to Epidural Analgesia After Thoracic Surgery, Journal of Cardiothoracic and Vascular Anesthesia,2005;19:630-35. Sukhminder Jit Singh Bajwa, Sukhwinder Kaur Bajwa and Jasbir Kaur, Comparison of epidural ropivacaine and ropivacaine clonidine combination for elective cesarean sections, Indian J Anaesth 2011;55(2):116-121. Ashraf M. Eskandar , Ayman M. Ebeid, Effects of epidural dexmedetomidine and low-volume bupivacaine on postoperative analgesia after total knee replacement, Ain-Shams Journal of Anesthesiology 2014;07:193- 7. Mohamed Fouad Selim, Ali Mohamed Ali Elnabtity, and Ali Mohamed Ali Hasan, Comparative evaluation of epidural bupivacaine – dexmedetomidine and bupivacaine –fentanyl on Doppler velocimetry of uterine and umbilical arteries during labor, J Prenat Med. 2012;6(3):47-54. Memis D, Turan A and Karamanlioglu B, adding dexmedetomidine to lidocaine for intravenous regional anathesia., Anesth analg. 2004;98(3):835-840. Jain D, Khan RM, Kumar D, Perioperative effect of epidural dexmedetomidine with intrathecal bupivacaine on haemodynamic parameters and quality of analgesia, South Afr J Anaesth Analg 2012;18(1):105-9