[Epidural clonidine or dexmedetomidine for post-cholecystectomy analgesia and sedation.].

Departamento de Fisiologia, Morfologia e Patologia, Faculdade de Ciências Médicas de Pouso Alegre, Universidade do Vale do Sapucaí.
Revista brasileira de anestesiologia 09/2004; 54(4):473-8. DOI: 10.1590/S0034-70942004000400003
Source: PubMed

ABSTRACT Clonidine and dexmedetomidine are alpha2-adrenergic agonists with analgesic proprieties which potentiate local anesthetic effects when epidurally administered. The goal of this study was to evaluate the analgesia and sedation promoted by clonidine or dexmedetomidine associated to epidural ropivacaine, in the postoperative period of subcostal cholecystectomy.
Forty patients of both gender participated in this randomized double-blind study , aged 18 to 50 years, weighing 50 to 100 kg, physical status ASA I or II, submitted to subcostal cholecystectomy. The subjects were distributed in two groups: Clonidine (CG), receiving clonidine (1 mL = 150 microg) associated to 0.75% epidural ropivacaine (20 mL); Dexmedetomidine (DG), receiving dexmedetomidine (2 associated to 0.75% epidural ropivacaine (20 mL). Analgesia and sedation were evaluated 2, 6 and 24 hours anesthetic recovery.
Both groups present some grade of sedation in the moments 2 and 6 hours , with statistically significant difference between the two moments for the dexmedetomidine group. There has been analgesia in both groups, especially at 2 and 6 hours. There have been statistically significant difference among periods of 2, 6 and 24 hours in the dexmedetomidine group; in the clonidine group, this statistically significant difference was observed between the periods of 2 and 6 hours and between 2 and 24 hours.
Our results allowed to conclude that the association of clonidine or dexmedetomidine to 0.75% ropivacaine induces analgesia and sedation in 2 and 6 hours after anesthetic recovery in patients submitted to subcostal cholecystectomy and that clonidine promotes more prolonged analgesia.

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    ABSTRACT: Dexmedetomidine (D) can prolong the duration of local anesthetics, but the effect of caudal dexmedetomidine on the potency of levobupivacaine (L) for caudal block has not been investigated. This study was designed to determine the effect of caudal dexmedetomidine on levobupivacaine for caudal block in pediatric patients. Eighty-nine children scheduled for elective inguinal hernia repair or hydrocele were randomly assigned to one of the three groups: Group L (caudal levobupivacaine), Group LD1 (levobupivacaine plus 1 μg·kg(-1) dexmedetomidine), or Group LD2 (levobupivacaine plus 2 μg·kg(-1) dexmedetomidine). The primary endpoint was the minimum local anesthetic concentration (MLAC), which was determined using the Dixon up-and-down method. The secondary endpoints were the duration of analgesia and sedation. The MLAC values (sd) of caudal levobupivacaine were 0.103 (0.01)%, 0.068 (0.02)%, and 0.055 (0.03)% in Groups L, LD1, and LD2, respectively. The values of EC50 and EC95 (95% CI) of caudal levobupivacaine from logistic regression analysis were 0.094 (0.083-0.105)% and 0.129 (0.1-0.159)%, 0.058 (0.044-0.072)% and 0.106 (0.067-0.144)%, and 0.046 (0.033-0.059)% and 0.091 (0.055-0.127)% in Groups L, LD1, and LD2, respectively. The mean durations of analgesia in the postoperative period were 141, 378, and 412 min in Groups L, LD1, and LD2, respectively (L vs LD1 or LD2, P < 0.001). The mean durations of sedation in both Groups LD1 and LD2 also were significantly prolonged, compared with Group L (P < 0.01). Caudal dexmedetomidine reduces the MLAC values of levobupivacaine and improves postoperative analgesia in children without any neurological side effects.
    Pediatric Anesthesia 12/2013; 23(12):1205-12. DOI:10.1111/pan.12278 · 2.44 Impact Factor
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    ABSTRACT: Background Dexmedetomidine has become a popular additive for regional anesthesia. Aim of this meta-analysis was to assess the effect of this additive on the duration of postoperative analgesia and possible adverse events in pediatrics undergoing orchidopexy or lower abdominal surgery. Methods The literature databases of PubMed, Google Scholar, and Cochrane Library were searched for randomized, controlled trials (RCTs). Odds ratio (OR), weighted mean difference (WMD), and the corresponding 95% confidence intervals (CIs) were calculated using the RevMan software, version 5.2, for data synthesis and statistical analysis, which in accordance with the PRISMA statement. ResultsSix RCTs were selected for this meta-analysis, involving a total of 328 pediatric patients. There was a significant longer duration of caudal analgesia (time to first analgesic requirements) in patients receiving dexmedetomidine with CA compared with CA alone (WMD: -8.21h; 95% CI: -11.40 to -5.02; P<0.00001). Side effects in these two groups were comparable (OR: 1.02; 95% CI: 0.51-2.04; P=0.95). Subgroup analysis indicated there was no significant difference in hemodynamic changes during operation (WMD: 1.78; 95% CI: -3.20 to 6.77; P=0.48) and the emergence time (time from the end of surgery to opening the eyes on calling) after surgery (WMD: 0.47min; 95% CI: -5.27 to 6.22; P=0.87). Conclusions Dexmedetomidine as an additive to local anesthetic provides a significantly longer postoperative analgesia with comparable adverse effects and hemodynamic changes, when compared to local anesthetics alone. There were insufficient data of the effects of different concentrations of dexmedetomidine; further studies are required to explore this issue.
    Pediatric Anesthesia 09/2014; 24(12). DOI:10.1111/pan.12519 · 2.44 Impact Factor
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    ABSTRACT: To evaluate the hypothesis that adding dexmedetomidine to ropivacaine prolongs axillary brachial plexus block. Forty-five patients of ASA I~II and aged 25-60 yr who were scheduled for elective forearm and hand surgery were randomly divided into 3 equal groups and received 40 ml of 0.33% ropivacaine + 1 ml dexmedetomidine (50 μg) (Group DR1), 40 ml of 0.33% ropivacaine + 1 ml dexmedetomidine (100 μg) (group DR2) or 40 ml of 0.33% ropivacaine + 1 ml saline (group R) in a double-blind fashion. The onset and duration of sensory and motor blocks and side effects were recorded. The demographic data and surgical characteristics were similar in each group. Sensory and motor block onset times were the same in the three groups. Sensory and motor blockade durations were longer in group DR2 than in group R (P < 0.05). There was no significant difference in the sensory blockade duration between group DR1 and group R. Bradycardia, hypertension and hypotension were not observed in group R and occurred more often in group DR2 than in group DR1. Dexmedetomidine added to ropivacaine for an axillary brachial plexus block prolongs the duration of the block. However, dexmedetomidine may also lead to side effects such as bradycardia, hypertension, and hypotension.
    International Journal of Clinical and Experimental Medicine 01/2014; 7(3):680-5. · 1.42 Impact Factor

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