Comparative Study between Bupivacaine Clonidine and Bupivacaine Fentanyl in Lumbar Epidural Analgesia In Pelviabdominal Surgeries in Females

Abstract

Postoperative pain is the most undesired consequence of surgery, and if not managed adequately, can lead to delayed recovery and increased hospital stay. Adequate treatment of postoperative pain remains challenging. The use of an analgesia before surgical incision may offer one of the most innovative and promising strategies for better pain control throughout the perioperative period.The epidural analgesia is the most effective analgesic strategy for most of pelvi-abdominal surgeries.Although usage of epidural opioids promotes the analgesia,but it produces severe side effects.The use of clonidine in regional anaesthesia is increasing nowadays because of its analgesic action and its anaesthetic sparing effect with less frequent side effects when compared to epidural opioids. Clonidine is a central α2 adrenergic receptor agonist.It stimulates central presynaptic α2 receptors resulting in decreased noradrenaline release (i.e. decreased central sympathetic outflow) which in turn leads to hypotension, bradycardia, sedation and anxiolysis.It has an analgesic action via action on pre- and postsynapticα2 receptors. The current study compared the postoperative analgesic effect of an epidural mixture of bupivacaine with either clonidine or fentanyl.One hundred and twenty six adult female patients classified as ASA I and II undergoing pelviabdominal surgeries under combined epidural and general anaesthesia were submitted to this study. The patients were divided randomly into two equal groups. They all received single epidural dose before the skin incision after induction of general anaesthesia.The two groups were:  Group (A): received 75μg fentanyl plus bupivacaine 0.25% (total volume of 10ml).  Group (B):received 75µg clonidine plus bupivacaine 0.25% (total volume of 10ml).