Comparative Study of Clonidine with Ropivacaine versus Ropivacaine Alone in Epidural Anesthesia for Lower Limb Orthopedic Surgery

Comparison of Epidural Bupivacaine and Buprenorphine to Bupivacaine and Butorphanol for Postoperative Analgesia in Lower Limb Orthopedic Surgery

Background

Postoperative analgesia is of utmost importance in the treatment of patients undergoing surgery. Good postoperative pain management reduces hospital stay and improves early ambulation. This study compared the efficacy of epidural bupivacaine with buprenorphine to butorphanol in lower limb orthopedic surgery.

Objectives

This study was carried out to investigate the onset of analgesia, the extent of analgesia, sedation score, and side effects of butorphanol with bupivacaine versus buprenorphine with bupivacaine.

Methods

In a clinical trial study, 100 patients who underwent elective orthopedic lower limb surgery were randomly allocated to two groups. A total of 100 patients with American Society of anesthesiologists grades I and II posted for lower limb orthopedic surgery were enrolled in this randomized, double-blind study. The patients were divided into groups A and B. Subarachnoid block was achieved with 3.4 mL of 0.5% bupivacaine. The pain was monitored by the visual analog scale postoperatively. The patients in group A received bupivacaine with buprenorphine, and group B received bupivacaine with butorphanol when they complained of pain in the postoperative period. The onset of analgesia, duration of analgesia, sedation score, and side effects were compared between the two groups.

Results

The onset of analgesia was observed earlier in group A than in group B (7.7 ± 1.6 vs. 12.6 ± 1.7 minutes, P < 0.001). The duration of analgesia was longer in group A than in group B (590 ± 40 vs. 480 ± 54 minutes, P < 0.001). Pulse rates and mean arterial pressures were significantly different (P < 0.001). Side effects were common in both groups.

Conclusions

Buprenorphine added to bupivacaine provides earlier onset and longer postoperative epidural analgesia than epidural butorphanol with bupivacaine.

The Effect of Adding Clonidine to Articaine and Epinephrine on Post-treatment Pain: A Randomized Clinical Trial Study

Introduction

Articaine is reported to have a fast onset and a short-acting pulpal anesthesia in inferior alveolar nerve blocks. Clonidine is an α ₂-adrenoceptor agonist and is used as an adjunct to enhance the anesthetic efficacy and induce greater analgesia. In an attempt to search for more effective ways to achieve profound analgesia after root canal treatment, this randomized clinical trial assessed the efficacy of clonidine added to articaine/epinephrine solution on post-operative pain relief after root canal treatment in mandibular molars with irreversible pulpitis.

Materials and Methods

Our randomized clinical trial study enrolled one hundred patients with symptomatic irreversible pulpitis in mandibular molars. They were divided into two groups, each group received either 0.2 mL 150 µg/mL clonidine or distilled water added to 1.8 mL of 4% articaine with 1:100,000 epinephrine cartridge. The alveolar nerve block in the two groups was administered by the same clinician and the subject's pain scores were recorded at 6, 12, 24, 48 and 72 h post-operatively using a Heft-Parker visual analog scale. Data were analyzed using t, chi-square and repeated-measures ANOVA statistical tests.

Results

The mean pain scores for clonidine group were significantly lower than control at all the time intervals after treatment (P<0.05). We did not notice any clinical and there were no complaints from the patients either.

Conclusion

Based on this randomized clinical trial study the addition of clonidine to the articaine/epinephrine solution using an inferior alveolar nerve block during root canal treatment in mandibular molars with irreversible pulpitis may be effective in reducing post-operative pain.