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International Journal of Recent Trends in Science and Technology, ISSN 2277-2812 E-ISSN: 2249-8109
Volume 15, Issue 2, June 2015 pp 295-297
Effectiveness of intrapleural bupivacaine and adrenaline combination with and without clonodine used for postoperative analgesia
Ashwani Kumar1, Ovais Nazir2, Smriti Gulati3, Anuradha4
1Lecturer, 2PG, 3HOD, 4Sr Resident, Department of Anaesthesiology, Government Medical College, Jammu, Jammu & Kashmir, INDIA.
Introduction: Cholecystectomy is now commonly performed by laparoscopic technique because it provides distinct advantages over open cholecystectomy. The pain produced by laparoscopic cholecystectomy is mainly visceral. Recent report have demonstrated that many patients experience considerable pain after laparoscopic cholecystectomy, which is a relatively new procedure, so there is no general agreement on effective postoperative pain control. The various method used with variable success includes NSAID suppository, parenteral NSAID, infiltration of wounds with local anacesthtics, intermittent parentral narcotics, intraperitoneal local aneshtetics and interpleural block etc. Aims and objectives: To evaluate and compare the role of interpleural block with bupivacaine with adrenaline and interpleural bupivacaine with adrenaline and clonidine for postoperative analgesia in patients of laproscopic cholecystectomy. Material and methods: The present study was conducted in the department of anesthesiology of Government Medical College, Jammu during August 2011 to July 2012. After obtaining approval from the hospital ethics committee, this study was conducted on 40 adult patients of aged 18-70 years of either sex belonging to ASA I and II, admitted in surgical ward for elective laproscopic cholcystectomy. After thorough pre-anesthetic checkup and informed written consent, patients were randomly divided into two groups of 20 each. Group I- patients who received bupivacaine with adrenaline. Group II- patients who received bupivacaine with adrenaline and clonidine.All the patients were explained details of visual analogue scale and how to rate it on the scale of 0-10. All patients were given tablet ranitidine 150 mg and alprazolam 0.25mg before sleep and made to fast overnight. Anesthesia was standardized, consisting of glycopyrrolate 0.2mg as premedication i.m 30min before induction..For intraoperative analgesia i/v fentanyl 2microgram/kg given to all the patients. Induction with propofol 2.5mg/kg and succinyl choline 1.5mg/kg IV for intubation given, followed by maintenance with isoflurane and nitrous oxide 60-70% mixture in oxygen. After spontaneous reversal from succinyl choline, neuromuscular blockade was maintained with atracurium. At the end of surgical procedure, just before reversal patient of group I received 20ml bupivacaine 0.5% with adrenaline 5mcg/ml and Group II received 20ml bupivacaine 0.5% with adrenaline 5mcg/ml and 50mcg clonidine through interpleural route. Time required for onset of analgesia and total duration of analgesia was measured and recorded. Pain assessment was done by using visual analog scale.Rescue analgesia was given with i/v diclofenac sodium 75mgin both the groups. Results: The difference observed in patients characteristics such as age, sex, weight, male/female ratio and hemodyanamic parameters was founds non significant (p value>0.05) as shown in the table. It was observed that mean duration required for onset of analgesia was 30 min in group I whereas 15min in group II. The mean duration of analgesia in group I was 8.26hrs whereas in group II was 16.54hrs. The difference observed in onset and duration of analgesia between group I and II was statistically significant. It was observed that in group I, pain was present till 30 min after interpleural block whereas reappeared after 6 hrs after the interpleural block. In group II pain disappeared after 15min of interpleural block whereas reappeared after 12 hrs of block. The difference observed in group I and II on VAS was also statistically significant. Conclusion: Thus we conclude that addition of clonidine in interpleural bupivacaine with adrenaline can be used for the control of postoperative analgesia in patient of laproscopic cholecystectomy more effectively than using only interpleural bupivacaine with adrenaline.