The Efficacy of adjuvants for epidural anaesthesia in orthopedic surgery

Abstract

The aim of the study was to evaluate the efficacy of the addition of ketamine and clonidine to bupivacaine 0.5%, compared with just plain bupivacaine 0.5 % solution, as anaesthetics for orthopedic surgery.
In a prospective study, 65 patients ASA I-III, were randomly allocated to receive: group A, 0.5% bupivacaine, group B 0.5% bupivacaine plus clonidine 2 μg/kg and group C, 0.5% bupivacaine plus ketamine 30 mg. The epidural anaesthesia was performed using the loss of resistance technique.
Patients were assessed for sensitive and motor blockade, postoperative analgesia by visual analogue scores, the incidence of side effects and surgical team satisfaction.
The onset of analgesia was shorter in bupivacaine plus ketamine group, but not statistically significant (p>0.05). The duration was longer in bupivacaine plus clonidine group in comparison with controls and with the bupivacaine plus ketamine group (p<0.05). There were no differences between groups regarding the onset and duration of motor blockade.
The most common side effects were: hypotension, shivering, nausea and vomiting. The blood pressure was moderately decreased in all groups, apart from group B, which presented a marked decrease.
This study suggests that clonidine is a suitable adjuvant agent for epidural anaesthesia for orthopedic surgery. Its sedative properties are useful for regional anaesthesia and the side effects are tolerable.
Ketamine offers no advantage over the studied parameters.

Key words: epidural anaesthesia, bupivacaine, clonidine, ketamine

Jurnalul Român de Anestezie Terapie intensivă 2002 Vol.9 Nr.2, 118-123

Eficienţa adjuvanţilor analgetici în anestezia peridurală pentru chirurgia ortopedică