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Dr. V.Philitsen .

COMPARISON OF EFFECTS OF SPINAL ADDITIVES FENTANYL and CLONIDINE WITH HYPERBARIC BUPIVACCAINE. Dr. V.Philitsen. MY GUIDE. PROFESSOR Dr. P.S.SHANMUGAM, M.D.,D.A H.O.D. OF ANESTHESIOLOGY KILPAUK MEDICAL COLLEGE CHENNAI. AIM OF THE STUDY.

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Dr. V.Philitsen .

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  1. COMPARISON OF EFFECTS OF SPINAL ADDITIVESFENTANYL and CLONIDINE WITH HYPERBARIC BUPIVACCAINE Dr. V.Philitsen .

  2. MY GUIDE PROFESSOR Dr. P.S.SHANMUGAM, M.D.,D.A H.O.D. OF ANESTHESIOLOGY KILPAUK MEDICAL COLLEGE CHENNAI

  3. AIM OF THE STUDY To compare the effects of intrathecal fentanyl with 0.5% Bupivaccaine(H) and clonidine with 0.5% Bupivaccaine(H) with control group of patients who received only 0.5% Bupivaccaine(H).

  4. STUDY DESIGN Prospective randomised control study After Ethical committee approval Pre – operative assesment done for all cases Informed consent obtained ,

  5. INCLUSION CRITERIA ASA PS – 1 & 2 patients Both male and female patients Age within 20 and 40 years Patients who have given consent Elective surgeries

  6. EXCLUSION CRITERIA Contraindication for spinal anesthesia ASA PS 3,4 & 5 patients Patients who have not given consent Age more than 40 years and less than 20 years

  7. Drugs Used • 0.5 % Hyperbaric Bupivaccaine • Preservative free Fentanyl • Preservative free Clonidine • 0.9 % Normal Saline

  8. GROUPS A – 15 mg of 0.5% bupivaccaine(H) + 0.5ml of N.S. B – 15 mg of 0.5% bupivaccaine(H) + 25 µg of Fentanyl C – 15 mg of 0.5% bupivaccaine(H) + 50 µg of clonidine corrected to a volume of 0.5ml by adding N.S.

  9. STUDY METHODOLOGY • - 45 Patients were assigned to 3 groups 15 each • No patients were sedated intra operatively. • After recording pre-operative vitals intra - venous • line was started and pre-loaded with 500 ml of • Ringer lactate fluid 15 minutes before the time of • spinal anesthesia.

  10. Table was ensured to be horizontal • Under aseptic precautions SAB was done for all • patients in right lateral position and in L3-4 space using a 25 G Quincke - Babcock needle • -Patients who had hypotension were managed with • Ephedrine and intra venous fluids

  11. MONITORS -NIBP (for every 5 min.) -ECG -PULSEOXIMETER -TEMPERATURE Vital parameters were monitored for every 5 min in the first hour and every 10 min thereafter.

  12. CLINICAL PARAMETERS Maximum sensory level blocked (Until grade 3) Time to achieve maximum sensory level Regression time to L1 (Until grade 0) Onset of grade 4 motor block Regression time to grade 1 motor block Sedation score

  13. ASSESSMENT OF SENSORY BLOCK HOLLMAN’S SCALE 0 - Normal sensation of pin prick + - Pin prick felt as sharp pointed but weaker compared with the same area in other side. ++ - Pin prick felt as touch with blunt object +++ - No perception of pin prick Assessment of sensory loss to pain was done by using 24 gauge intramuscular needle until the patient had grade 3 Sensory block.

  14. ASSESMENT OF MOTOR BLOCK BROMAGE SCORE

  15. ASSESMENT OF SEDATION LEVEL RAMSEY SEDATION SCORE 1 - Anxious or agitated or restless 2 – Cooperative ,oriented 3 – Responds only to commands but awake 4 – Asleep and brisk response to commands 5 – Asleep and sluggish response to commands 6 – No response to auditory stimulus

  16. STATISTICAL ANALYSIS

  17. DEMOGRAPHIC DETAILS

  18. CLINICAL PARAMETERS

  19. Post Hoc Tests No statistical significance between group 2 and 3 but both groups are significant on comparing to group 1.

  20. Post Hoc Tests No statistical significance between group 2 and 3 but both groups are significant on comparing to group 1.

  21. Post Hoc Tests

  22. HEMODYNAMIC VARIABLES

  23. BP AT 15 MIN

  24. BP AT 30 MIN

  25. ANOVA

  26. P= 0.000 SIGNIFICANT.

  27. GROUP 1 2 3 15 11 8 7 3 1

  28. RESULTS

  29. Onset of grade 4 motor block was shorter in group 2 and 3 • with an average of around 5 to 7 minutes. • Regression to grade 1 motor block is significantly prolonged • in group 3 and 2 but group 3 is longer than 2. • -Sensory regression to L1 is prolonged in the additive groups • but not significantly prolonged while comparing these two • groups. • -Maximum height of dermatomal block was not significant • in all these groups and the time to achieve it was also • not significant.

  30. Hemodynamic variables were relatively lower in • clonidine group. • -All the patients in clonidine group were well sedated.

  31. CONCLUSION CLONIDINE when used as a spinal additive to hyperbaric bupivaccaine In healthy adults it prolongs the duration of spinal anesthesia but with a hemodynamic variation which can be easily managed while comparing with fentanyl which also prolongs the spinal Anesthesia with not of much variation in the hemodynamic variables. Clonidine has an additional advantage of sedating the patient.

  32. THANK YOU.

  33. REFERENCES • Chavda et al Internet Journal of Anesthesia ‘09. • Mary Samuel et al IJA ‘07. • Stephan Strebe et al Anesth.Analg.’04. • Biswas et al IJA ‘02

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