Wirksamkeit von Clonidin und Fentanyl als Zusatz bei der postoperativen patientenkontrollierten Epiduralanalgesie mit Bupivacain

• DOI: 10.1055/s-2005-870397
• Publication Date: 2005-09-06T09:42:40Z
• Authors: I. Topcu; N. Luleci; S. Tekin; A. Kefi; T. Erincler
• Keywords: Adult; Pain, Postoperative; Adolescent; Hemodynamics; Analgesia, Patient-Controlled; Middle Aged; Hysterectomy; Bupivacaine; Clonidine; 3. Good health; Analgesia, Epidural; Analgesics, Opioid; Fentanyl; 03 medical and health sciences; 0302 clinical medicine; Humans; Female; Anesthetics, Local; Adrenergic alpha-Agonists; Aged; Pain Measurement

The aim of this prospective randomized double-blinded study was to compare the analgesic and side-effects of bupivacaine in combination with clonidine or fentanyl during patient-controlled-epidural analgesia (PCEA) in the postoperative period after abdominal hysterectomy.75 patients from 18 to 65 years of age with ASA status I - II were investigated. After preoperative epidural catheterization, the patients were operated in general anesthesia. After surgery, the patients were randomly allocated to 3 PCEA-groups: Group B 0.125 % bupivacaine, Group F 0.125 % bupivacaine plus 1 microg x ml (-1) fentanyl, Group C 0.125 % bupivacaine plus 0.75 microg x ml (-1) clonidine (10 ml loading dose, 5 ml repetitive bolus dose, 10 min lockout time, 30 ml limit within 4 h). During the following 24 hours, hemodynamic parameters, pain score using visual analog scale (VAS), total analgesic consumption, additional analgesic requirements, sedation, satisfaction, nausea scores and probable side-effects were evaluated.Total analgesic consumption was not different between Group F and Group C, but lower than in Group B (p < 0.05). Additional analgesic use was not different between the groups. Group F and Group C had lower VAS-scores in 24 hours than Group B (p < 0.05). Hemodynamic and sedation scores of patients were not different. In Group C, incidence of nausea was lower and satisfaction of patients was higher (p < 0.05).Addition of clonidine or fentanyl to local anesthetics for PCEA can reduce the analgetic demand. Epidural clonidine can reduce postoperative nausea and is connected with higher patients' satisfaction.