Observational Study to Compare Transdermal Nitroglycerin and Placebo Patch in Enhancing the Post-Operative analgesic Effect of Intrathecal Clonidine with Bupivacaine in Abdominal Hysterectomies
Keywords:Bupivacaine, Clonidine, Spinal Anaesthesia, Transdermal Nitroglycerin (tNTG) patch
Background: Hyperbaric Bupivacaine 0.5% is the most commonly used for spinal anaesthesia.To improve the
quality & duration of analgesia many adjuvants have been used.Intrathecal clonidine binds with postsynaptic
alpha-2 receptors at the dorsal horn of the spinal cord,resulting in anti-nociceptive action.Transdermal
nitroglycerin (tNTG) has been found to be converting nitroglycerin to Nitric Oxide(NO),which results in
pain modulation in the central and peripheral nervous system by cyclic Guanosine Monophosphate(cGMP)
through which the post-operative analgesia effect enhances.
Method: Sixty patients Of ASA I/II aged between 20to60 years posted for hysterectomy under spinal
anaesthesia were selected.Patients were randomly allotted into 2 equal groups.
Group A received:Hyperbaric bupivacaine 0.5% (17.5 mg)+clonidine(50 mcg) + placebo patch
Group B received:hyperbaric bupivacaine0.5% (17.5 mg) + clonidine (50 mcg) + nitroglycerin (tntg)
patch(nitroglycerin 25 mg/patch)
We have observed onset and duration of sensory.and motor block,two segment regression time, duration of
analgesia, hemodynamic changes and complication if any.
Results: There was no statistically significant difference in demographic data and onset and duration of
motor and sensory block. Duration of analgesia was significantly prolonged in clonidine with tNTG group
as compared to clonidine group with placebo group.
Conclusion: Transdermal Nitroglycerin patch with intrathecal clonidine prolonged duration of analgesia
without any changes in onset and duration of sensory and motor block.
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