Dose-Response Effects of Added Clonidine to Ropivacaine-Fentanyl Epidural Anesthesia for Lower Extremity Surgery / 대한마취과학회지

BACKGROUND: Ropivacaine is an amino amide local anesthetic that has an advantage of a low-toxicity profile. Clonidine, an alpha2 adrenergic agonist, is known to prolong and intensify anesthesia from epidural local anesthetics. The aim of this study was to evaluate the dose-response effects of added clonidine to ropivacaine-fentanyl epidural anesthesia for lower extremity surgery. METHODS: Forty-five patients undergoing lower extremity surgery were randomly allocated to three groups to be given the following agents by an epidural route: 0.75% ropivacaine 15 ml+fentanyl 50microgram with clonidine 50microgram (group I), 100microgram (group II), or 150microgram (group III). Onset and maximal height of sensory block, and duration of sensory and motor block were assessed. Also, blood pressure, heart rate and sedation score were measured. RESULTS: Duration of sensory and motor block of groups II and III was significantly longer than that of group I, but there was no difference between group II and group III. Two segment regression times were significantly different among the three groups. Onset of sensory block, blood pressure, heart rate, and sedation scores were not significantly different among the three groups. CONCLUSIONS: The addition of Clonidine 100 and 150microgram prolonged duration of anesthesia more than 50microgram with ropivacaine-fentanyl epidural anesthesia for lower extremity surgery.

Intravenous Regional Anesthesia Using Mepivacaine and Tramadol / 대한마취과학회지

BACKGROUND: Tramadol, an opioid n receptor agonist and monoaminergic reuptake inhibitor, has been studied as an adjunct to general and regional anesthesia. Tramadol has been added to local anesthetic regimens for various peripheral nerve blocks, resulting in prolonged anesthesia and analgesia. The purpose of this study was to evaluate the effectiveness of using tramadol as a component of intravenous regional anesthesia (IVRA) to enhance postoperative analgesia. METHODS: Thirty-six patients undergoing hand surgery received IVRA with mepivacaine 0.5%, and were assigned randomly and blindly to one of the following groups: Group I (n = 12) received only 0.5% mepivacaine 40 ml, Group II (n = 12) was given 0.5% mepivacaine 40 ml and 50 mg tramadol, and Group III (n = 12) received 0.5% mepivacaine 40 ml and 100 mg tramadol. After the completion of the operations, analgesic effects were evaluated by using the visual analogue scale (0 - 10). Sedation scores (0 - 3), supplemental analgesic use, and side effects were also evaluated. RESULTS: Patients who received IVRA with 100 mg tramadol reported a significantly lower pain score after tourniquet deflation compared with other groups, and a decreased need for analgesics in the postanesthesia care unit. No significant postoperative sedation, nausea, vomiting, or headache developed in any of the patients. CONCLUSIONS: The addition of 100 mg tramadol to 0.5% mepivacaine for IVRA provided improved analgesia in the postanesthesia care unit after the operation and decreased the need for analgesic supplements after the operation.