RESUMEN
Background: pain relief is a primary therapeutic objective in major abdominal surgery. Many strategies to control intraoperative and postoperative pain have been described. Epidural anesthesia is the most logical approach to produce effective analgesia, stable hemodynamics, and less anesthetic drugs use with more efficient muscle relaxation and less postoperative side effects. This study was designed to investigate the effect of epidural variables of drug combination on intraoperative hemodynamics and muscle relaxant drug needed during general anesthesia, also to evaluate postoperative analgesia, sedation and adverse effects of the given epidural drugs
Patients and methods: The current study was carried on sixty adult patients of either sex with age ranging from 25 60 years admitted to surgical department in Mansoura University Hospital and scheduled for elective major abdominal surgery. The patients were allocated into four groups 15 patients each according to the drug combination injected epidurally. Ropivacaine group [R 9]: patients received 10ml ropivacaine 075% plus 10ml normal saline 0.9% epidurally to a total volume of 20ml.Ropivacaine-Sufentanil group [RS 9]: patients received 10ml ropivacaine 0.75% plus sufentanil 0.5mg/kg epidurally and normal saline 0.9% to a total volume of 20ml. Ropivacaine Clonidine group [RC 9]: patients received 10ml ropivacaine 0.75% plus clonidine 1.5mg/kg and normal saline 0.9% to a total volume of 20ml. Ropivacaine-SufentaniI-Clonidine group [R80 9]: patients received 10ml ropivacaine 0.75% plus sufentanil 0.5mg/kg plus clonidine 1.5mg/kg epidurally and normal saline 0.9% to a total volume of 20ml.After epidural injection peak sensory level and time to peak sensory level, maximum Modified Bromage Score [M88] and time to maximum modified bromage score were assessed, then general anesthesia was induced and maintained with isoflurane 1.2% and nitrous oxide/oxygen 1:1 and controlled ventilation by using atracurium in a bolus intubating dose of 0.6mg/ kg. lntraoperative and postoperative mean arterial blood pressure, heart rate and oxygen saturation were monitored every 30min intraoperatively and for 24 hours postoperatively. Time of onset of atracurium in minutes, bolus dose and total doses of atracurium in mg and their duration guided by T1% and TOF°/o monitoring were estimated. Postoperative Visual Analogue Score, sedation score and postoperative adverse effects were assessed
Results:the peak sensory level was significantly increased in RS, RC and RSC groups in comparison to R group With the decrease of time to peak sensory level in RSC group in comparison to R group. Maximurn Modified Bromage score was significantly decreased in RS, RC and R80 group in comparison to R group. Mean arterial blood pressure and heart rate were significant decreased in RS,RC and R80 group in comparison to R group.VAS was significantly decreased in RC and R30 group in comparison to R group sedation score was significantly increased in RC and R80 groups in comparison to R group. Postoperative side effects: nausea, vomiting and rigidity were significantly increased in RS and RSC groups in comparison to R group. Total dose of muscle relaxant atracurium was significantly decreased in RS,RC and RSC groups in comparison to R group
Conclusion: we can conclude that epidural clonidine analgesia and decreases the total dose of muscle relaxant needed and also decrease postoperative nausea and vomiting when added with epidural sufentanil