The use of intravenous dexmedetomidine as an additional drug to epidural morphine in providing adequate pain relief and sedation in patients undergoing major operations like thoracotomy.

Completed

• Conditions: carcinoma lung patients undregoing thoracotomy

• Registration Number: CTRI/2012/06/002746
• Lead Sponsor: ALL INDIA INSTITUTE OF MEDICAL SCIENCES

Brief Summary

Post thorocotomy pain delays recovery and increases the postoperative morbidity.The anguish caused by thoracotomy is gruelling to patients with toilsomepostoperative pain. The incision in thoracotomy is extremely painful as itinvolves resection of rib and muscle cutting incisions. Therefore pain followingthoracotomy is of serious concern. The acute incissional pain in thorocotomy impedes the chestwall expansion and cough reflex leading on to accumulation of secretions,ventilation perfusion mismatch, atelectasis , hypoxia , infection therebydelaying the recovery.

 Thoracicepidural analgesia is a common modality for providing pain relief in patientsundergoing thoracotomy. Other methods of analgesia used as a part of multimodalanalgesia regimen are intravenous, intrathecal or epidural narcotics, NSAIDS, lumbarepidural block, paravertebral block,  intercostalnerve block, intrapleural analgesia , cryoanalgesia, and transcutaneous nerve stimulation.Multimodalanalgesia techniques along with multidisciplinary rehabilitation program mayenhance postoperative recovery, decrease the duration of hospital stay, andfacilitate early convalescence. Multimodal analgesia provides superior dynamicpain relief with reduced analgesic-related side effects.  Many researchers have found thatthe use of adjuvants like fentanyl, morphine , clonidine , ketamine,ketorolac  with epidural localanaesthetics increases the efficacy of epidural analgesia and decreases theside effects .

                         Clonidine and dexmedetomidine are two α2-agonists used as an intravenous anaesthetics. Dexmedetomidineis eight times more α2 selective  than clonidine .Dexmedetomidine has beenrecommended for use as a sedative in patients on mechanical ventilation inIntensive care unit. The use of intravenous dexmedetomidine for has been found to reduce the requirement of opioidanalgesia and also improve hemodynamic stability. It provides anxiolysis andsedation without respiratory depression. Patientsare sedated but arousable following use of dexmedetomidine. It also provides haemodynamicstability and attenuates the increases in heart rate and stress response duringintubation and emergence of anesthesia. It reduces stress response to surgeryand provide perioperative cardio protection in patients having coronary riskfactors. Recently dexmedetomidine due to these various advantages is used as anadjuvant analgesic in various vascular, bariatric and thoracic surgeries. Otherroutes like epidural dexmedetomidine also have been tried by few researchers.They have found that the use of dexmedetomidine through epidural route  also reduces the postoperative morphinerequirement 19.

                         This prospective,randomized study has been designed to find out the efficacy of intravenous dexmedetomidineto provide adjuvant analgesia along with epidural morphine in 0.1% bupivacaine indecreasing the perioperative analgesic requirement and awareness in patientsundergoing thorocotomy

Detailed Description

Not available

Study Timeline

• Study Start: 2011-03-14
• Last Update Posted: 2013-06-10

Recruitment & Eligibility

• Status: Completed
• Sex: All
• Target Recruitment: 30

Inclusion Criteria

ELECTIVE THORACOTOMY.

Exclusion Criteria

•patients refusal to participate •patients who have psychiatric disturbances •severe chest wall/spinal deformity •patients with coagulation disorders/pts on anticoagulants •severe ventricular dysfunction •patients in shock •liver disease patients.

Study & Design

• Study Type: Interventional
• Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
To study the effect of intravenous dexmedetomidine as an adjuvant to epidural morphine on perioperative analgesic requirement in patients undergoing thoracotomy.	Amount of intravenous morphine used intaraoperatively in each groups

Secondary Outcome Measures

Name	Time	Method
Postoperative analgesia requirement	Total amount of PCA morphine used at the end of 24 hrs in postoperative period

Trial Locations

Locations (1)

AIIMS; 🇮🇳 South, DELHI, India

AIIMS

🇮🇳South, DELHI, India

LOKESH KASHYAP

Principal investigator

9868397821

lokeshkashyap@yahoo.com