291: Epidural Clonidine for Postoperative Analgesia After Major Urological Procedures. A Report of 15 Cases

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Postoperative Pain Management

291. Epidural clonidine for postoperative analgesia after major urological procedures. A report of 15 cases

294. Evaluation of postoperative ropivacaine infusion (single shot) for pain management after urological procedures

A. Dimakopoulou, N. Pentilas, K. Vagdatli, A. Glinavou, V. Dimitriou General Hospital of Athens ‘G. Gennimatas’, Dpt Anesthesiology, Athens, Greece

N. Pentilas1, A. Dimakopoulou1, A. Tachmintzi1, T. Demeli1, G. Stathouros2, K. Doumas2 1General Hospital of Athens ‘G. Gennimatas’, Dpt Anesthesiology, Athens, Greece, 2General Hospital of Athens ‘G. Gennimatas’, Dpt. Urology, Athens, Greece

The aim of our study was to determine the effectiveness of a small dose of clonidine to a low concentration mixture of ropivacaine and fentanyl under continuous infusion via an epidural catheter for the management of postoperative pain after major urological procedures. We enrolled fifteen patients aged ⱕ80 yr, ASA physical status I-III, undergoing total nephrectomy or total cystectomy. Preoperative an epidural catheter (18G) was inserted at T11-T12 or T12-L1 interspace. A test dose of xylocaine/adrenaline performed in all patients. General anaesthesia was induced with fentanyl 1,5␮g/kg, propofol 2mg/kg, xylocaine 1,5mg/kg i.v. and tracheal intubation was facilitated with cis-atracurium 0,2mg/kg. Anaesthesia was maintained with Sevoflurane, N2O/O2 and remifentanyl. One hour before the end of operation continuous infusion of a ropivacaine 0,1%-0,12%, fentanyl 1-2␮g/ml, clonidine 0,5␮g/kg with a total volume 300ml and a rate 5-7ml/h was initiated, while remifentanyl infusion rate was titrated accordingly. We recorded the VAS scale at rest and with cough, the Bromage scale, the hemodynamic profile and the sedation score for each patient twice a day. The addition of a small amount of clonidine to a low dose ropivacaine / fentanyl mixture for continuous epidural infusion provides adequate postoperative analgesia without any other side effects. NUMBER OF VAS VAS VAS VAS SEDATION PATIENTS : AT AT WITH WITH RAMSAY/SAS HEMODYNAMIC BROMAGE 15 REST REST COUGH COUGH SCALE INSTABILITY SCALE ⬎1 RECOVERY ROOM 0-3 10/15 RECOVERY ROOM 4-6 RECOVERY ROOM 7-10 6H&12H 0-3 15/15 6H&12H 4-6 6H&12H 7-10 24H 0-3 14/15 24H 4-6 1/15 24H 7-10 -

0-3

10/15

2/4

1/15

1/15

4-6

-

2/4

1/15

1/15

7-10 0-3 4-6 7-10 0-3 4-6 7-10

15/15 12/15 3/15 -

2/4 2/4 2/4 2/4 2/4 2/4 2/4

1/15 0/15 0/15 0/15 0/15 0/15 0/15

1/15 0/15 0/15 0/15 0/15 0/15 0/15

The use of local anesthetic wound infusion may have the potential to provide long term postoperative analgesia while reducing postoperative opioid requirements. The aim of this study was to evaluate the efficacy of a single shot dose of local anesthetic in a multimodal management of postoperative pain after urological procedures. Fifteen patients, ASA I-II, between 40-75 yrs undergoing retropubic prostatectomy, pyelolithotomy, and uretirolysis were enrolled in this study. General anaesthesia was induced with fentanyl 1,5␮g/kg, propofol 2mg/kg, xylocaine 1,5mg/kg. and cisatracurium 0,15mg/kg. Before surgical insult 1000mg paracetamol and 8mg lornoxicam were given via an i.v. route. Anaesthesia was maintained with sevoflurane, N2O/O2. 40 minutes before the end of the operation 0,5-0,7␮g/kg clonidine and 0,05 mg/kg morphine were given intravenously and a local preperitoneal infusion with local anaesthetic (ropivacaine 0,375% , 40 ml) was performed. We record the VAS scale at rest and with cough and the need for additional analgesic. All patients received a standard scheme with 500mg paracetamol i.v. three times a day and 8mg lornoxical one to two time a day. Management of pain in urologic surgery is best achieved through a multimodal approach to analgesia. Wound infiltration as a single shot technique is simple and safe. NUMBER OF PATIENTS : 15 RECOVERY ROOM 6h 12 h 24 h

VAS AT REST

VAS AT REST

VAS WITH COUGH

VAS WITH COUGH

0-3 4-10 0-3 4-10 0-3 4-10 0-3 4-6 7-10

15/15 15/15 15/15 13/15 2/15 -

0-3 4-10 0-3 4-10 0-3 4-10 0-3 4-6 7-10

15/15 14/15 15/15 12/15 2/15 1/15