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Korean Journal of Anesthesiology 1997;32(4):630-641.
DOI: https://doi.org/10.4097/kjae.1997.32.4.630   
Analgesic Interaction of Epidural Fentanyl and Clonidine for Pain Control after Perianal Surgery.
Won Joo Choe, Seung Joon Lee, Hyun Choi, Ho Yeong Kil, Young Joon Yoon
1Department of Anesthesiology, Hallym University College of Medicine, Seoul, Korea.
2Department of Anethesiology, Dongin General Hospital, Kangnung, Korea.
3Department of General Surgery, Ajou University of School of Medicine, Suwon, Korea.
Abstract
BACKGROUND
The spinal opioid is one of the excellent analgesic methods for acute postoperative pain and intractable terminal cancer pain, but some side effects limit its use. Many studies had been continued to decrease the frequency and severity of these side effects and to reinforce the analgesic potency of spinal opioid by administering of other drugs.
METHODS
Ninety healthy patients who received perianal surgery were divided into 3 groups randomly and we observed VAS, sedation score, blood pressure, pulse rates and SpO2 after epidural clonidine (Group 1), fentanyl (Group 2) and combination of two drugs (Group 3) were injected. The ED50 of epidural clonidine and fentanyl were evaluated from VAS of Group 1 and 2 using the linear regression on log dose versus %MPE(Percent Maximal Possible Effect). We injected epidurally 1/4, 1/2, full dosage of ED50 to Group 3 patients and isobologram was constructed for evaluating the interaction of two drugs.
RESULTS
The ED50 and 95% confidence limit of clonidine were 119 mcg, 78~161 mcg and those of fentanyl were 105 mcg, 68~204 mcg. At the ED95 level, the isobologram is nearly straight, suggesting additive interaction. At the lower level, the isobologram was bent toward the origin, a sign of synergy, the interaction below the ED80 was synergistic.
CONCLUSION
At the large dose(ED95) to achieve nearly complete pain relief, epidural fentanyl and clonidine showed additive interaction and the other hand, at the smaller dose(below the ED80)which relieves most pain but not all pain, they showed synergistic interaction.
Key Words: Analgesics; clonidine fentanyl; Interaction; additive synergistic


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