International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
logo
slider
slider
slider
slider
Bootstrap Slider

Indexed and Abstracted in: Crossref, CAS Abstracts, Publons, Google Scholar, Open J-Gate, ROAD, Indian Citation Index (ICI), ResearchGATE, Ulrich's Periodicals Directory, WorldCat (World's largest network of library content and services)

Search Articles

Track manuscript

Full Html

IJCRR - 8(3), February, 2016

Pages: 11-18

Date of Publication: 11-Feb-2016


Print Article   Download XML  Download PDF

A COMPARATIVE STUDY OF CLONIDINE VERSUS TRAMADOL AS ADDITIVE TO BUPIVACAINE IN EPIDURAL ANAESTHESIA

Author: Mahesh Sutariya, Anand J. Amin, Miss Archana B. Behl

Category: Healthcare

Abstract:Introduction:
Pain is unpleasant sensory-emotional experience and one of the most feared symptoms experienced. Epidural anesthesia is safe, well practiced and inexpensive neuraxial block technique. Bupivacaine is commonly used for epidural anaesthesia. Researches have been conducted to identify different techniques and drugs that improve the quality of surgical anaesthesia, prolong the effect of bupivacaine and duration of postoperative analgesia. Objectives: To evaluate efficacy of epidural tramadol and clonidine used as adjuvant to bupivacaine. To compare onset and duration of sensory and motor blockade, quality of anaesthesia and duration of postoperative analgesia. Methods: A prospective, randomized placebo control study was undertaken, involving 90 patients from SMIMER hospital, Surat. Three groups were allotted 30 patients each and were given, bupivacaine+saline (Group A)/ Bupivacaine+tramadol (Group B)/ bupivacaine+clonidine (Group C). Results were recorded and analyzed. Results: The onset of sensory block was fastest in Group C. Total duration of sensory blockade was longest in Group B. Total duration of analgesia was longest in Group B, followed by Group C based upon Visual Analogue Scale. Both tramadol (Group B) and clonidine (Group C) prolong duration of analgesia and decrease requirement of post-operative analgesic doses and amongst them tramadol (Group B) is superior. Conclusion: Tramadol and clonidine both are used as adjuvant to bupivacaine for epidural anaesthesia and post-operative analgesia. Tramadol provides longer duration of post-operative analgesia without sedation and requirement of analgesic is less within 24 hours. Tramadol is useful because of its cost-effectiveness and easy availability.

Keywords: Pain, Pre-emptive anesthesia, Sensory blockade, Motor blockade

Full Text:

Introduction
Pain is unpleasant sensory-emotional experience and one of the most feared symptoms experienced. Epidural anesthesia is safe, well practiced and inexpensive neuraxial block technique. Bupivacaine is commonly used for epidural anaesthesia. Researches have been conducted to identify different techniques and drugs that improve the quality of surgical anaesthesia, prolong the effect of bupivacaine and duration of postoperative analgesia. Objectives: To evaluate efficacy of epidural tramadol and clonidine used as adjuvant to bupivacaine. To compare onset and duration of sensory and motor blockade, quality of anaesthesia and duration of postoperative analgesia. Methods: A prospective, randomized placebo control study was undertaken, involving 90 patients from SMIMER hospital, Surat. Three groups were allotted 30 patients each and were given, bupivacaine+saline (Group A)/ Bupivacaine+tramadol (Group B)/ bupivacaine+clonidine (Group C). Results were recorded and analyzed. Results: The onset of sensory block was fastest in Group C.

Total duration of sensory blockade was longest in Group B. Total duration of analgesia was longest in Group B, followed by Group C based upon Visual Analogue Scale. Both tramadol (Group B) and clonidine (Group C) prolong duration of analgesia and decrease requirement of post-operative analgesic doses and amongst them tramadol (Group B) is superior. Conclusion: Tramadol and clonidine both are used as adjuvant to bupivacaine for epidural anaesthesia and post-operative analgesia. Tramadol provides longer duration of post-operative analgesia without sedation and requirement of analgesic is less within 24 hours. Tramadol is useful because of its cost-effectiveness and easy availability 

Preemptive analgesia is given to decrease acute pain after tissue injury, to prevent pain-related pathologic modulation of the central nervous system, to inhibit persistent postoperative pain and development of chronic pain[2]. Epidural anaesthesia is safe, inexpensive neuraxial block technique which provides surgical anaesthesia and postoperative pain control. Nowadays anaesthesiologists use polypharmacy approach to provide the best possible surgical anaesthesia and post-operative pain relief with minimal side effects[3]. Bupivacaine is amide local anaesthetic, commonly used for epidural anaesthesia. Studies are being conducted to evaluate different techniques and add-on drugs (fentanyl, tramadol etc.) to improve the quality of surgical anaesthesia, prolong the effect of bupivacaine and duration of postoperative analgesia[4]. Clonidine is centrally acting partial α2 -adrenergic agonist which inhibits voltage gated Na+ channels and prevents action potential generation in dorsal horn cells causing analgesia.

It also decreases activity of second-order neurons and weakens the input from peripheral nociceptive Aδ and C fibres. When given epidurally, 2 μg/kg of body weight, it increases the duration of analgesia without side effects like bradycardia, hypotension, respiratory depression and fall in oxygen saturation[5]. Tramadol is synthetic codeine analogue, acting by weak μ-opioid receptor agonism and reuptake inhibition of serotonin and noradrenaline, resulting in antinociceptive effect. Reports show that epidural tramadol can provide post-operative analgesia safely[6]. The purpose of this study was to evaluate efficacy of epidural tramadol and clonidine used as adjuvant to bupivacaine, to compare onset and duration of sensory and motor blockade, quality of anaesthesia and duration of postoperative analgesia.

MATERIALS AND METHOD
After approval from institutional ethical committee and written informed consent, a prospective, randomized placebo controlled, parallel group clinical study was conducted on 90 patients. Preanaesthetic evaluation was done on the previous day of surgery and procedure was explained. Study duration: From November 2011 to January 2014. Inclusion Criteria: Patients of either sex belonging to ASA (American Society of Anaesthesiologists) I or II between age group of 20 to 60 years. Exclusion Criteria: - History of cardiac or renal diseases and taking antihypertensive medications. - History of analgesic use. - Chronic pain syndrome. - Patients with communication difficulties. - History of any adverse reaction to study drugs.

Methodology: -
Preloading was done with injection Ringer’s lactate 15 ml/kg intravenously. - Injection glycopyrrolate 0.004 mg/kg and injection midazolam 0.08 mg/kg was given intramuscularly as premedication 30 minutes before surgery. - Epidural space was located by using loss of resistance technique into the space between L2-L3 or L3-L4 spine and 20G epidural catheter was inserted through 18G Touhy needle. Placement of epidural catheter in epidural space was confirmed by 3cc injection of lignocaine with adrenaline. The patients were randomly divided into 3 groups using a computer generated random numbers (30 patients in each). Blinding was not done.

Study groups: Group-A: 19ml of 0.5% bupivacaine + 2ml 0.9% saline Group-B: 19ml of 0.5% bupivacaine +2ml tramadol (2 mg/ kg) Group-C: 19ml of 0.5% bupivacaine + 2ml clonidine (2 μg/ kg) Volume of bupivacaine (0.5%) was kept constant 19ml. Total volume was 21ml. Sensory blockade: was assessed by using pinprick with hypodermic needle. 0= No sensation 1= Pin sensed as dull pressure 2= Sharp Motor blockade: Assessed by modified Bromage scale. 0= No block 1= Inability to raise extended leg 2= Inability to flex knee 3= Inability to flex ankle and foot Sedation: Assessed by five point scale. 1= alert and awake, 2= arousable to verbal command 3= arousable with gentle tactile stimulation 4= arousable with vigorous shaking 5= unarousable Observations: were recorded as following: - Measurement, time of onset and total duration of sensory blockade: - Effective analgesia: - Measurement, time of onset and total duration of motor blockade: - Time to achieve T6 level: - Time from epidural medication to two segment regression: - Visual analogue scale (VAS) for postoperative pain assessment. 0= no pain, 2= annoying, 4= uncomfortable, 6= dreadful, 8= horrible, 10= worst pain.

- Top up dose given when VAS ≥ 4 Group-A: 0.125% bupivacaine 8ml + 2ml 0.9% NS Group-B: 0.125% bupivacaine 8ml+ 2ml tramadol (1mg/kg) Group-C: 0.125% bupivacaine 8ml+2ml clonidine (1μg/kg) - Time of 1st top up dose.

Definitions: -
Onset of sensory blockade - Time from injection of study drugs to complete ablation of pin prick (score 0). - Effective analgesia - Time between complete sensory block to the return of pain sensation which is tolerable (VAS 4). - Onset of motor blockade - Time from injection of study to the time till complete paralysis (Modified Bromage scale 3). - Duration of motor blockade- Time of onset of complete motor block to the restoration of normal musculature force (Modified Bromage scale 0).

Statistical analysis:
Results were presented a ± mean ± SD (standard deviation). ANOVA test was applied for quantitative data and chi-square test for qualitative data. Significance of p value was suggested as follows: ‘p’ Value was >0.05 insignificant. ‘p' Value was <0.05 significant. ‘p’ Value was <0.001 highly significant.

RESULTS
This study was conducted on 90 patients of either sex belonging to ASA I and II in age group of 20 to 60 years. Patients undergoing lower abdominal and lower limb surgeries under epidural anaesthesia were selected for the study at SMIMER (Surat Municipal Institute of Medical Education and Research), Surat. Total 154 patients were sought for this study, 44 patients were excluded as per eligibility criteria, while 20 were not willing to participate. Patients were randomly divided into three groups. Demographic data of the patients are mentioned in Table 1. Patients were comparable in all groups according to age, weight and height distribution (p> 0.05).

Mean duration of surgery in Group-A (101.16 ±28.24 minutes), Group-B (99.66 ±28.76 minutes) and Group-C (94.5 ±21.26 minutes) were comparable among all groups (p> 0.05). Out of 90 patients, 45 patients underwent lower limb and 45 patients underwent lower abdominal surgery. Patients were comparable as per type of surgery. The onset of sensory block in both Group-C (10.06 ±2.03 minutes) and Group-B (12.6 ±2.01 minutes) were faster than the Group-A (13.83 ±1.96 minutes), with that in Group-C being faster (p< 0.001) (Table 2).

Total duration of sensory blockade was longer in Group-B (251.33 ±58.5 minute) and Group-C (160 ±46.46 minutes) as compared to Group-A (143.33 ±53.5 minutes) (p< 0.001) (Table 2). The time to achieve T6 sensory block was shorter in GroupC (15.12 ±2.96 minutes) and Group-B (17.38 ±4.19 minutes) than Group-A (19.82 ±2.33 minutes) (p 0.05) (Table 3). Time of onset of motor blockade was comparable in GroupA (14.7 ±2.24 minutes), Group-B (13.93 ±2.74 min) and Group-C (13.2 ±4.30 min) (p> 0.05) (Table 4). Total duration of motor block were, 136.33 ±27.47 minutes, 139.33 ±35.03 minutes and 141 ±38.26 minutes in Group-A, B and C respectively (p> 0.05) (Table 4).

In Group-A, patients had VAS ≥4 at an average duration of 170.66 ±51.44 minutes after giving epidural anaesthesia when 1st rescue analgesic dose was supplemented. In GroupB, analgesia lasted longer and VAS exceeded 4 after an average of 354.33 ±90.19 min. In Group-C, patients were comfortable till 220.33 ±96.34 minutes, when first rescue analgesic was required (Table 5). The total duration of analgesia was longest in Group-B, followed by Group-C.

Time required for first rescue analgesic was longer in GroupB (354.33 ±90.19 minutes) than Group-C (218 ±30.10 minutes) and minimum in Group-A (168.33 ±26.40 minutes) (p< 0.001) (Table 6). Requirement of total number of analgesic doses in 24 hours were higher in Group-A (3.73 ±0.5) than in Group-C (2.9 ±0.5) and minimum in Group-B (2.4 ±0.5) (p<0.001) (Table 6). Duration of effective analgesia was maximum in Group-B (314.47 ±50.88 minutes) and minimum in Group-A (152.67 ±58.7 minutes) (p <0.001).

DISCUSSION In the postoperative period effective pain control must be ensured. However, despite advances in the knowledge of pathophysiology of pain, pharmacology of analgesics and development of more effective techniques, patients continue to experience considerable post-operative pain. Better postoperative analgesia and faster recovery of gut function were observed when epidural anaesthesia is used as compared to use of systemic opioids. Also, general anaesthesia alone is associated with higher chances of perioperative mortality and morbidity, while epidural anaesthesia can reduce both[7].

Both epidural and parenteral clonidine has been used to relieve postoperative pain. As clonidine induced analgesia is mediated by activation of α2 -adrenoceptors on the dorsal horn of the spinal cord, its intrathecal or epidural administration close to its site of action seems logical. Clonidine is rapidly and widely absorbed into systemic circulation and reaches to target sites [8]. Tramadol may act by; a weak μ-opioid receptor agonistic action and/or serotonin-noradrenaline reuptake inhibition, leading to antinociceptive effect [9]. After ethical permissions from institutional ethics committee, this study was undertaken to evaluate the effect of tramadol and clonidine as an adjuvant to epidural bupivacaine in patients undergoing lower abdominal and lower limb surger ies. Study was conducted on 90 patients of either sex belonging to ASA I & II between age group of 20 to 60 years. In this study, patients’ demographical data in all groups and duration of surgery were comparable (p> 0.05). In present study, the onset of sensory block when clonidine administered was faster as compared to tramadol and control group. Differences in onset of sensory block among the groups were highly significant (p< 0.001).

We observed that, tramadol group had longest total duration of sensory block, followed by clonidine group, while shortest in control group. The differences in total duration of sensory blockage between the groups were highly significant (p< 0.001). We noted that, time to achieve T6 sensory block was 17.38 ±4.19 minutes, 15.12 ±2.96 minutes and 19.82 ±2.33 minutes in tramadol, clonidine and control group respectively. These differences between groups were highly significant (p 0.05). Tanmoy Ghatak et al [3] conducted similar study using clonidine or magnesium sulphate as adjuvant to epidural bupivacaine in lower abdominal and lower limb surgery. They observed that onset of anaesthesia was significantly (p< 0.001) rapid in magnesium group, 11.80 ±3.21 minutes, whereas it was 16.93 ±3.43 minutes in clonidine group and 18.73 ±2.79 minutes in control group. Time to achieve T6 block was 11.80 ±3.21 minutes, 16.93 ±3.43 minutes and 18.73 ±2.79 minutes in magnesium, clonidine and control group respectively.

The difference between the groups was significant (p< 0.05). Also the time from epidural medication to two segment regression among groups was statistically insignificant (p> 0.05). Shobhana Gupta et al [10] evaluated the analgesic effect of combination of epidural clonidine with bupivacaine versus epidural bupivacaine alone. In their study the mean time for onset of sensory anaesthesia was significantly faster (493.8 ±31.66 seconds) in clonidine group than control group (686.4 ±47.42 seconds).

Yaun-Shiou Huang et al [11] conducted a dose-response study of epidural clonidine for postoperative pain after total knee arthroplasty. They divided patients in 4 groups (20 of each). After surgery, groups C0, C1, C2, C4 received patient control epidural analgesia (PCEA) with clonidine 0, 1.0, 2.0, 4.0 μg/ml respectively and morphine 0.1 mg/ml in 0.2% ropivacaine. They observed that five patients in group C4 and one patient in group C2 suffered from prolonged sensory blockade (longer than 24 h).

They concluded that the highest concentration of clonidine (4.0 μg/mL; group C4) produced the best analgesia, but the degree of sedation, sensory and motor blockade were more severe and longer lasting than with lower concentrations of clonidine, and required careful monitoring of patients. Noha Sayed Hussien [12] compared magnesium sulphate and clonidine as an adjuvant to epidural anaesthesia. They noted that onset of anaesthesia was significantly rapid in magnesium group, 11.80 ±3.24 minutes, compared to 13.83 ±3.72 minutes in clonidine group and 17.71 ±2.66 minutes in control group. Time to reach T6 sensory level were 17.71 ±2.66 minutes, 10.80 ±3.24 minutes and 13.63 ±3.72 minutes in control, magnesium and clonidine group respectively. These differences between the groups were highly significant (p 0.05). The results of all the studies above were consistent with the present study. Administration of clonidine with local anaesthetic accelerates onset and increases duration of sensory block. The probable mechanisms are – (1) Interference with vascular resorption of local anaesthetic by producing vasoconstriction. (2) Direct action on neural tissue especially at the spinal level reducing the release of substance P from primary afferent neurons [13].

Addition of tramadol and clonidine to epidural bupivacaine produce rapid onset and prolong duration of sensory block without affecting two segment regression times. In present study the onset and total duration of motor block wasn’t significantly (p> 0.05) affected by either tramadol or clonidine. Noha Sayed Hussien [12] and Tanmoy Ghatak et al [3] observed no difference in the quality of motor blocks between the groups. Yaun-Shiou Huang et al[11] observed that higher concentration of clonidine produce prolonged motor block. The results of above studies were consistent with the present study.

The onset and duration of motor blockade remained statistically insignificant in present study (p >0.05). In the present study, time required for first rescue analgesic were 354.33 ±90.19 minutes, 218 ±30.10 minutes and 168.33 ±26.40 minutes in Group-B, C and A respectively. The differences were statistically highly significant (p <0.001) among the groups. We observed that, requirement of total number of analge sic doses in 24 hours were higher in Group-A (3.73 ±0.5) than Group-C (2.9 ±0.5) and was minimum in Group-B (2.4 ±0.5), the difference was statistically highly significant (p <0.001). Tanmoy Ghatak et al [3] noted that, in clonidine group, time taken for first epidural top up dose after epidural anaesthesia, was highest in clonidine group as compared to magnesium group (161.67 ±30.10 minutes) and lowest in control group (150.67 ±35.80 minutes).

They suggested that clonidine prolongs duration of anaesthesia with lower VAS score. Noha Sayed Hussien [12] observed that, in clonidine group, time taken for first epidural top up dose after epidural anaesthesia, was highest(162.22 ±26.66 minutes) as compared to magnesium group (158.62 ±28.11 minutes) and lowest(150.48 ±28.7 minutes) in control group of patients. They said that clonidine prolongs duration of anaesthesia and sedation with lower VAS score. Shahid Khan et al [14] conducted a randomized controlled trial to compare the effects after caudal bupivacaine alone and bupivacaine-tramadol in children with hypospadias repair. They observed that duration of analgesia was significantly higher in tramadol group (10.40 ±1.69 h) than control group (7.93 ±1.52 h). Y. Demiraran et al [15] studied a comparison of the postoperative analgesic efficacy of single-dose epidural tramadol versus morphine in children undergoing urological surgery. A single dose of morphine 0.1 mg/kg in isotonic saline 0.2 ml/kg (morphine group) and tramadol 2 mg/kg in isotonic saline 0.2 ml/kg (tramadol group) was administered epidurally.

They observed that supplementary analgesia wasn’t needed for 16 hours in the tramadol group and for 18 hour in the morphine group, thus pain score and average time for analgesia required were similar in both groups. S. Prakash, R. Tyagi et al [16] evaluated the analgesic efficacy of three doses of tramadol, administered caudally with bupivacaine, in providing postoperative pain relief in children.

Eighty patients were randomized into four groups to received bupivacaine (0.25%) 0.75 ml/kg (Group B), bupivacaine (0.25%) 0.75 ml/kg with tramadol 1 mg/kg (Group BT1), bupivacaine (0.25%) 0.75 ml/kg with tramadol 1.5 mg/kg (Group BT1.5), or bupivacaine(0.25%) 0.75 ml/kg with tramadol 2 mg/kg (Group BT2) by caudal route. They observed that duration of analgesia was longer in Group BT2 (12 ±0.9 h) compared with Group B (4 ±1 h), Group BT1 (8 ±0.9 h), or Group BT1.5 (11 ±1 h). Results of the above studies were in accordance with present study. Administration of clonidine with local anaesthetic increases duration of post-operative analgesia. The probable mecha- nism for prolong duration of analgesia are – (1) Clonidine may interfere with vascular resorption of local anaesthetic by producing vasoconstriction. (2) Clonidine may induce analgesia by direct distribution to brainstem after vascular resorption [13].

Tramadol inhibits noradrenaline uptake and stimulate serotinin release, and these are transmitter in the descending pathways which enhance analgesia [6]. Thus from the present study we can state that both tramadol and clonidine prolongs duration of analgesia and decreases the requirement of postoperative analgesic doses, however tramadol as an adjuvant to epidural anaesthesia is superior. Limitations of the current study were: a.) it was a non-blind study which might have lead to observer bias. b.) a larger sample size might have more impact.

CONCLUSION From this study we concluded that both tramadol and clonidine can be used as an adjuvant to bupivacaine for epidural anaesthesia and post operative analgesia. However tramadol provides comparatively longer duration of post operative analgesia without sedation and less requirement of analgesic within 24 hours. We conclude that tramadol can be a used as an alternative add-on drug to epidural bupivacaine because of its cost effectiveness, easy availability and lesser side effects. Compliance with ethical standards: Funding source: None. Conflict of interest: Dr. Mahesh Sutariya, Dr Anand Amin and Ms Archana Behl declare that they have no conflict of interest. Statement of human rights: Ethical approval: “All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.” Informed consent: “Informed consent were obtained from all individual participants included in the study.”

ACKNOWLEDGEMENTS We are thankful to Dr. Pragna Vachrajani, Head of the Department of Anaesthesia, SMIMER hosptital, Surat for permitting us for this study.

Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.

References:

1. Wall PD. The prevention of postoperative pain. Pain 1988;33:289–90.

2. Wu CT, Jao SW, Borel CO, Yeh CC, Li CY, Lu CH, Wong CS. The effect of epidural clonidine on perioperative cytokine response, postoperative pain, and bowel function in patients undergoing colorectal surgery. Anesth Analg 2004;99:502-09.

3. Ghatak T, Chandra G, Malik A, Singh D, Bhatia VK. Evaluation of the effect of magnesium sulphate vs. clonidine as adjunct to epidural bupivacaine. Indian Journal of Anaesthesia. 2010;54:308–13.

4. Davis M., Gendelman D. S., Tischler M. D., Gendelman P. M. 1982 A primary acoustic startle circuit: lesion and stimulation studies. J. Neurosci.; 2:791-805.

5. Upadhyay KK, Prabhakar T., Handa R., Beena H. Study of the efficacy and safety of clonidine as an adjunct to bupivacaine for caudal analgesia in children. Indian Journal of Aanaesthesia, 2005; volume 49(3): 199-201.

6. Anis Baraka, Samar Jabbour, Antoun Nader, Abla Sibai. A comparison of epidural tramadol and epidural morphine for post-operative analgesia. Can J Anaesth. Volume 40, Issue 4 , pp 308-13

7. Rodgers A, Walker N, Schug S et al. Reduction of post operative mortality and morbidity with epidural or spinal anaesthesia: Results from overview of randomised trials. Brit Med J. 2000;321:1493–97.

8. M De Kock, M.D., B Crochet, M.D., C Morimont, M.D., J-L Scholtes, M.D.; Intravenous or Epidural Clonidine for Intra- and Postoperative Analgesia. Anesthesiology 1993;79(3):525-31.

9. Wylie and Churchill Davidson: A practice of Anaesthesia, 7th edition. Edward Arnold publication. 608-13.

10. Gupta S, Raval D, Patel M, Patel N, Shah N. Addition of epidural Clonidine enhances postoperative analgesia: A doubleblind study in total knee- replacement surgeries. Anesthesia, Essays and Researches. 2010;4(2):70-74. doi:10.4103/0259- 1162.73510.

11. Huang Yuan-Shiou, Lin Liu-Chi, Huh Billy K. Epidural clonidine for postoperative pain after total knee arthroplasty: A doseresponse study. Anesth Analg. May 2007: Volume 104: Issue 5- pp 1230-1235.

12. Noha Sayed H. A comparative study between magnesium sulphate and clonidine as adjuvant to epidural anaesthesia in patients undergoing abdominal hysterectomyhy. Ain-Shams Journal of Anaesthesiology. 2011: 4: no. 3: 1-9.

13. Sterling K. textbook of Pharmacology and Physiology in Anaesthesia practice (Lippincott Williams and Wilkins) 4th edition. Cha-15 – (clonidine) antihypertensive drugs. 340-345. Cha-7, local anaesthesia. 179-207.

14. Shahid Khan and Mohammad Iqbal memon et al: caudal bupivacaine alone and bupivacaine-tramadol in children with hypospadias repair.JCPSP- J Coll Physici 2008. Vol. 18 (10). 601- 604.

15. Y. demiraran, B. Kocaman and R. y. Akman. A comparision of the postoperative analgesic efficacy of single dose epidural tramadol versus morphine in children. Brit J Anaesth. (October 2005) 95 (4): 510-513.

16. S. Prakash, R. Tyagi, A. R. Gogia, R. Shing, S. Prakash. Efficacy of three doses of tramadol with bupivacaine for caudal analgesia in paediatric inguinal herniotomy. Brit J Anaesth. 97(3): 385- 388 (2006).

Announcements

Dr. Pramod Kumar Manjhi joined Editor-in-Chief since July 2021 onwards

COPE guidelines for Reviewers

SCOPUS indexing: 2014, 2019 to 2021


Awards, Research and Publication incentive Schemes by IJCRR

Best Article Award: 

One article from every issue is selected for the ‘Best Article Award’. Authors of selected ‘Best Article’ are rewarded with a certificate. IJCRR Editorial Board members select one ‘Best Article’ from the published issue based on originality, novelty, social usefulness of the work. The corresponding author of selected ‘Best Article Award’ is communicated and information of award is displayed on IJCRR’s website. Drop a mail to editor@ijcrr.com for more details.

Women Researcher Award:

This award is instituted to encourage women researchers to publish her work in IJCRR. Women researcher, who intends to publish her research work in IJCRR as the first author is eligible to apply for this award. Editorial Board members decide on the selection of women researchers based on the originality, novelty, and social contribution of the research work. The corresponding author of the selected manuscript is communicated and information is displayed on IJCRR’s website. Under this award selected women, the author is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.

Emerging Researcher Award:

‘Emerging Researcher Award’ is instituted to encourage student researchers to publish their work in IJCRR. Student researchers, who intend to publish their research or review work in IJCRR as the first author are eligible to apply for this award. Editorial Board members decide on the selection of student researchers for the said award based on originality, novelty, and social applicability of the research work. Under this award selected student researcher is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.


Best Article Award

A study by Dorothy Ebere Adimora et al. entitled \"Remediation for Effects of Domestic Violence on Psychological well-being, Depression and Suicide among Women During COVID-19 Pandemic: A Cross-cultural Study of Nigeria and Spain\" is awarded Best Article of Vol 14 issue 23
A study by Muhas C. et al. entitled \"Study on Knowledge & Awareness About Pharmacovigilance Among Pharmacists in South India\" is awarded Best article for Vol 14 issue 22
A study by Saurabh Suvidha entitled \"A Case of Mucoid Degeneration of Uterine Fibroid with Hydrosalphinx and Ovarian Cyst\" is awarded Best article of Vol 14 issue 21
A study by Alice Alice entitled \"Strengthening of Human Milk Banking across South Asian Countries: A Next Step Forward\" is awarded Best article of Vol 14 issue 20
A study by Sathyanarayanan AR et al. entitled \"The on-task Attention of Individuals with Autism Spectrum Disorder-An Eye Tracker Study Using Auticare\" is awarded Best article of Vol 14 issue 19
A study by Gupta P. et al. entitled \"A Short Review on \"A Novel Approach in Fast Dissolving Film & their Evaluation Studies\" is awarded Best Article of Vol 14 issue 18.
A study by Shafaque M. et al. entitled \"A Case-Control Study Performed in Karachi on Inflammatory Markers by Ciprofloxacin and CoAmoxicillin in Patients with Chronic Suppurative Otitis Media\" is awarded Best Article of Vol 14 issue 17
A study by Ali Nawaz et al. entitled \"A Comparative Study of Tubeless versus Standard Percutaneous Nephrolithotomy (PCNL) \? A Randomized Controlled Study\" is awarded Best Article for Vol 14 issue 16.
A study by Singh R. et al. entitled \"A Prospective Study to Find the Association of Astigmatism in Patients of Vernal Keratoconjunctivitis (VKC) in a Tertiary Health Care Centre in India (Vindhya Region MP)\" is awarded Best Article for Vol 14 issue 15
A Study by Humaira Tahir et al. entitled "Comparison of First Analgesic Demand after Major Surgeries of Obstetrics and Gynecology between Pre-Emptive Versus Intra-Operative Groups by Using Intravenous Paracetamol: A Cross-Sectional Study" is awarded Best Article for Vol 14 issue 14
A Study by Monica K. entitled "Risk Predictors for Lymphoma Development in Sjogren Syndrome - A Systematic Review" is awarded Best Article for Vol 14 issue 13
A Study by Mokhtar M Sh et al. entitled "Prevalence of Hospital Mortality of Critically Ill Elderly Patients" is awarded Best Article for Vol 14 issue 12
A Study by Vidya S. Bhat et al. entitled "Effect of an Indigenous Cleanser on the Microbial Biofilm on Acrylic Denture Base - A Pilot Study" is awarded Best Article for Vol 14 issue 11
A Study by Pandya S. et al. entitled "Acute and 28-Day Repeated Dose Subacute Toxicological Evaluation of Coroprotect Tablet in Rodents" is awarded Best Article for Vol 14 issue 10
A Study by Muhammad Zaki et al. entitled "Effect of Hemoglobin Level on the Severity of Acute Bronchiolitis in Children: A Case-Control Study" is awarded Best Article for Vol 14 issue 09
A Study by Vinita S & Ayushi S entitled "Role of Colour Doppler and Transvaginal Sonography for diagnosis of endometrial pathology in women presenting with Abnormal Uterine Bleeding" is awarded Best Article for Vol 14 issue 08
A Study by Prabhu A et al. entitled "Awareness of Common Eye Conditions among the ASHA (Accredited Social Health Activist) Workers in the Rural Communities of Udupi District- A Pilot Study" is awarded Best Article for Vol 14 issue 07
A Study by Divya MP et al. entitled "Non-Echoplanar Diffusion-Weighted Imaging and 3D Fiesta Magnetic Resonance Imaging Sequences with High Resolution Computed Tomography Temporal Bone in Assessment and Predicting the Outcome of Chronic Suppurative Otitis Media with Cholesteatoma" is awarded Best Article for Vol 14 issue 06
A Study by Zahoor Illahi Soomro et al. entitled "Functional Outcomes of Fracture Distal Radius after Fixation with Two Different Plates: A Retrospective Comparative Study" is awarded Best Article for Vol 14 issue 05
A Study by Ajai KG & Athira KN entitled "Patients’ Gratification Towards Service Delivery Among Government Hospitals with Particular Orientation Towards Primary Health Centres" is awarded Best Article for Vol 14 issue 04
A Study by Mbungu Mulaila AP et al. entitled "Ovarian Pregnancy in Kindu City, D.R. Congo - A Case Report" is awarded Best Article for Vol 14 issue 03
A Study by Maryam MJ et al. entitled "Evaluation Serum Chemerin and Visfatin Levels with Rheumatoid Arthritis: Possible Diagnostic Biomarkers" is awarded Best Article for Vol 14 issue 02
A Study by Shanthan KR et al. entitled "Comparison of Ultrasound Guided Versus Nerve Stimulator Guided Technique of Supraclavicular Brachial Plexus Block in Patients Undergoing Upper Limb Surgeries" is awarded Best Article for Vol 14 issue 01
A Study by Amol Sanap et al. entitled "The Outcome of Coxofemoral Bypass Using Cemented Bipolar Hemiarthroplasty in the Treatment of Unstable Intertrochanteric Fracture of Femur in a Rural Setup" is awarded Best Article Award of Vol 13 issue 24
A Study by Manoj KP et al. entitled "A Randomized Comparative Clinical Trial to Know the Efficacy of Ultrasound-Guided Transversus Abdominis Plane Block Against Multimodal Analgesia for Postoperative Analgesia Following Caesarean Section" is awarded Best Article Award of Vol 13 issue 23
A Study by Karimova II et al. entitled "Changes in the Activity of Intestinal Carbohydrases in Alloxan-Induced Diabetic Rats and Their Correction with Prenalon" is awarded Best Article of Vol 13 issue 22
A Study by Ashish B Roge et al. entitled "Development, Validation of RP-HPLC Method and GC MS Analysis of Desloratadine HCL and It’s Degradation Products" is awarded Best Article of Vol 13 issue 21
A Study by Isha Gaurav et al. entitled "Association of ABO Blood Group with Oral Cancer and Precancer – A Case-control Study" is awarded Best Article for Vol 13 issue 20
A Study by Amr Y. Zakaria et al. entitled "Single Nucleotide Polymorphisms of ATP-Binding Cassette Gene(ABCC3 rs4793665) affect High Dose Methotrexate-Induced Nephrotoxicity in Children with Osteosarcoma" is awarded Best Article for Vol 13 issue 19
A Study by Kholis Ernawati et al. entitled "The Utilization of Mobile-Based Information Technology in the Management of Dengue Fever in the Community Year 2019-2020: Systematic Review" is awarded Best Article for Vol 13 issue 18
A Study by Bhat Asifa et al. entitled "Efficacy of Modified Carbapenem Inactivation Method for Carbapenemase Detection and Comparative Evaluation with Polymerase Chain Reaction for the Identification of Carbapenemase Producing Klebsiella pneumonia Isolates" is awarded Best Article for Vol 13 issue 17
A Study by Gupta R. et al. entitled "A Clinical Study of Paediatric Tracheostomy: Our Experience in a Tertiary Care Hospital in North India" is awarded Best Article for Vol 13 issue 16
A Study by Chandran Anand et al. entitled "A Prospective Study on Assessment of Quality of Life of Patients Receiving Sorafenib for Hepatocellular Carcinoma" is awarded Best article for Vol 13 issue 15
A Study by Rosa PS et al. entitled "Emotional State Due to the Covid – 19 Pandemic in People Residing in a Vulnerable Area in North Lima" is awarded Best Article for Vol 13 issue 14
A Study by Suvarna Sunder J et al. entitled "Endodontic Revascularization of Necrotic Permanent Anterior Tooth with Platelet Rich Fibrin, Platelet Rich Plasma, and Blood Clot - A Comparative Study" is awarded Best Article for Vol 13 issue 13
A Study by Mona Isam Eldin Osman et al. entitled "Psychological Impact and Risk Factors of Sexual Abuse on Sudanese Children in Khartoum State" is awarded Best Article for Vol 13 issue 12
A Study by Khaw Ming Sheng & Sathiapriya Ramiah entitled "Web Based Suicide Prevention Application for Patients Suffering from Depression" is awarded Best Article for Vol 13 issue 11
A Study by Purushottam S. G. et al. entitled "Development of Fenofibrate Solid Dispersions for the Plausible Aqueous Solubility Augmentation of this BCS Class-II Drug" is awarded Best article for Vol 13 issue 10
A Study by Kumar S. et al. entitled "A Study on Clinical Spectrum, Laboratory Profile, Complications and Outcome of Pediatric Scrub Typhus Patients Admitted to an Intensive Care Unit from a Tertiary Care Hospital from Eastern India" is awarded Best Article for Vol 13 issue 09
A Study by Mardhiah Kamaruddin et al. entitled "The Pattern of Creatinine Clearance in Gestational and Chronic Hypertension Women from the Third Trimester to 12 Weeks Postpartum" is awarded Best Article for Vol 13 issue 08
A Study by Sarmila G. B. et al. entitled "Study to Compare the Efficacy of Orally Administered Melatonin and Clonidine for Attenuation of Hemodynamic Response During Laryngoscopy and Endotracheal Intubation in Gastrointestinal Surgeries" is awarded Best Article for Vol 13 issue 07
A Study by M. Muthu Uma Maheswari et al. entitled "A Study on C-reactive Protein and Liver Function Tests in Laboratory RT-PCR Positive Covid-19 Patients in a Tertiary Care Centre – A Retrospective Study" is awarded Best Article of Vol 13 issue 06 Special issue Modern approaches for diagnosis of COVID-19 and current status of awareness
A Study by Gainneos PD et al. entitled "A Comparative Evaluation of the Levels of Salivary IgA in HIV Affected Children and the Children of the General Population within the Age Group of 9 – 12 Years – A Cross-Sectional Study" is awarded Best Article of Vol 13 issue 05 Special issue on Recent Advances in Dentistry for better Oral Health
A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" is awarded Best Article of Vol 13 issue 06
A Study by Chen YY and Ghazali SRB entitled "Lifetime Trauma, posttraumatic stress disorder Symptoms and Early Adolescence Risk Factors for Poor Physical Health Outcome Among Malaysian Adolescents" is awarded Best Article of Vol 13 issue 04 Special issue on Current Updates in Plant Biology to Medicine to Healthcare Awareness in Malaysia
A Study by Kumari PM et al. entitled "Study to Evaluate the Adverse Drug Reactions in a Tertiary Care Teaching Hospital in Tamilnadu - A Cross-Sectional Study" is awarded Best Article for Vol 13 issue 05
A Study by Anu et al. entitled "Effectiveness of Cytological Scoring Systems for Evaluation of Breast Lesion Cytology with its Histopathological Correlation" is awarded Best Article of Vol 13 issue 04
A Study by Sharipov R. Kh. et al. entitled "Interaction of Correction of Lipid Peroxidation Disorders with Oxibral" is awarded Best Article of Vol 13 issue 03
A Study by Tarek Elwakil et al. entitled "Led Light Photobiomodulation Effect on Wound Healing Combined with Phenytoin in Mice Model" is awarded Best Article of Vol 13 issue 02
A Study by Mohita Ray et al. entitled "Accuracy of Intra-Operative Frozen Section Consultation of Gastrointestinal Biopsy Samples in Correlation with the Final Histopathological Diagnosis" is awarded Best Article for Vol 13 issue 01
A Study by Badritdinova MN et al. entitled "Peculiarities of a Pain in Patients with Ischemic Heart Disease in the Presence of Individual Combines of the Metabolic Syndrome" is awarded Best Article for Vol 12 issue 24
A Study by Sindhu Priya E S et al. entitled "Neuroprotective activity of Pyrazolone Derivatives Against Paraquat-induced Oxidative Stress and Locomotor Impairment in Drosophila melanogaster" is awarded Best Article for Vol 12 issue 23
A Study by Habiba Suhail et al. entitled "Effect of Majoon Murmakki in Dysmenorrhoea (Usre Tams): A Standard Controlled Clinical Study" is awarded Best Article for Vol 12 issue 22
A Study by Ghaffar UB et al. entitled "Correlation between Height and Foot Length in Saudi Population in Majmaah, Saudi Arabia" is awarded Best Article for Vol 12 issue 21
A Study by Siti Sarah Binti Maidin entitled "Sleep Well: Mobile Application to Address Sleeping Problems" is awarded Best Article for Vol 12 issue 20
A Study by Avijit Singh"Comparison of Post Operative Clinical Outcomes Between “Made in India” TTK Chitra Mechanical Heart Valve Versus St Jude Mechanical Heart Valve in Valve Replacement Surgery" is awarded Best Article for Vol 12 issue 19
A Study by Sonali Banerjee and Mary Mathews N. entitled "Exploring Quality of Life and Perceived Experiences Among Couples Undergoing Fertility Treatment in Western India: A Mixed Methodology" is awarded Best Article for Vol 12 issue 18
A Study by Jabbar Desai et al. entitled "Prevalence of Obstructive Airway Disease in Patients with Ischemic Heart Disease and Hypertension" is awarded Best Article for Vol 12 issue 17
A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09

List of Awardees

A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award


A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award


RSS feed

Indexed and Abstracted in


Antiplagiarism Policy: IJCRR strongly condemn and discourage practice of plagiarism. All received manuscripts have to pass through "Plagiarism Detection Software" test before Toto Macau forwarding for peer review. We consider "Plagiarism is a crime"

IJCRR Code of Conduct: To achieve a high standard of publication, we adopt Good Publishing Practices (updated in 2022) which are inspired by guidelines provided by Committee on Publication Ethics (COPE), Open Access Scholarly Publishers Association (OASPA) and International Committee of Medical Journal Editors (ICMJE)

Disclaimer: International Journal of Current Research and Review (IJCRR) provides platform for researchers to publish and discuss their original research and review work. IJCRR can not be held responsible for views, opinions and written statements of researchers published in this journal.



ABOUT US

International Journal of Current Research and Review (IJCRR) provides platform for researchers to publish and discuss their original research and review work. IJCRR can not be held responsible for views, opinions and written statements of researchers published in this journal

Contact

148, IMSR Building, Ayurvedic Layout,
        Near NIT Complex, Sakkardara,
        Nagpur-24, Maharashtra State, India

editor@ijcrr.com

editor.ijcrr@gmail.com


Copyright © 2024 IJCRR. Specialized online journals by ubijournal .Website by Ubitech solutions