Abstract

A COMPARATIVE STUDY OF THE EFFECTS OF INTRATHECAL BUPIVACAINE (0.5%) WITH CLONIDINE (1?g/kg) VERSUS INTRATHECAL BUPIVACAINE (0.5%) WITH FENTANYL (25?g) FOR SPINAL ANAESTHESIA

Author(s): Deepak V. Dhummansure1, S. G. Patil2, M. M. Haque3, Subodh Kamtikar4

ABSTRACT: BACKGROUND: Hyperbaric bupivacaine has been the gold standard drug for the safe conduct of spinal anaesthesia. It offers duration of 1.5 to 2.5 hours of anaesthesia and analgesia, various adjuvants are being used with local anesthetics for prolongation of intraoperative and postoperative analgesia. clonidine, an α2 adrenergic agonist is new neuraxial adjuvant gaining popularity. AIM: The purpose of this study was to compare the efficacy of sensory and motor block, degree of postoperative analgesia, and adverse effects of clonidine and fentanyl used intrathecally with hyperbaric bupivacaine for spinal anaesthesia. SETTINGS AND DESIGN: the study was conducted in prospective, double blind manner, included 60 ASA class I and II patients undergoing lower limb, lower abdominal, gynaecological and urological surgeries under spinal anaesthesia after approval from hospital ethics committee with written and informed consent of patients. MATERIALS AND METHODS: the patients were randomly allocated into two groups (30 patients each), group C received hyperbaric bupivacaine 15mg with clonidine 1μg. kg-1 and group F received hyperbaric bupivacaine15mg with fentanyl 25μg. This randomized study was conducted to compare the effects with regards to, Onset and duration of block, degree of post-operative analgesia (evaluated by VAS scale) and side effects associated with the drugs were recorded. RESULTS: Patients in group C had significantly longer sensory and motor block times than group F. The mean onset of sensory block in group C was 136.67sec and in group F was 138.33 sec. The mean onset of motor block in group C was 200.00sec and in group F was 206.67 sec. There were no differences with respect to the onset of block .The mean duration of sensory block in group C was 343.67min and in group F was 250.83min. CONCLUSIONS: There were no differences in the onset of sensory and motor blockade. The duration of analgesia, two segment regressions, and recovery of motor blockade were prolonged when clonidine 1μg.kg-1 was used as an additive to intrathecal hyperbaric bupivacaine compared to fentanyl 25μg for spinal anaesthesia, with side effects like bradycardia, hypotension and pruritus which did not require any treatment. Mild sedation was associated with intrathecal administration of clonidine 1μg.kg-1 which did not require any treatment.