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: In the anquity of post-operative analgesia, the inception of α-2 adrenergic agonist agents in subarachnoid space with adjuvance to bupivacaine has opened new chapter. The intent of the study was to compare the onset of duration of sensory and motor block, hemodynamic effects, post-operative analgesia and adverse effects of dexmedetomidine and clonidine with hyperbaric 0.5% bupivacaine for spinal anaesthesia. : Sixty adult patients received subarachnoid block either with Injection Bupivacaine (15mg) with clonidine (30µg) or Injection Bupivacaine (15mg) with Dex medetomidine (10µg). Patients were monitored for variations in heart rate and noninvasive blood pressure after the spinal anaesthesia was given till the surgery got over every 5 minutes. Both the groups were compared for onset time for sensory block, time to reach sensory block to T and T level, time of regression of sensory block by 2 dermatomes and duration of analgesia.: Mean Onset time of sensory block, time to reach T and T level was greater but not significant in Dexmedetomidine group but regression time of sensory block by 2 dermatomes was significantly higher in clonidine group, 100.21±2.58 minutes as compared to 80.43±3.45 in dexmedetomidine group. Onset time to reach bromage II was significantly faster in group BD (35.53 ±3.57seconds) as compared to Clonidine group (49.03 ± 30.15seconds). Dexmedetomidine group patients had significantly (p<0.0001) higher duration of analgesia (589 ± 5.5minutes) as compared to Group clonidine (507 ± 4.8minutes). There was no sedation and no hemodynamic instability observed in either of the groups. We conclude that though both Clonidine and Dexmedetomidine prolongs duration of sensory and motor block of Bupivacaine, But Dexmedetomidine is more appropriate as it provides better VAS score (quality) and longer duration of postoperative analgesia than clonidine.

Background. Preemptive analgesia is an antinociceptive treatment that prevents establishment of altered processing of afferent input. Gabapentin, a structural analogue of gamma-amino butyric acid, has been used as an anticonvulsant and antinociceptive drug and is claimed to be more effective in preventing neuropathic component of acute nociceptive pain of surgery. Methods Fifty patients of ASA grade I and II were assigned to receive oral 600mg Gabapentin or Placebo 2 hours before surgery. Surgeries were conducted under spinal anesthesia. Post operatively pain was assessed by visual analogue score (VAS) at 2, 4, 8, 12 and 24 hrs. Patients were given rescue analgesic on demand. Sedation score and total numbers of analgesics during first 24 hours postoperatively were noted. Results. Gabapentin group resulted in faster onset of motor and sensory block, significantly longer duration of analgesia, substantial reduction in post-operative pain and the rescue analgesics. Patients remained in sleeping but cooperative state and Gabapentin group were not associated with side effects when compared with placebo group. Conclusions. Preemptive use of Gabapentin 600mg orally significantly prolongs the analgesia with reducing postoperative pain and rescue analgesics in patients undergoing total abdominal hysterectomy under spinal anesthesia.

Background Spinal anesthesia is establishing a place in pediatric daycare anesthesia as a possible substitute for general anesthesia in children undergoing infraumbilical abdominal or lower extremity surgeries. Clonidine intensifies the effect of bupivacaine when given intrathecally as an adjuvant. Methods and  Objective of study This is a prospective randomized double-blind study carried out in 60 ASA physical status 1 and 2 (3–13 years) pediatric patients scheduled for infraumbilical abdominal or lower extremity surgeries. Participants were randomly allocated to two groups. Group B received hyperbaric bupivacaine 0.5% alone (0.4 mg/kg for wt. 5–15 kg or 0.3 mg/kg for wt. > 15 kg), and group BC received hyperbaric bupivacaine 0.5% (0.4 mg/kg for wt. 5–15 kg or 0.3 mg/kg for wt. > 15 kg) and preservative-free clonidine (1 μg/kg), comprising 30 patients each. The primary outcome was the measurement of the time of onset of sensory block, the maximum level of sensory block, duration of sensory block, and duration of post-op analgesia. Results The mean onset of sensory block was 3.04 ± 1.5 min in group BC vs. 5.01 ± 0.30 in group B p = 0.0001. The mean onset of motor block was also earlier in group BC 3.81 ± 0.38 min vs. 6.47 ± 4.66 min in group B p = 0.0028. The mean duration of analgesia was 391.33 ± 33 min in group BC vs. 194.5 ± 28 min in group B with a p-value of 0.0001. None of the patients belonging to either group demonstrated a segmental level higher than T5. Conclusions We infer that clonidine is a good adjuvant to bupivacaine in spinal anesthesia in pediatric patients as far as comfort is concerned. It decreases the time taken for onset, has a longer duration of postoperative analgesia, and has a better quality of sedation with no added side effects as compared to bupivacaine alone, in pediatric patients undergoing surgeries below T8 dermatome.