Opioids and local anesthetics administered together intrathecally are known to have synergistic analgesic effects. [1] Fentanyl, a short-acting lipophilic opioid, was administered intrathecally along with local anesthetics by Belzarena. [2] Clonidine, an α 2 adrenergic agonist, has been used as an antihypertensive agent for many years. Recently its desirable anesthetic properties in human have been highlighted, which include reducing anesthetic requirements, improving hemodynamic stability, and providing analgesia. [3-5] The problem of postoperative pain relief seeks utmost attention since past few years. Postoperative pain treatment should be an integral component of the routine surgical and anesthetic management because it helps to reduce morbidity and complications as well as accelerate rehabilitation. [6] Good postoperative analgesia is an important avenue to attenuate the surgical stress response. [7] When local anesthetic bupivacaine is combined with intrathecal clonidine, complete surgical anesthesia could be obtained along with intra-and postoperative pain relief with fewer side effects. [5,8-10] Clonidine has been used as an Background: Various adjuvants have been used in spinal anesthesia to avoid intraoperative visceral and somatic pain and prolonged postoperative analgesia. Clonidine, partially selective α 2-agonist drug, is now being used as a neuraxial adjuvant. Objective: To compare the duration and quality of analgesia of clonidine and fentanyl used as adjuvants to intrathecal bupivacaine. Materials and Methods: American Society of Anesthesiologist grade 1 and 2 patients (90 patients) were randomly divided into three groups of 30 patients each for lower limb orthopedic surgeries. Group A received intrathecal 15 mg hyperbaric bupivacaine and 1 ml normal saline, group B received 15 mg hyperbaric bupivacaine and 1 ml (50 µg) fentanyl, and group C received 15 mg hyperbaric bupivacaine and 1 ml (150 µg) clonidine. The onset and duration of sensory and motor block, quality of analgesia, and the incidence of side effects in three groups were observed and compared. Results: Three groups were compared based on the demographic data, and the onset of sensory block at T 8 level and of motor block was compared among these groups. Significant prolongation of duration of sensory (P = 0.0000001) and motor block (P = 0.0000001) was found in group C. Significant hypotension was found in group C (P < 0.05) and the postoperative pain scoring chart (VAS chart) was 1.07 ± 0.87 in group C and 3.27 ± 0.67 in group B (P < 0.05). Conclusion: Intrathecal clonidine is associated with prolonged motor and sensory block, hemodynamic stability, and low postoperative pain score compared to fentanyl.
Etomidate and propofol are two common anaesthetic drugs. Etomidate can be used in patients with little hemodynamic reserve, whereas Propofol can result in more hemodynamic instability, according to prior research. During the induction of anaesthesia with Etomidate or, as a comparison, Propofol in elective surgeries, the cardiovascular response was examined in this study. Patients who were admitted for elective surgeries and ranged in age from 18 to 60 were included in this cross-sectional observational study. The cardiovascular responses of 50 (47) patients were assessed prior to induction, after the induction of anaesthesia with drugs, and at 1, 3, 5, and 10 minutes following the laryngoscopy. These measurements included systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), and O2 saturation (O2 sat). In terms of patient gender, age, and weight, there were no statistically significant differences between the two groups. At different times, changes in groups I and II's SBP, DBP, MAP, and HR were statistically significant. There were no discernible differences between groups I and II in terms of O2 saturation. Conclusion: Because Etomidate-treated patients have improved hemodynamic stability, it may be preferable to Propofol for general anaesthesia in the absence of contraindications.
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