Clinical efficacy of clonidine versus nalbuphine as intrathecal adjuvants to 0.5% hyperbaric bupivacaine for subarachnoid block during gynaecological procedures: a double blind study

Abstract

Background: Regional anesthesia techniques for gynaecological procedures are on increasing trends due to their advantage of postoperative analgesia owing to intrathecal adjuvants. The present study was aimed to comparatively evaluate the clinical efficacy of clonidine with nalbuphine when co-administered intrathecally with 0.5% hyperbaric bupivacaine for gynaecological procedures.Methods: Regional anesthesia techniques for gynaecological procedures are on increasing trends due to their advantage of postoperative analgesia owing to intrathecal adjuvants. The present study was aimed to comparatively evaluate the clinical efficacy of clonidine with nalbuphine when co-administered intrathecally with 0.5% hyperbaric bupivacaine for gynaecological procedures.Results: The onset of sensory block was earlier in patients of Group BN (3.91±2.25 min vs 4.30±0.87 min, p=0.039). The onset of motor block was also earlier in patients of Group BN (p=0.042). The time to first rescue analgesia in patients receiving intrathecal clonidine was significantly delayed (283±14.18 min vs 231.50±26.18 min, p=0.001). Intraoperative hemodynamic changes were comparable and none of the patient suffered from respiratory depression, shivering, nausea or vomiting.Conclusions: Intrathecal clonidine as adjuvant to bupivacaine provided was clinically more effective than nalbuphine for prolonging the duration of analgesia for gynaecological procedures.

A Comparative Study of Clonidine Versus Nalbuphine as Intrathecal Adjuvants to 0.5% Hyperbaric Bupivacaine During Lower Abdominal Surgeries – A Randomized Double Blind Interventional Study.

“…In the present study, the clonidine and nalbuphine were used as intrathecal adjuvant to hyperbaric bupivacaine, which revealed that statistically highly significant difference for onset of sensory block (p<0.001) and onset of motor block (p<0.001) between both the groups. The onset of sensory and motor blockade was earlier with intrathecal nalbuphine while duration of motor blockade was more prolonged by intrathecal clonidine as compared to intrathecal nalbuphine which was statistically highly significant (p<0.001), these results were also similar found by Bansal M. et al (9) These effects showed synergism between bupivacaine and intrathecal adjuvants.…”

“…In present study, the mean time to two segment regression and time to first rescue analgesic request was significantly delayed in patients of clonidine group when compared to nalbuphine group. Similar results were also observed by Bansal M. et al (9) and Chetty D.K. et al (10) This was also in accordance to the study of Tilker Y et al (5) , Elia N et al (2) and Stebral S et al (4) who also reported that the time taken for regression of sensory block and time of first rescue analgesia were statistically more in patients of clonidine group than 0.5% bupivacaine alone and to the study of Clubras X et al (3) and Fareed A. et al (7) who were found that the time of two segment regression and time of first rescue analgesia also prolonged with intrathecal nalbuphine as compared to control group.…”

“…Thus our study demonstrated that clonidine produce longer duration of post-operative analgesia when compared to nalbuphine with comparable minimal hemodynamic changes and adverse effects which was supported by Bansal M. et al (9) and Chetty D.K. et al…”

Comparison of intrathecal nalbuphine hydrochloride and clonidine hydrochloride as an adjuvant to hyperbaric bupivacaine in abdominal hysterectomy

“…However, it is comparable between nalbuphine and clonidine while Bansal et al . [ 23 ] demonstrated faster onset of sensory and motor block due to nalbuphine.…”

“…The present study demonstrated no clinically significant difference in the hemodynamic parameters and adverse effects (nausea, vomiting, and pruritus) among the three groups, supported by Bansal et al . [ 23 ] Low-dose clonidine is not associated with hemodynamic instability as evidenced by Dutta et al . [ 21 ] Opioid-related side effects were not encountered significantly in nalbuphine group due to its mu (μ)-antagonist property.…”