COMPARATIVE STUDY OF 0.5% BUPIVACAINE AND 0.5% BUPIVACAINE WITH CLONIDINE (30μg) FOR SPINAL ANAESTHESIA

Abstract

ABSTRACT:In the present day practice of Anesthesiology, bupivacaine is the most commonly used drug for spinal anesthesia. To improve upon the quality of analgesia and prolong the duration of its action, many adjuvants have been tried. Intrathecal clonidine an α2 adrenceptor agonist has potent central antinoceptive properties with analgesic effect at spinal level mediated by postsynaptically situated adrenoreceptor in dorsal horn of spinal cord. Low doses of clonidine have shown effectiveness in intensifying spinal anesthesia. Hence this study was done in our institute to evaluate the efficacy of spinal anesthesia with clonidine added to hyperbaric bupivacaine in elective lower limb, lower abdominal, gynaecological and urological surgeries under spinal anaesthesia. This prospective, single center parallel group, double blind study conducted over a span of 1 year with 100 patients, was effective in proving that Clonidine potentiates bupivacaine spinal anesthesia by increasing the duration and improving the quality of analgesia without producing significant hemodynamic side effects and with mild sedation. KEYWORDS: Alpha 2 agonist, 0.5% Bupivacaine, Clonidine as adjuvant, Effective analgesia. INTRODUCTION:Spinal anesthesia, defined as the regional anesthesia obtained by blocking nerves in the subarachnoid space is a popular and common technique used worldwide. The advantages of an awake patient, simple to perform, offers rapid onset of action, minimal drug cost, relatively less side effects and rapid patient turnover has made this the choice of many a surgical procedure. 1 These advantages are sometimes offset by relatively short duration of action and uncomfortable postoperative period when its action wears off. In order to extend intraoperative analgesia into postoperative period a number of spinal adjuvants like opioids, clonidine, ketamine, morphine and buprenorphine and so on have been added to prolong intrathecal bupivacaine action.Recently clonidine which is an α2 adrenergic agonist has been tried as an adjuvant to prolong the action of local anesthetics. Intrathecal clonidine produces dose dependent analgesia and has been successfully used as a sole analgesic via the intrathecalroute. 2 hence, this study was designed to evaluate the effectiveness of adding30μg clonidine to bupivacaine for spinal anesthesia and to compare its use with that of bupivacaine.