Comparison of effect of intrathecal dexmedetomidine and clonidine as an adjuvant to hyperbaric bupivacaine in patients undergoing surgery for fracture femur and tibia

Abstract

Background: Spinal anaesthesia with bupivacaine is administered routinely for lower abdominal and lower limb surgeries. The ensuing nerve block is sufficient to ensure patient’s wellbeing, while motor block facilitates the surgeon’s work. Post-operative pain relief can be achieved by various methods namely systemic opioid and non-opioid peripheral nerve blocks and local wound infiltration, each with their own merits and demerits. the present study was undertaken to compare the effect of intrathecal dexmedetomidine and clonidine as an adjuvant to hyperbaric bupivacaine in patients undergoing surgery for fracture femur and tibia.Methods: 80 patients between 20-60 years, undergoing elective surgery for closed fracture shaft of femur and tibia with ASA physical status of 1 and 2 were included in the study. All the subjects were randomly allocated to one of the two groups (Group C and Group D) by a computer-generated randomization chart. Group C received 2.5ml of 0.5% hyperbaric bupivacaine with 50mcg clonidine and group D received 2.5ml of 0.5% hyperbaric bupivacaine with 5mcg dexmedetomidine.Results: 30 of the 40 patients in group C were of ASA I and 10 were ASA II, while in group D, 25 were ASA I and 15 were ASA II. A significant difference was found in the onset time for sensory and motor block, receding time for sensory and motor block and the need of the first rescue analgesia between the two groups, showing that Dexmedetomidine was more potent than clonidine.Conclusions: Dexmedetomidine is a potent, highly selective and specific α2-adrenoreceptor agonist that has both sedative and analgesic effects and is also a valuable adjuvant when regional anaesthesia is incorporated.

A Comparative Study of Intrathecal Dexmedetomidine and Clonidine as an Adjuvant to Hyperbaric Bupivacaine in Surgeries for Fracture Femur and Tibia

“…4 We found a decrease in onset time of motor block after adding dexmedetomidine as compared to clonidine as measured by Bromage scale, the dfference being significant. Our findings are in accordance with Chandra et al 1 and Singh et al 10 and in contrast to Kanazi et al 4 The mean duration of receding time of sensory and motor block showed an increased duration of sensory block in dexmedetomidine group as compared to clonidine group. The difference between the groups was significant (P<0.05).…”

“…4 In the present study, it was found that, adding dexmedetomidine to bupivacaine decreased the time of onset of sensory block up to T10 level. These findings were similar to Chandra et al and Singh et al 1,10 However our findings were different from Kanazi et al who found that the onset of sensory block upto T10 level was faster for clonidine group (7.6 ± 4.4 mins) as compared to dexmedetomidine group (8.6±3.7 mins), but the difference found was not significant. 4 We found a decrease in onset time of motor block after adding dexmedetomidine as compared to clonidine as measured by Bromage scale, the dfference being significant.…”

“…Our findings are similar to Chandra et al, Kanazi et al and Singh et al who concluded that dexmedetomidine produced significantly longer duration of sensory block as compared to clonidine. 1,4,10 The duration of request for supplemental analgesia was more in Dexmedetomidine group. This is in accordance with Chandra et al and Singh et al 1,10…”

“…Preoperative evaluation with complete history, clinical examination and routine investigations were carried out on all the patients. One hour before surgery, pre-operative 1 sedation was given with injection butorphanol 1mg + Injection promethazine 12.5mg. With a 25G spinal needle subarachnoid block was given in sitting position.…”

“…The concurrent injection of alpha-2 adrenergic agonist drugs improves the nerve block characteristic of local anaesthetics through either local vasoconstriction and facilitation of C fibre blockade or spinal action caused by retrograde axonal transport or simple diffusion along the nerve. [1][2][3] Clonidine and dexmedetomidine are selective α-2 adrenergic agonists with some α-1 agonist property. Local anesthetic, bupivacaine, is the most common agent used for spinal anesthesia but has relatively short duration of action.…”