Epidural Clonidine as an Adjuvant to Local Anesthetic in Lower Abdominal and Lower Limb Surgeries: A Randomised Controlled Study

Abstract

Background: Acute pain leads to adverse physiological and psychological disturbances. Hence, this study was done to evaluate and compare the onset and duration of sensory anesthesia, motor paralysis and duration of analgesia using 0.5% plain bupivacaine, with clonidine (2μg/kg) in patients posted for lower abdominal and lower limb surgeries under epidural anaesthesia. Materials and methods: 62 Patients posted for elective lower abdominal, gynaecological and lower limb surgeries under epidural anesthesia, aged 18 to 60 years, height more than 150 cms of ASA physical status 1 or 2 were included. All patients were randomized into two groups of 31 individuals each. Results: Clonidine in the dose of 2μg/kg added to bupivacaine injected into epidural space significantly prolonged the duration of analgesia when compared to bupivacaine alone. No effect on the onset of sensory and motor blockade was observed. However, it increases the duration of motor blockade. Clonidine also has effect on sedation level, pulse rate and mean arterial blood pressure. Conclusion: Clonidine causes increased sedation; fall in pulse rate and mean arterial blood pressure, which however, did not require active intervention in this study.

Comparative study of intrathecal bupivacaine and bupivacaine with clonidine to assess degree of sensory and motor effect and postoperative analgesia in lower limb orthopedic surgeries

“…H Saxena et al (2009) [12] et al also emphasized that mean time of duration of sensory block was significantly longer in clonidine groups in a dose dependent manner compared to control. In accordance to our findings, Arora R et al (2018) [10] also agreed from their study that the mean duration of sensory block was significantly longer in Group II (bupivacaine 12.5 mg with 15 mcg) and Group III (bupivacaine 12.5 mg with clonidine 30 mcg intrathecally) than in Group I (12.5 mg bupivacaine).…”

“…Arora R et al 2018 [10] and Sethi BS et al 2007 [7] also had convincing results as per ours regarding duration of analgesia suggesting longer time to request for rescue analgesic in clonidine group than the control group. Sedation was higher in clonidine with bupivacaine group than plain bupivacaine but was insignificant which can be because of slow intravenous absorption.…”

“…Similarly, on comparing the mean duration of motor block between both the groups, significant longer motor blockade was seen in group C (213.54 ± 19.08 mins) as compared to group B (160.86 ± 13.65 mins) ( p <0.0001) Arora R et al (2018) [10] concluded that the duration of motor block was longer in Group III (bupivacaine 12.5 mg with clonidine 30 mcg intrathecally) and group II(bupivacaine 12.5 mg with 15 mcg) in comparison to Group I (12.5 mg bupivacaine), but statistically significant.…”

“…Similarly Arora et al 2018 [10] found mean time of onset of motor block was faster in groups with clonidine and bupivacaine as compared with groups with bupivacaine alone, this difference was however not significant. According to Saxena H et (2009) [12] al, the onset of motor block in clonidine groups with different doses was faster but statistically insignificant.…”

“…Group C (mean 2.82 ± 0.72 minutes) had early onset of sensory blockage at T12 level than group B (mean 3.21 ± 0.88 minutes) but was statistically insignificant. (p>0.05) Arora R et al (2018) [10] in their study discovered that the mean time to onset of sensory block was shorter in Group III (12.5 mg bupivacaine with 30 mcg clonidine) than in Group II (bupivacaine 12.5 mg with clonidine 15 mcg) and in Group I(bupivacaine alone intrathecally). The difference in mean time of the onset of the sensory block between Group II and Group III was not significant.…”