Intrathecal clonidine added to small-dose bupivacaine prolongs

Abstract

Introduction: The aim of this prospective, double-blinded study was to investigate the effects of clonidine in co-administration with bupivacaine during spinal anesthesia, regarding the onset and regression of motor and sensory block, postoperative analgesia and possible side effects. Methods: We randomly selected 66 male patients (age 35 to 70), from the American Society of Anesthesiologists (ASA) class I-II; these patients were scheduled for transurethral surgical procedures. These patients were randomly allocated into two groups of 33 patients each: group B (bupivacaine) only received 0.5% isobaric bupivacaine 7.5 mg intrathecally and group BC (bupivacaine + clonidine) received bupivacaine 7.5 mg and clonidine 25 µg intrathecally. We performed the spinal anesthesia at a level of L3-L4 with a 25-gauge needle. We assessed the sensory block with a pinprick, the motor block using the Bromage scale, analgesia with the visual analog scale and sedation with the modified Wilson scale. We also recorded the hemodynamic and respiratory parameters. Results: The groups were demographically similar. The mean time of achievement of motor block (Bromage 3) and sensory block at level T9 was significantly shorter in the BC group compared with B group (p = 0.002, p = 0.000, respeectively). The motor block regression time was not significantly different between the two groups (p = 0.237). The postoperative analgesia requirement was significantly longer in group BC compared with group B (p = 0.000). No neurological deficit, sedation or other significant adverse effects were recorded. Conclusion: The intrathecal application of clonidine in combination with bupivacaine improves the duration and quality of spinal anesthesia; it also provides longer duration of postoperative analgesia, without significant side effects.

Comparison of Effect of Clonidine Added to Bupivacaine-Fentanyl Mixture on the Quality of Spinal Anaesthesia and Peri-Op Analgesia with Bupivacaine-Fentanyl or Bupivacaine-Clonidine Mixture in Major Orthopaedic Lower Limb Surgeries

“…We found the time of onset of sensory and motor blockade to be significantly less in patients who were given intrathecal clonidine. Similar results were observed by Strebel et al, 8 and Gecaj-Gashi et al, 9 who reported shorter onset of sensory and motor block in patients receiving intrathecal clonidine.…”

“…This could be explained by adequate preloading which was performed in all the patients prior to subarachnoid block. In addition, the dose used in our study was small (30 μg), and the mean level of anaesthesia achieved was T [8][9] . Our results are similar to those of Singh et al who observed no significant difference in HR and blood pressure in patients receiving 30 μg and 50 mcg of clonidine intrathecally undergoing cesarean section 13 .…”

“…The duration of effective spinal anaesthesia was defined as the period from the spinal injection to the first occasion when the patient complained of pain in the postoperative period. Surgery was allowed to commence on achieving adequate sensory block height (T [8][9] ). Sensory block was recorded 5, 10, 15, and 20 min after intrathecal injection and subsequently every 15 min.…”

Comparing spinal anesthesia approaches for transurethral lithotripsy in patients with proximal ureteral stones: A randomized clinical trial of bupivacaine alone versus bupivacaine with fentanyl

“…Lower doses of intrathecal bupivacaine caused a reduction in the number of blocked dermatomes, and the duration of SA was reported. The co-administration of other adjuvant drugs can reduce the required bupivacaine dose and improve the quality of SA [3]. Several studies have reported improved surgical outcomes by including fentanyl, a lipophilic opioid, in spinal anesthesia [6,[14][15][16][17][18][19][20].…”

“…It is the first and standard choice for many urological surgeries. It is also commonly used in transurethral surgeries, making it easy to detect the symptoms of overhydration, bladder perforation, and transurethral resection of prostate (TURP) syndrome [3]. There is a tendency to perform transurethral lithotripsy (TUL) with SA due to fewer complications than general anesthesia [2,4].…”