Intrathecal clonidine as an adjuvant to hyperbaric bupivacaine in patients undergoing inguinal herniorrhaphy: A randomized double-blinded study

Background and Aims:Mixing adjuvants with hyperbaric bupivacaine in a single syringe before injecting the drugs intrathecally is an age old practice. In doing so, the density of the hyperbaric solution and also of the adjuvant drugs may be altered, thus affecting the spread of drugs. Administering local anaesthetic and the adjuvants separately may minimise the effect of the changes in densities. We aimed to compare block characteristics, intraoperative haemodynamics and post-operative pain relief in parturients undergoing caesarean section (CS) after administering hyperbaric bupivacaine and clonidine intrathecally as a mixture and sequentially.Methods:In this single-blind prospective randomised controlled study at a tertiary care centre from 2010 to 12, 60 full-term parturients scheduled for elective CSs were divided into two groups on the basis of technique of intrathecal drug administration. Group M received mixture of clonidine (75 mcg) and hyperbaric bupivacaine 0.5% (10 mg) intrathecally, whereas Group B received clonidine (75 mcg) followed by hyperbaric bupivacaine 0.5% (10 mg) through separate syringes. Observational descriptive statistics, analysis of variance test, Wilcoxon test and Chi-square test were used as applicable.Results:Duration of analgesia was significantly longer in Group B (474.33 ± 20.79 min) in which the drug was given sequentially than in Group M (337 ± 18.22 min). Furthermore, the time to achieve highest sensory block and complete motor block was significantly less in Group B without any major haemodynamic instability and neonatal outcome.Conclusions:When clonidine and hyperbaric bupivacaine were administered in a sequential manner, block characteristics improved significantly compared to the administration of the mixture of the two drugs.

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“…[45] Several studies have shown that clonidine also has antihyperalgesic effect and thus reduces the post-operative analgesic requirement. [6]…”

Section: Introductionmentioning

confidence: 99%

Intrathecal clonidine with hyperbaric bupivacaine administered as a mixture and sequentially in caesarean section: A randomised controlled study

2014

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“…Thakur et al in India reported that 15 μg and 30 μg of clonidine increased the time to regression of sensory block by the two dermatomes, sensory recovery in L3 and mean time to motor recovery; yet the 15 μg dosage was associated with less drop in mean systolic BP ( 11 ). Dobrydnjov in 2003 that 15 μg and 30 μg of clonidine were not significantly different in terms of duration of motor block ( 7 ).…”

Section: Discussionmentioning

confidence: 99%

“…Clonidine has been assumed to have an inhibitory effect on afferent neurons in the posterior spinal horn, which may be due to the activation of noradrenergic descending pathways. Many studies have suggested administration of 15 - 75 µg, and 0.75, 1 and 2 µg/kg doses of clonidine with no serious complications in children and adults ( 7 - 11 ).…”

Section: Introductionmentioning

confidence: 99%

Effect of Addition of Clonidine to Bupivacaine in Spinal Anesthesia on Analgesia After Cruciate Ligament Repair: A Randomized Double-Blinded Clinical Trial

et al. 2015

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Background:Several researchers have suggested that addition of local anesthetics to spinal anesthesia increases the duration of post-operative analgesia.Objectives:This study sought to assess the effect of addition of clonidine to bupivacaine in spinal anesthesia on analgesia after cruciate ligament repair.Patients and Methods:This double-blind clinical trial was conducted on 50 American Society of Anesthesiologists (ASA) class I or II patients who were candidates for cruciate ligament repair. Patients were randomly assigned to two groups; one group received 15 mg of bupivacaine (group B) and the other 15 mg of bupivacaine plus clonidine (75 µg, group BC). The two groups were compared in terms of post-operative analgesia and related factors using the SPSS software version 20.Results:All patients were males with a mean age of 24.9 years in group B, and 25.2 years in group BC (P > 0.05). In group BC, time lapse to request analgesics was 160 minutes longer and the Visual Analog Scale (VAS) at this time was 0.3 units less than group B. The time to regression of sensory block by two dermatomes was seven minutes longer, VAS in the recovery room was 1 unit less and Bromage scale in the recovery room and ward was 0.6 and 0.9 units more, respectively in the BC group. Hypotension and ephedrine usage was 36% more in the BC group (P < 0.05).Conclusions:Clonidine plus bupivacaine can increase the duration of motor and sensory block in arthroscopic cruciate ligament repair under spinal anesthesia. However, due to significant hemodynamic changes, further studies are required to determine a safer dose.

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“…Sensorial block levels of patients were evaluated with the “pin-pick” test applied in 5 min intervals. A Modified Bromage Scale 5 was used to evaluate the motor block.…”

Section: Methodsmentioning

confidence: 99%

Ultrasound-guided evaluation of the lumbar subarachnoid space in lateral and sitting positions in pregnant patients to receive elective cesarean operation

Ucarli¹,

Türkay²,

Nadir³

et al. 2014

Pak J Med Sci

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Background and Objective:The aim was to compare visibility of the spinal space in sitting and lateral positions, number of attempts, spinal needle depth, skin-dura mater distance and the possible complications; in application of spinal anesthesia, using ultrasound in pregnant patients scheduled to receive elective cesarean operations.Methods:The study was conducted prospective-randomly after receiving approval from the ethics committee and the patients’ permission. ASA I-II 50 pregnant patients were divided into two groups. The patients in Group SP were those placed in a sitting position and the patients in Group LP were those placed in a lateral position. In both groups, the skin-dura mater distance was recorded through an out-of plane technique accompanied by ultrasound. The depth of the spinal needle was measured. The number of attempts, the level of attempts recorded. The degree of visibility of the vertebral space was observed through ultrasound and was numerically scored. Intraoperative and postoperative complications were recorded.Results: There was no difference between the number of attempts, Modified Bromage Scale and mean measurements of skin-dura mater distance observed through ultrasound. The mean needle depths of Group LP were statistically found significantly higher than Group SP (p=0.002).Conclusion:Our study supports the notion that access to the skin-dura mater distance is longer in the lateral decubitus position when skin-dura mater distance is evaluated by measuring needle depth.

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Intrathecal clonidine as an adjuvant to hyperbaric bupivacaine in patients undergoing inguinal herniorrhaphy: A randomized double-blinded study

Cited by 37 publications

References 13 publications

Intrathecal clonidine with hyperbaric bupivacaine administered as a mixture and sequentially in caesarean section: A randomised controlled study

Intrathecal clonidine with hyperbaric bupivacaine administered as a mixture and sequentially in caesarean section: A randomised controlled study

Effect of Addition of Clonidine to Bupivacaine in Spinal Anesthesia on Analgesia After Cruciate Ligament Repair: A Randomized Double-Blinded Clinical Trial

Ultrasound-guided evaluation of the lumbar subarachnoid space in lateral and sitting positions in pregnant patients to receive elective cesarean operation

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