Letter to Editor: An inquest into alpha-2 agonists as a better adjuvant to intrathecal bupivacaine

Response to Letter to the Editor Appeared in ( Khan and Karim Ain-Shams Journal of Anesthesiology (2023) 15:78 https://doi.org/10.1186/s42077-023-00378-8)

“…We thank the authors for their knowledgeable comments on our study.we would like to clarify why clonidine was considered better than dexmedetomidine as an intrathecal adjuvant in our study. [1,2] In the study ,the mean onset of sensory block was less than a minute earlier and duration of sensory and motor block was 43-47 min longer in patients when dexmedetomidine was used as an adjuvant over clonidine. Similar results were seen in a meta analysis by Zang C et al where they observed a sensory onset of 40 sec early and an extended duration of stable sensory block of 10.8 min, 22.3 min prolonged duration of overall sensory block, and 38.6 min prolonged need for analgesic requirements where dexmedetomidine was used over clonidine as an adjuvant to local anesthetics.…”

“…Similar results were seen in a meta analysis by Zang C et al where they observed a sensory onset of 40 sec early and an extended duration of stable sensory block of 10.8 min, 22.3 min prolonged duration of overall sensory block, and 38.6 min prolonged need for analgesic requirements where dexmedetomidine was used over clonidine as an adjuvant to local anesthetics. [1] Thus the use of a drug which is 2-3 dollars expensive (drug cost is around 2 dollars more and 1 dollar is the average cost of diluting agent) is debatable especially in third world country like ours when the mean prolongation of duration of analgesia as observed by different researchers is around 11 min to 43 min only and the mean difference in sensory onset time is less than a minute. This cost will be over and above the cost of analgesic drug which will be used in any case after 20-40 min in such scenerio.…”