A Comparative Study of Bupivacaine and Bupivacaine With Clonidine Under Spinal Anesthesia in Patient for Total Abdominal Hysterectomy

Abstract

BACKGROUND:Bupivacaine is the most commonly used drug for spinal anesthesia. To improve upon the quality of analgesia and prolong the duration of its action, many adjuvants have been tried. Intrathecal clonidine an α2 adrenoreceptor agonist with analgesic effect at spinal level mediated by postsynaptically situated adrenoreceptor in dorsal horn of spinal cord. Low doses of clonidine and buprenorphine have shown effectiveness in intensifying spinal anesthesia. AIM: This study is designed to evaluate the effectiveness of spinal blockade by adding 50µgm clonidine to bupivacaine. SETTINGS AND DESIGN: This a prospective, randomized, comparative clinical study involved 60 ASA grade Ι/ΙΙ patients aged 18-55 years undergoing elective hysterectomy under spinal anesthesia after approval from hospital ethics committee with written and informed consent of patients. MATERIALS AND METHODS: 60 ASA grade Ι/ΙΙ patients aged 18-55 years selected for the study are divided in two groups of 30 each. Group B (Bupivacaine group) patients will receive intrathecally 0.5% hyperbaric bupivacaine 4 ml (Total 4 ml) whereas Group C (Clonidine group) patient will receive intrathecally 0.5% hyperbaric bupivacaine 3. 5 ml + 50µg (Total 4 ml). The onset time to reach peak sensory and motor level, post-operative analgesia, hemodynamic changes, and side effects were recorded. RESULTS: The onset of sensory and motor blockade was faster in the group C compared to group B [137.60 seconds and 112.22 seconds] (p<0.001), [231.80 seconds and 165.1 seconds] (p<0.001). Duration of sensory block, motor block and postoperative analgesia [221.4 minutes in group B vs. 362.84 minutes in group C] (P<0.001), was significantly prolonged in group C. There were no significant hemodynamic changes in both the groups. CONCLUSION: Clonidine potentiates bupivacaine spinal anesthesia by increasing the duration and improving the quality of analgesia without significant hemodynamic side effects.