Effect of adding clonidine versus fentanyl to intrathecal bupivacaine on spinal block characteristics in orthopedic procedures: A double blind controlled study

Abstract

Opioids and local anesthetics administered together intrathecally are known to have synergistic analgesic effects. [1] Fentanyl, a short-acting lipophilic opioid, was administered intrathecally along with local anesthetics by Belzarena. [2] Clonidine, an α 2 adrenergic agonist, has been used as an antihypertensive agent for many years. Recently its desirable anesthetic properties in human have been highlighted, which include reducing anesthetic requirements, improving hemodynamic stability, and providing analgesia. [3-5] The problem of postoperative pain relief seeks utmost attention since past few years. Postoperative pain treatment should be an integral component of the routine surgical and anesthetic management because it helps to reduce morbidity and complications as well as accelerate rehabilitation. [6] Good postoperative analgesia is an important avenue to attenuate the surgical stress response. [7] When local anesthetic bupivacaine is combined with intrathecal clonidine, complete surgical anesthesia could be obtained along with intra-and postoperative pain relief with fewer side effects. [5,8-10] Clonidine has been used as an Background: Various adjuvants have been used in spinal anesthesia to avoid intraoperative visceral and somatic pain and prolonged postoperative analgesia. Clonidine, partially selective α 2-agonist drug, is now being used as a neuraxial adjuvant. Objective: To compare the duration and quality of analgesia of clonidine and fentanyl used as adjuvants to intrathecal bupivacaine. Materials and Methods: American Society of Anesthesiologist grade 1 and 2 patients (90 patients) were randomly divided into three groups of 30 patients each for lower limb orthopedic surgeries. Group A received intrathecal 15 mg hyperbaric bupivacaine and 1 ml normal saline, group B received 15 mg hyperbaric bupivacaine and 1 ml (50 µg) fentanyl, and group C received 15 mg hyperbaric bupivacaine and 1 ml (150 µg) clonidine. The onset and duration of sensory and motor block, quality of analgesia, and the incidence of side effects in three groups were observed and compared. Results: Three groups were compared based on the demographic data, and the onset of sensory block at T 8 level and of motor block was compared among these groups. Significant prolongation of duration of sensory (P = 0.0000001) and motor block (P = 0.0000001) was found in group C. Significant hypotension was found in group C (P < 0.05) and the postoperative pain scoring chart (VAS chart) was 1.07 ± 0.87 in group C and 3.27 ± 0.67 in group B (P < 0.05). Conclusion: Intrathecal clonidine is associated with prolonged motor and sensory block, hemodynamic stability, and low postoperative pain score compared to fentanyl.

Comparison of intrathecal clonidine and fentanyl as adjuvant to hyperbaric bupivacaine in subarachnoid block for lower limb orthopedic surgery

“…They concluded that addition of intrathecal clonidine to hyperbaric bupivacaine was more advantageous than fentanyl with special regard to its analgesic properties. [ 19 ] Singh et al . evaluated the effect of addition of intrathecal clonidine to hyperbaric bupivacaine on postoperative pain after caesarean section and has shown that the duration of postoperative analgesia increases significantly on adding 75 μg clonidine to 2 ml of hyperbaric bupivacaine without any increase in maternal side effects.…”

Comparative Study of Bupivacaine-Fentanyl Versus Bupivacaine-Clonidine in Patients Undergoing Spinal Anaesthesia for Orthopedic Procedures

“…Tilkar et al conducted a prospective study to differentiate between the effects of fentanyl versus clonidine when added to intrathecal bupivacaine in spinal anesthesia. They concluded that addition of intrathecal clonidine to hyperbaric bupivacaine was more advantageous than fentanyl with special regard to its analgesic properties [29] . Singh et al evaluated the effect of addition of intrathecal clonidine to hyperbaric bupivacaine on postoperative pain after caesarean section and has shown that the duration of postoperative analgesia increases significantly on adding 75 μg clonidine to 2 ml of hyperbaric bupivacaine without any increase in maternal side effects.…”

Comparison of the postoperative analgesic effects of intrathecal Clonidine and Fentanyl as adjuvant: Mata Analysis of randomized control trials

“…According to some study, even at higher dose of clonidine (450 µg) only in intrathecal, didn't result muscle weakness and motor block [28] , but combination to spinal bupivacaine caused significant enhancement of the strength and duration of motor block [29,30]. Tilkar et al study compared clonidine and fentanyl added to intrathecal bupivacaine and reached as conclusion of clonidine was more helpful than fentanyl in pain-relieving properties [31].…”