Postoperative analgesia after panhysterectomy, addition of clonidine to bupivacaine: Boon for the patients

Abstract

Introduction:Postoperative period after panhysterectomy is very painful as there is too much tissue handling. In the practice of regional anesthesia neuraxial, opioids have been used extensively as an adjuvant to bupivacaine to enhance the potency and duration of sensory and motor block produced by bupivacaine with satisfactory results. However, delayed respiratory depression by opioids has prompted further research to develop nonopioid analgesics. This study was undertaken to assess the degree of sensory and motor block and postoperative analgesia provided by low dose 50 μg intrathecal clonidine admixed with 0.5% hyperbaric bupivacaine as compared to bupivacaine alone in patients undergoing a total abdominal hysterectomy.Materials and Methods:Hundred adult patients of American Society of Anesthesiologist Class 1 and 2 were randomly allocated to Group A and Group B. Group A patients received 15 mg 0.5% hyperbaric bupivacaine with 50 μg clonidine intrathecally. Group B patients received 15 mg 0.5% hyperbaric bupivacaine with normal saline.Observation and Results:The mean duration of motor block was significantly higher in Group A (270.80± 66.0 min) as compared to Group B (184.60 ± 72.03 min), with statistically significant difference. There was also statistically significant difference in the duration of sensory block between Group A (290.20 ± 80.27 min) and Group B (190.83 ± 86.90 min). The duration of postoperative analgesia was significantly higher in Group A as compared to Group B (541.06 ± 130.64 min and 252.80 ± 84.10 min respectively).Conclusion:Addition of intrathecal clonidine 50 μg to bupivacaine (15 mg, 0.5%) prolongs the duration of sensory and motor block and duration of analgesia, thus produces an effective spinal anesthesia and good postoperative analgesia for longer duration and reduced postoperative analgesic requirement.

Effect of clonidine on the cutaneous silent period during spinal anesthesia

“…The results of our study show that intrathecal administration of levobupivacaine with added clonidine in comparison to levobupivacaine alone yields a significantly shorter CSP and longer CSP latency during block regression after SAB application (Table 2). It is known that intrathecal administration of small doses of clonidine (15-50 μg) as an adjuvant to local anesthetics in inguinal hernia repair surgery and hysterectomy can prolong the motor and sensory blockade as well as the duration of analgesia in comparison to local anesthetics alone, without significant differences in hemodynamic parameters (MAP and HR)[9,10,22,23]. In our study, we used a dose of 50 μg of clonidine in order to achieve a prolongation of the SAB, and showed the effects of intrathecal clonidine on the CSP without significant hemodynamic disturbances.…”