The efficacy and safety of epidural dexmedetomidine and clonidine with bupivacaine in patients undergoing lower limb orthopedic surgeries

Abstract

Background and Aims:Alpha (α-2) adrenergic agonists have both analgesic and sedative properties when used as an adjuvant in regional anesthesia. A prospective randomized double-blind study was carried out to evaluate the efficacy of epidural route and to compare the efficacy and clinical profile of dexmedetomidine and clonidine as an adjuvant to bupivacaine with special emphasis on their quality of analgesia, sedation and the ability to provide the smooth intra-operative and postoperative course.Material and Methods:The study was conducted in prospective, randomized and double-blind manner. It included 60 American Society of Anesthesiologists Class I and II patients undergoing lower limb surgery under epidural anesthesia. Patients were randomly divided into Group A receiving 0.5% isobaric bupivacaine 15 ml with dexmedetomidine 1 μg/kg and Group B receiving 0.5% isobaric bupivacaine 15 ml with clonidine 2 μg/kg epidurally. Onset and duration of sensory and motor blocks, duration of analgesia, sedation, and adverse effects were assessed.Results:Demographic data, surgical characteristics cardio-respiratory parameters, side-effect profile were comparable and statistically not significant in both the groups. However, sedation scores with dexmedetomidine were better than clonidine and turned out to be statistically significant. The onset times for sensory and motor blocks were significantly shorter in Group A as compared to Group B. The duration of analgesia and motor block was significantly longer in A Group as compared to Group B.Conclusion:Dexmedetomidine is a superior neuraxial adjuvant to bupivacaine when compared to clonidine for early onset of analgesia, superior intra-operative analgesia, stable cardio-respiratory parameters, prolonged postoperative analgesia and providing patient comfort.

Comparative Study of Epidural Dexmedetomidine with Clonidine as Adjuvant to Isobaric Ropivacaine in Abdominal Hysterectomy

“…Our study has shown that the addition of either 1.5μg/kg dexmedetomidine or 2μg/kg clonidine as adjuvant to epidural Ropivacaine improves the quality of anesthesia and efficacy of local anaesthetic agent, which was supported by the previous studies. 11,12,13 Onset and peak levels of analgesia provided by both drugs dexmeditomidine> Clonidine) were statistically significant in our study which was in concordance with the observations of Bajwa et al 11 Unlike our study Salgado et al 13 and Shaikh SI et al 14 found no statistical significance in the onset and peak levels of analgesia provided by both drugs. But it has to be noted that the dose used by them for the study was less than ours.…”

“…But it has to be noted that the dose used by them for the study was less than ours. Our study showed statistically significant sedation score in the Dexmeditomidine group (RD) compared to the other groups which was similar to findings of the Bajwa SJ et al 11 , Saravana Babu M et al 12 ,Shaikh SI et al 14 andSchnaider TB et al 15 ,…”

“…Similar hemodynamic & respiratory findings were observed in other studies also. [11][12][13][14][15][16][17] Post operative block characteristics like Time to 2 segment regression, Regression to bromage 1, Time to first rescue top up and comparison of total dose of bupivacaine required for post operative analgesia were all better in the Dexmeditomidine group. These findings were similar to those of Bajwa et al and Salgado et al There is statistically significant difference in maximum pain score attained over 24hrs between Ropivacaine & Ropivacaine-Dexmeditomidine groups.…”

A Comparative Study of Dexmedetomidine and Clonidine in Epidural Anaesthesia With Ropivacaine for Lower Abdominal and Lower Limb Surgery

“…Although clonidine dose (2 µg/kg) used was higher than dexmedetomidine (1 µg/kg) it resulted in lesser motor blockade and sedation scores. 11 However, the haemodynamic parameters compared between the two groups were similar and statistically insignificant. 11 A study was conducted using 1 µg/kg of dexmedetomidine or clonidine in addition to epidural ropivacaine (15 ml) and they observed to have statistically insignificant difference with respect to haemodynamic parameters and motor blockade.…”

A Prospective Randomized Double Blind Study on Efficacy of Dexmedetomidine and Ketamine as Adjuvant to Epidural Ropivacaine in Lower Abdominal and Lower Limb Surgery

“…[12] Shaikh et al opined that dexmedetomidine is a superior neuraxial adjuvant to bupivacaine when compared to clonidine for early onset of analgesia,stable cardio-respiratory parameters and prolonged postoperative analgesia. [13] Bajwa et al studied dexmedetomidine and clonidine, in epidural anaesthesia and concluded that dexmedetomidine is a better neuraxial adjuvant compared to clonidine for providing early onset of sensory analgesia, prolonged post operative analgesia and adequate sedation. [14] The above studies supports our finding that dexmedetomidine as adjuvant to local anesthetics provides both early onset of block and prolongs the duration of analgesia.Vaidya et al carried out a prospective double blind study to see whether the sympathomimetic effect of intrathecal ketamine attenuates bupivacaine induced hypotension and bradycardia.…”