RANDOMIZED COMPARATIVE STUDY OF ANALGESIC EFFICACY OF BUPRENORPHINE AND CLONIDINE AS ADJUVANTS WITH INTRATHECAL BUPIVACAINE IN PATIENTS UNDERGOING TOTAL ABDOMINAL HYSTERECTOMY.

Abstract

Introduction: Understanding pain and continued efforts to alleviate pain is utmost priority perioperatively. Most often pain is underestimated in all age groups. This study is intended to evaluate and compare analgesic efcacy of two drug combinations with local anesthetic agent in spinal anesthesia. In this study efcacy of Clonidine-Bupivacaine, Buprenorphine-Bupivacaine and Bupivacaine is studied in patients undergoing total abdominal hysterectomy. This study was a prospective randomized study conducted on 114 patients age Material and Methods: d 35-60 years who underwent total abdominal hysterectomy at Sri Siddhartha Medical College and Research institute for a period of 24 months.After the approval of institutional ethical clearance committee, 114 ASA I and II patients scheduled for elective total abdominal hysterectomy were selected for study. All the patients were evaluated as per the protocol. The anesthetic procedure was explained to the patients in a simple language and informed consent were obtained. The patients were divided into three groups of 38 each using chit in a box technique. Three groups included Bupivacaine 0.5% hyperbaric (Group B), Clonidine and Bupivacaine 0.5% hyperbaric (Group BC), Buprenorphine and Bupivacaine 0.5% hyperbaric (Group BB). Time of onset of sensory blockade, the height of sensory blockade, motor blockade as per Bromage scale were recorded. Total duration of sensory blockade and motor blockade were also noted. Quality of analgesia (visual analogue score), two segment sensory regression time and time to rst rescue analgesia in 24h were documented. Results:The total duration of analgesia was statistically signicant in all three groups. The mean duration of analgesia was 2.436 ± 0.24h in group B, 2.96 ± 0.32h in group BB and 4.35± 0.62h in group BC. The total duration of motor block was found to be statistically signicant between the groups. Mean duration of motor block was 3.10 ± 0.34h in group B , 3.41 ± 0.25h in group BB, 4.48± 0.19h in group BC. The VAS score was found to be statistically signicant between the groups. It was 4.68 ± 0.47 in group B, 4.92 ± 1.07 in group BB and 4.42± 0.50 in group BC. Clonidine is an effective intrathecal Conclusion: adjuvant to Bupivacaine(H) than Buprenorphine in providing post-operative analgesia and the analgesic efcacy of both Clonidine and Buprenorphine as adjuvants with Bupivacaine(H) were better than Bupivacaine(H) alone.