Effect of Addition of Clonidine to Intrathecal Bupivacaine on Postoperative Analgesia in Inguinal and Lower Limb Surgeries in Adults

Abstract

BACKGROUND Subarachnoid block with bupivacaine is a popular technique in infra umbilical surgeries. Various adjuvants like clonidine, morphine, buprenorphine, and fentanyl are added to bupivacaine to prolong its duration of action. Clonidine is an alpha 2 adrenergic agonist with analgesic effect at spinal level. This study evaluated the effects of addition of clonidine 60 µgm to intrathecal bupivacaine on postoperative analgesia in inguinal and lower limb surgeries. The primary objective of the study was to assess the duration of postoperative analgesia. METHODS This prospective, randomized, double blind study was conducted among 60 ASA I and II patients posted for inguinal and lower limb surgeries. They were divided into two groups, Group I (clonidine) received subarachnoid block with 2.8ml bupivacaine (heavy) and 60 µgm (0.4ml) clonidine. Group II (control) received subarachnoid block with 2.8ml bupivacaine (heavy) + 0.4ml normal saline. Data was analysed using independent t test and chi-square test. ‘p’ value < 0.05 was considered significant. RESULTS The duration of postoperative analgesia was 384.20 ± 50.571 minutes in Group I as compared to 160.30 ±7.764 minutes in Group II. The time of sensory regression to T10 dermatome was 108.03 minutes in Group I as compared to 79.37 minutes in Group II. Incidence of hypotension, sedation bradycardia and side effects were comparable in both groups. Postoperative requirement of diclofenac injection was significantly lower in Group I compared to Group II. CONCLUSIONS Addition of clonidine to intrathecal bupivacaine significantly increased the duration of postoperative analgesia without significant side effects. KEY WORDS Subarachnoid Block, Intrathecal Bupivacaine, Clonidine, Postoperative Analgesia