A Comparative Study of Epidural Bupivacaine-Fentanyl and Bupivacaine-Clonidine for Post operative Pain Relief in Lower Abdominal Surgeries

Abdominal surgery can lead to postoperative pain, organ dysfunctions and lengthy hospital stay due to different neurohumoral changes. If not controlled, postoperative pain may be damaging and costly for the patient, hence there is a need of appropriate therapy for pain management.

To analyze efficacy and safety of 100 μg clonidine and fentanyl as an adjuvant to 20 ml of 0.5% bupivacaine hydrochloride for postoperative pain.

A prospective study was done on 90 patients belonging to American Society of Anesthesiology (ASA) grade I or II, who were referred for major lower abdominal surgery. Patients were randomly divided into three groups (30 patients each) to receive: 2ml of normal saline (Group B) or 100 μg of clonidine (Group BC) or100 μg of fentanyl (Group BF) as an adjuvant to 20 ml of 0.5% bupivacaine hydrochloride. Postoperative pain was assessed over 8 h using Visual Analogue Scale (VAS). The frequency of rescue analgesia, sedation score along with events like nausea, vomiting, shivering or pruritus was also recorded.

Significantly less pain was noted in Group BC compared to Group BF (p<0.05). Duration of analgesia was more in Group BC compared to Group BF (p<0.05). Out of 30 patients in each group, 93.34% in Group B, 90% in Group BC and 86.67% in Group BF had sedation score of zero. Episode of nausea and vomiting were less in all groups. Pruritus was found in 20% patients of Group BF.

Clonidine is better choice as adjuvant to epidural bupivacaine hydrochloride for postoperative pain relief because of prolonged duration of analgesia and less side effects.