The Effect of Clonidine on Hemodynamics, Recovery and Post-Operative Pain in Laparoscopic Gynaecological Surgeries: A Comparative Study Involving Two Routes of Administration

Laparoscopy requires creation of a pneumoperitoneum which produces a significant rise in heart rate, mean arterial pressure, reduction in venous return and systemic vascular resistance. Various pharmacologic agents are used to control hemodynamic changes associated with pneumoperitoneum.

To compare the effects of Clonidine administered intravenously (group IV) and intraperitoneally (group IP) on hemodynamics, recovery and post-operative pain in patients undergoing elective laparoscopic gynaecological surgeries.

Randomized controlled trial.

Sixty patients undergoing elective laparoscopic gynaecological surgeries were selected. General anaesthesia was administrered in all cases. After inserting ports Group IV: received Clonidine 1μg/kg i.v along with Ropivacaine 0.25% 20cc intraperitoneally using a ryles tube introduced and directed towards hepatophrenic recess Group IP: received Clonidine 1μg/kg along with Ropivacaine 0.25% 20cc.intraperitoneally Vitals weremonitored every 30min during the procedure. Postoperatively oxygen saturation, heart rate, and blood pressure weremonitored. Aldrete recovery scoring system was used to assessreadiness for discharge. When the score was>8, and pain was monitored using VAS scoring in lying and sitting posture next 12hours.

Continous data was analysed using student t-test while categorical data was analysed using fisher's exact test and chi square test.

Intravenous Clonidine significantly reduced the MAP (group IP: 80.5±6.7, group IV: 67.44±5.6) during intraoperative period while intraperitoneal group showed reduced MAP in postoperative period (group IP: 75.98±7.35, group IV: 83.36±17.05). Heart rate both during intraoperativeperiod (group IP: 63.2±6.35, group IV: 77.6±9.35) and postoperative period (group IP: 75.6±7.35, group IV: 83.36±17.05) showed significant decrease in intraperitoeal group. Intraperitoneal Clonidine showed better hemodynamic control by maintaining heart rate and MAP postoperatively and better recovery profile in the form of VAS Scoring(2.0±0.618 p value <0.05) and time to request first rescue analgesia(6.567±0.9 p value <0.05).

Clonidine when added to ropivacaine (0.25%) intraperitoneally provide better hemodynamic control and prolonged analgesia with less side effects than intravenous clonidine.