Intrathecal Clonidine with Hyperbaric Bupivacaine and Hyperbaric Bupivacaine alone in Gynaecological Surgeries - A Comparative Study

To increase the duration of analgesia produced by local anaesthetics a number of adjuvant has been added to centrineuraxial block. Administration of intrathecal clonidine has shown to improve the quality of spinal anaesthesia and without neurotoxicity. With these considerations, present clinical study was undertaken to assess the behavior and feasibility of administration of intrathecal clonidine as an adjuvant to bupivacaine in augmenting sensory block in patients undergoing gynaecological surgeries.

A 100 ASA physical status I and II patients randomly selected and divided into 2 groups 50 of each. Group I received 0.5% hyperbaric bupivacaine 3ml (15mg). Group II received 0.5% hyperbaric bupivacaine 2.5ml (12.5mg) + clonidine 0.5ml (75μg) to keep the volume constant. The onset of sensory block, onset of motor block, time taken for two segment regression of sensory block, intraoperative hemodynamic stability and total duration of analgesia were studied. Patients were observed for 24 hours post operatively to look for any complications

Addition of 75μg clonidine to hyperbaric bupivacaine resulted in a statistically significant faster onset of sensory block (Group I - 4.03min; Group II - 1.74min) and motor block (Group I 4.81min; Group II - 2.70min). The time taken for two segment regression was significantly prolonged in Group II (Group I - 133.58min; Group II - 207.60min). The duration of analgesia was also longer in group II (Group I - 211.70min; Group II - 316.40min). Patients in group II experienced a relative hemodynamic stability with minimum side effects like dry mouth and sedation (16% and 28% respectively).

The results suggest that the use of 75μg clonidine provides relative intraoperative hemodynamic stability and prolonged post operative analgesia with minimal side effects.