Intrathecal Hyperbaric Bupivacaine with Two Different Doses of Clonidine in Lower Limb Orthopaedic Surgery: A Comparative Study

Title: Intrathecal Hyperbaric Bupivacaine with Two Different Doses of Clonidine in Lower Limb Orthopaedic Surgery: A Comparative Study

Authors: Dr Prasad Ingley, Dr C.P. Gadkari, Dr Neelakshi Kalita, Dr A.R. Bhure

DOI: https://dx.doi.org/10.18535/jmscr/v5i5.143

Abstract

Introduction: Spinal anaesthesia has long been known to be of benefit to patients undergoing major orthopaedic procedure. Numerous studies have investigated the effects of intrathecal clonidine co-administered with local anesthetics; very few studies have focused on small doses and a real dose-response in orthopedic patients. We assessed effectiveness and safety profile of two different combinations.

Material and Method: 75 patients undergoing lower limb orthopaedic surgery were randomised into 3 groups of 25 each to receive 0.5% hyperbaric bupivacaine (B); clonidine 75 μg (0.5 ml) with 0.5% hyperbaric bupivacaine (BC-75); or clonidine 150 μg (1 ml) with 0.5% hyperbaric bupivacaine (BC-150). The onset and duration of sensory and motor blockade; and duration of post-operative analgesia were the primary outcome. Safety and hemodynamic changes were assessed as secondary outcomes.

Results: The onset and time to reach surgical anaesthesia at level L1 were significantly early with combinations (BC-150 < BC-75 < B). Total duration of analgesia and time to 2-segment regression were significantly longer (BC-150 > BC-75 > B). The response was dose dependant. No patients required supplemental analgesia intra-operatively. Onset of motor block was less in BC-75. Duration was significantly higher with combinations (BC-150 > BC-75 > B). The response was again dose dependant. Post-operative analgesia was also significantly longer (BC-150 > BC-75 > B). Minor haemodynamic changes were seen in all three groups. Few complications were reported with BC-150.

Conclusion: Small doses of clonidine (≤150 mg) when added to bupivacaine, significantly improves the sensory anaesthesia and post-operative analgesia in dose dependent manner; with relative haemodynamic stability and few adverse effects. The combinations are recommended when patients are scheduled for long orthopaedic procedures.

References

1. Sethi BS, Samuel M, Sreevastava D. Efficacy of analgesic effects of low dose intrathecal clonidice as adjuvant to bupivacaine. J Anaesthesia 2007;51: 415-9.

2. Veering BT, Stienstra R.Duration of block: drug, dose, and additives. Reg Anesth Pain Med 1998; 23: 352-6.

3. Bonnet F, Brun-Buisson V, Saada M, et al. Dose-related prolongation of hyperbaric tetracaine spinal anesthesia by clonidine in humans. Anesth Analg 1989;68: 619-22.

4. Niemi L. Effects of intrathecal clonidine on ‘duration of bupivacaine spinal anaesthesia, haemodynamics, and postoperative analgesia in patients undergoing knee arthroscopy. Acta Anaesthesiol Stand 1994;38: 724 - 8.

5. Fogarty DJ, Carabine UA, Milligan KR. Comparison of the analgesic effects of intrathecal clonidine and intrathecal morphine after spinal anaesthesia in patients undergoing total hip replacement. Br J Anaesth 1993;71: 661–4.

6. Racle JP,Benkhadra A, Poy JY, Gleizal B. Prolongation of isobaric bupivacaine spinawl anesthesia with epinephrine and clonidine for hip surgery in the elderly. Anesth Analg. 1987:66: 442–6. .

7. Juliao MC, Lauretti GR. Low-dose intrathecal clonidine combined with sufentanil as analgesic drugs in abdominal gynecological surgery. J Clin Anesth 2000;12: 357–62.

8. Dobrydnjov I, Axelsson K, Thorn SE, et al. Clonidine combined with small-dose bupivacaine during spinal anesthesia for inguinal herniorrhaphy: a randomized double-blinded study. Anesth Analg 2003; 96: 1496–503.

9. De Kock M, Gautier P, Fanard L, et al. Intrathecal ropivacaine and clonidine for ambulatory knee arthroscopy: a dose-response study. Anesthesiology 2001;94: 574–8.

10. Kanazi GE,Aouad MT,Jabbour – Khourg SI,Al Jazzar MD,Alameddine MM,Al-Yaman R “ Effect of low –dose Dexmedetomidine or Clonidine on characteristics of Bupivacaine spinal block.”Acta Anaesthesiol Scand. 2006 Feb;(2) 222.

11. Ghodki Poonam S, Sardesai Shalini P, Thombre Shalini K. Evaluation of the effect of intrathecal clonidine to decrease shoulder tip pain in laparoscopy under spinal anaesthesia. Indian Journal of Anesthesia. 2010:54:3:231-234

12. Gordh T Jr, Jansson I, Hartvig P, et al. Interactions between noradrenergic and cholinergic mechanisms involved in spinal nociceptive processing. Acta Anaesthesiol Scand 1989;33:39–47.

13. Erne-Brand F, Jirounek P, Drewe J, et al. Mechanism of antinociceptive action of clonidine in nonmyelinated nerve fibres. Eur J Pharmacol 1999;383:1–8.

14. Acalovschi I, Bodolea C, Manoiu C. Spinal anesthesia with meperidine: effects of added alpha-adrenergic agonists— epinephrine versus clonidine. Anesth Analg 1997;84:1333–9.

15. Grandhe RP, Wig J, Yaddanapudi LN Evaluation of Bupivacaine-Clonidine Combination for Unilateral Spinal Anaesthesia in Lower Limb Orthopedic Surgery J Anaesth Clin Pharmacol 2008; 24(2): 155-158.

16. Ttuijl v, m. Giezeman j.M. M. Braithwaite S. A, hennis P.J, Kalkman C. j and Van klei W. A. Intrathecal low-dose hyperbaric bupivacaine–clonidine combination in outpatient knee arthroscopy: a randomized controlled trial Acta Anaesthesiologica Scandinavica Volume 52 Issue 3, Pages 343 - 349.

17. Filos KS, Goudas LC, Patroni 0, Polyzou V. Hemodynamic and analgesic profile after intrathecal clonidine in humans. Anesthesiology 1994;81:591-601.

18. Saxena H, Singh S & Ghildiyal S: Low Dose Intrathecal Clonidine With Bupivicain Improves Onset And Duration Of Block With Haemodynamic Stability.The Internet Journal of Anesthesiology. 2010:23:1.

19. Baker Amir et al. Intrathecal Clonidine for postoperative analgesia in elderly patients:the influence of baricity on haemodynamics and analgesic effects. Anaes.Anal.2004,99:128.

20. Strebel S , Jürg A. Gurzeler, Schneider m .c, Aeschbach A, Kindler c.h, Small- Dose Intrathecal Clonidine and Isobaric Bupivacaine for Orthopedic Surgery: A Dose-Response Study Anesth Analg 2004;99:1231-1238.

21. Filos KS, Goudas LC, Patroni O, Polyzou V. Intrathecal clonidine as a sole analgesic for pain relief after cesarean section. Anesthesiology 1992;77: 267–74.

22. Mercier F.J.et al. Anaesthesiol. 1998:89:594-601.

23. Chiari A, Lorber C, Eisenach JC et al. Analgesic and hemodynamic effects of intrathecal clonidine as the sole analgesic agent during first stage of labor. Anesthesiology 1999; 91: 388-96.

24. Grace D, Bunting H, Milligan KR, Fee JP. Postoperative analgesia after co-administration of clonidine and morphine by the intrathecal route in patients undergoing hip replacement. Anesth Analg 1995;80:86–91.

25. Klimscha W; Chiari A; Krafft P; Plattner O; Taslimi R; Mayer N; Weinstabl C; Schneider B; Zimpfer M. Hemodynamic and analgesic effects of clonidine added repetitively to continuous epidural and spinal blocks. Anesthesia and analgesia 1995;80(2):322-7.

26. Eisenach JC, Dewan DM. Intrathecal clonidine in obstetrics: sheep studies. Anesthesiology 1990;72:663–8.

Abstract

References

Corresponding Author

Call For Paper Volume 12 Issue 10 November 2024

JMSCR Menu

Impact Factor SJIF 2024: 7.892

Crossref - DOI

Editorial Policy

Frequency of Publication

Submission of Articles

Search

Abstract

Call For Paper Volume 12 Issue 10 November 2024

JMSCR Menu

Impact Factor SJIF 2024: 7.892

Crossref - DOI

Editorial Policy

Frequency of Publication

Submission of Articles