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Category: Volume 05 Issue 11 November 2017
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Title: Effect of Clonidine and/or Fentanyl in Combination with Intrathecal Bupivacaine for Lower Limb Orthopedic Surgeries in Spinal Anaesthesia

Authors: Abdul Hakim, Arif Amin Bhat, Masrat Jan

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i11.219

Abstract

Background and Aims: Fentanyl and clonidine both prolong sensory and motor block of spinal anaesthesia and duration of postoperative analgesia when used as an adjuvant to intrathecal bupivacaine. This prospective observational study was conducted to evaluate the efficacy of adding clonidine and fentanyl in combination to bupivacaine.

Material and Methods: A total of 90 patients of (ASA) physical status I-II of both sexes, aged between 18 and 70 years, were randomly allocated to three groups. Each group consists of 30 patients.  Group A: 2.5ml of 0.5% hyperbaric bupivacaine and 50ug of clonidine in 0.5ml of normal saline. Group B: 2.5ml of 0.5% hyperbaric bupivacaine and 25ug of fentanyl in 0.5ml of normal saline.  Group C:  2.5ml of 0.5% hyperbaric bupivacaine and 12.5ug of fentanyl in 0.25ml of normal saline and 25ug of clonidine in 0.25ml of normal saline. The time of onset and duration of sensory block, highest dermatome level of sensory block, time of onset of motor block, time to complete motor block recovery and duration of spinal anesthesia, intraoperative and postoperative hemodynamics and side effects if any were recorded. VAS, total number of patients who were administered supplemental analgesic in each group and the total amount of supplemental analgesic administered in the next 24 h was quantified and documented in all the groups.

Results: The time of onset of sensory block (min) in groups A, B,  and C was 9.10 ± 1.40, 12.50 ± 1.30 and 9.0 ± 0.90 respectively, thus onset of sensory block was significantly earlier in groups A and C. Similarly, onset of motor block was also quicker in groups A and C. Time of requirement of supplemental analgesia was 208.80 ± 26.32 min, 198.20 ± 21.92 min, and 210.00 ± 26.58 min in groups A, B and C respectively.

Conclusion: We conclude that the addition of clonidine in doses of 50 μg and 12.5 μg to low-dose bupivacaine and bupivacaine fentanyl prolongs the sensory and motor block while increasing the duration of postoperative analgesia without significant side-effects.

Keywords: Subarachnoid block, Intrathecal clonidine, spinal adjuvants, subarachnoid fentanyl.

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Corresponding Author

Dr Arif Amin Bhat

GMC Srinagar, Kashmir University India

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