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.
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