Background: Without a proper post operative analgesic plan, patients undergoing elective lumbar spine surgeries suffer from acute post operative pain and tend to develop chronic low back pain syndromes. A prospective randomised study was done to compare the analgesic profile of dexmedetomidine and clonidine as adjuvants to ropivacaine, when used via epidural route.

Methods: Forty four subjects, 24 male and 20 female, 20-65 years, belonging to American Society of Anaesthesiologists Physical Status I and II, who underwent elective lumbar spine surgery were randomly divided into 2 groups, ropivacaine + clonidine (group C) and ropivacaine + dexmedetomidine (group D). At the end of the surgery,  an epidural catheter was placed by the surgeon under direct vision. Group C received 20 ml 0.2% ropivacaine + 2 µg/kg clonidine and group D received 20 ml 0.2% ropivacaine + 1 µg/kg dexmedetomidine through the catheter. Onset of analgesia, time to peak effect, duration of analgesia, haemodynamic parameters and side effects were noted.

Results: Patients of group D had faster onset, early peak effect, prolonged duration of analgesia and better haemodynamic stability. The incidence of nausea, vomiting, respiratory depression, dry mouth, motor block were comparable in both groups, but sedation scores were higher in group D.

Conclusion: Epidural analgesia with ropivacaine and alpha 2 adrenergic agonists provided safe and reliable pain relief in lumbar spine surgery in early post operative period. Dexmedetomidine as an adjuvant, was associated with better analgesic parameters, safe haemodynamics and less side effects compared to clonidine.

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Dr Chiranjib Bhattacharyya

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