Effect of Clonidine Addition To Hyperbaric 0.5% Bupivacaine For Spinal Anaesthesia In Lower Limb Surgery [A Comparative Study]
Low Dose Bupivacaine- Clonidine In Spinal Anaesthesia
Keywords:
Low dose spinal anaesthesia, bupivacaine, clonidineAbstract
Abstracts: Background: The use of subarachnoid block has become an established and reliable method of providing anaesthesia for lower abdominal and lower limb surgery. Regional anaesthesia is generally well tolerated by all patients, producing less postoperative confusion and delirium than general anesthesia. It is also associated with lesser incidence of post-operative thromboembolism. However subarachnoid block has got its own inherent complications, especially related to cardiovascular stability.Aim: to compare the haemodynamic ,sensory and motor effects of a low dose bupivacaine – clonidine spinal anesthesia versus conventional dose of bupivacaine in patients undergoing lower limb surgery.Method: Prospective, randomized double blind study was undertaken in 60 selected patients posted for lower limb surgeries. Data were collected for duration and onset of motor and sensory effects, haemodynamic changes and side effects of study drugs and they were statistically analyzed.Results: We found in our study that time of onset of adequate level of sensory block (T10) was significantly longer for group B which contains 30μ gm of clonidine (126±14) than group A (95±10). The total duration of sensory block for Group A was 227.6±9.8 mins while Group B had 351.9± 17.5 mins and motor block for group A was 162.5±7.51 mins while in group B had 274.8±14.4 mins. Conclusion: Clonidine when combined with low dose bupivacaine has prolonged the duration of motor and sensory blockage and incidence of intra operative pain with maintaining haemodynamic stability.
References
2. Chung F, Seyone C, Dyck B. et al. Age related cognitive recovery after general anaesthesia. Anaesthesiaanalgesia1990,71,217-24
3. Modig J (1989). Influenceof regional anaesthesia,local anaesthetics and sympathicomimetics on the pathophysiology of deep vein thrombosis [Review].Acta Chirugica Scandinavia, 550 (Suppl.), 119–24 (discussion 124–7).
4. L.Alfred Lee, R.S. Atkinson,Margaret J.Watt,Sir Robert Macintosh’s Lumber puncture and spinal analgesia : Intradural and extradural .5th Edition,Pp+135,illustrated,Churchill Livingstone,Edinburgh,London,Melbourne, New york,1985 .
5. NYSORA - The New York School of Regional Anesthesia-Spinal anaesthesia, (cited 2011 nov29) Available from:
www.nysora.com/regional_anesthesia/.../3119-spinal_anesthesia.html
6. Elia, Nadia M.D.,Clonidine as an adjuvant to intrathecal local anesthetics for surgery: Systematic review of randomized trials,Anesthesiology: August 2009 - Volume 111 - Issue 2 – page 406-415
7. Bromage PR, Burfoot MF, Cromwell DE, Pettigrew RT. Quality of epidural blockade. I. Influence of physical factors. British journal of anaesthesia 1964,36, 342-52
8. Guatier PE, Dekock M, Luc F,Steenberg AV,Intrathecal clonidine combined with sufentanil for labour analgesia.Anaesthhesiology a1998, 88,651-6
9. Mercier RJ, Dounas M,Bouaziz H et al.The effect of adding a minidose of clonidine to intrathecal sufentanil.Anaesthesilogy,1998,89,594 -60
10. Sitec BD, Christopher R. Biggs R. Beach ML, Wiley c. Intrathecal clonidine added to bupivacaine–morphine spinal improve postoperative analgesia following total knee arthroscopy.Anaesthesiology,2002, 96A-918
11. Hema Saxena, S. Singh & S. Ghildiyal ,Low dose intrathecal clonidine with bupivacaine improves onset and duration of block with hemodynamic stability.Internet Journal of Anesthesiology. 2010 Volume 23 Number 11
12. Grandhe RP, Wig J, Yaddanapudi LN. Evaluation of bupivacaine-clonidine combination for unilateral spinal anaesthesia in lower limb orthopedic surgery, J Anaesth Clin Pharmacology 2008; 24(2): 155
13. M.Kerci, T. Zhurda, D. Muzha, A. Greca, A. Hoxha, N. Baftiu et al Hyperbaric bupivacaine on spinal anesthesia with or without clonidine in orthopedic surgery, European Journal of Anesthesiology: June 2006 - Volume 23 - Issue - p 112
14. Kaabachi O, Ben Rajeb A, Mebazaa M, Safi H, Jelel C, et al Spinal anesthesia in children: comparative study of hyperbaric bupivacaine with or without clonidine. AnnFr Anesth Reanim. 2002 Oct; 21(8):617-21.
15. I. van Tuijl, W. A. van Klei, D. B. M. van der Werff and C. J. Kalkman The effect of addition of intrathecal clonidine to hyperbaric bupivacaine on postoperative pain and morphine requirements after caesareansection: A randomized controlled trial, British Journal of Anesthesia 97 (3): 365–70 (2006)
16. B.S.Sethi, Mary Samuel, Deepak Sreevastava.Efficacy of analgesic effects of low dose intrathecal clonidine as adjuvant to bupivacaine, Indian Journal of Anesthesia 2007; 51 (5): 415-419 Clinical Investigation
