EFFICACY OF LOW DOSE INTRATHECAL CLONIDINE AS AN ADJUVANT TO 0.5% HYPERBARIC BUPIVACAINE FOR SPINAL ANAESTHESIA
Dr. Ujjwala Bhiku Khairmode, *Dr. Saee Laxmikant Gosavi and Dr. Snehal Mohan Vhatkar
Introduction: Spinal anaesthesia is a safe, reliable, inexpensive technique with the advantage of providing surgical anaesthesia and prolonged postoperative pain relief by using various adjuvant drugs along with local anaesthetic agents. The possibility that intracthecal administration of Clonidine may produce better analgesic effect compared to epidural administration, with fewer side effects and at lower doses, provides rational of evaluating intrathecal clonidine. Primary objective: To determine effectiveness of sensory and motor blockade with bupivacaine alone and Bupivacaine with low dose clonidine. Secondary objective: To study hemodynamic changes, side effects and postoperative analgesia between two groups. Methods: After institutional review, board approval and written informed consent, 100 patients with ASA physical status I-II, aged 20-50 years scheduled for elective lower abdominal and lower limb surgeries were included in this study. Patients with comorbidities like diabetes, hypertension and any absolute contraindication for spinal anaesthesia were excluded. Patients were randomly divided into 2 groups with 50 patients in each group. Group B received 0.5% hyperbaric Bupivacaine and Group BC received 0.5% hyperbaric Bupivacaine+ 1microgram/kg of inj.clonidine. Adequate block to initiate surgery was defined as a sensory block bilaterally. The onset, degree and duration of motor block were measured in both legs by using a modified Bromage scale. The sedation was judged by Ramsay sedation score and postoperative analgesia was judged by VAS score. Observations and Results: The differences in parameters were statistically significant. Onset was seen earlier in Group BC than in Group B. Sensory maximum Level T was seen at higher level in Group BC than in Group B.Lesser time was required in Group B to achieve two segment regression than group BC. Higher duration of sensory blockade was seen in Group BC than in group B. Higher duration of Motor blockade was seen in Group BC than in group B. There was no significant difference in basal and minimum pulse rate, basal systolic blood pressure and diastolic blood pressure, minimum systolic blood pressure and diastolic blood pressure, mean basal SPO2 between two groups. In the study there was no complications noted among all the subjects in both the groups. Conclusion: This study concludes that intrathecal clonidine in the dose of 1microgram/kg along with 12.5mg 0.5% hyperbaric bupivacaine leads to earlier onset and prolonged duration of sensory and motor blockade, excellent postoperative analgesia with minimal side effects with good hemodynamic stability.
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