A Comparative Evaluation of Dexmedetomidine vs Clonidine used as Adjuvants with Hyperbaric Bupivacaine in Patients with Preeclampsia Undergoing LSCS

Abstract

Relief of operative as well as post operative pain should be the prime responsibility of an anesthesiologists. The most common treatment for post operative pain remains conventional intramuscular injection of narcoticswhich are associated with several side effects like nausea, vomiting, itching, hypotension, bradycardia,urinary retention, dysphoria,respiratory depression, early and later. Pregnancy induced hypertension is a major cause of morbidity and mortality in obstetrics, complicating 3-8% of pregnancies. Severe preeclampsia poses a dilemma for anesthesiologists, and there is some controversy about the best anaesthetic technique for caesarean delivery in such cases. Though spinal anasthesia reduces the risk of airway instrumentation in high risk patients of preeclampsia, there are still limitations about its limited duration of analgesia. In present study we intend to compare dexmedetomidine and clonidine used with hyperbaric bupivacaine for spinal anaersthesiain patients with preeclampsia undergoing LSCS. Primary Objective: To compare the clinical efficacy of intra the caldexmedetomidine vs Clonidine on: (a) Onset and duration of sensory block (b) Onset and duration of motor block (c) Duration of analgesia (d) Side effects if any. Secondary Objective: to compare the haemodynamic profile among patients of the two group. Methodology: All eligible patients were randomly assigned into two groups of 50 each by chit and envelope method: Group A: SAB was given with 2ml, 0.5 % Bupivacaine(H) + 45 µg Clonidine. Group B: SAB to be given with 2ml, 0.5% Bupivacaine (H) + 5µg dexmedetomidine. Results: Regression of sensory block was prolonged in group B as compared to group A.(p value <0.0001). There was regression of motor block in group B as compared to group A. p value<0.0001Heart rate remained stable and comparable at different time points in 2 groups. Except three patients in group A and one patient in group B, no other patient in either group developed bradycardia. Three patients in group A and in group B developed hypotension which responded to intravenous fluid therapy. Sedation score decreased to 0 within 5 hours. At no time, sedation score exceeded 2 and no patient developed signs of respiratory depression. Conclusion: Dexmedetomidine in the dose of 5µg added to 10 mg 0.5% Hyperbaric Bupivacaine in SAB for LSCS surgery in parturients with preeclampsia provides comparable onset for sensory and motor blockade but significantly prolonged duration as compared to 45µg of clonidine. Longer duration of postoperative analgesia with 5µg Dexmedetomidine makes it superior to clonidine in respect to postoperative analgesia. Both the drugs produce desirable level of intraoperative and postoperative sedation, stable hemodynamics and minimal side effects.