A comparative study of intrathecal clonidine and intrathecal tramadol for prolongation of neuraxial blockade analgesia with 0.5% bupivacaine in orthopaedic surgery

Abstract

Introduction: Spinal anaesthesia is advantageous in that it uses a small dose of the anaesthetic, is simple to perform and offers a rapid onset of action, reliable surgical analgesia and good muscle relaxation.Effective postoperative analgesia can be provided by neuraxially applied local anaesthetics or opioids, which may be accompanied byunwanted side effects like motor block, hypotension or respiratory depression. Aim: A comparative study of Intrathecal Clonidine and Intrathecal tramadol along with 0.5% hyperbaric Bupivacaine for prolongation of Subarachnoid neuraxial blockade. Materials and methods: it is prospective randomized study which have 2 groups, each group of 25 patients randomly selected. Group A (N-25): Received Inj Clonidine hydrochloride (37.5 mcg) and0.5% hyperbaric Bupivacaine hydrochloride (3.5 ml) + 0.75 ml Normal saline, Group B (N-25): Received inj Tramadol (25 mg) and 0.5% hyperbaric Bupivacaine hydrochloride (3.5 ml). Results: Intraoperatively significant differences in BP, pulse rate were noted, like hypotension and bradycardia more in the clonidine group.Time to full motor recovery was not delayed in any of the patients in both the groups.The mean duration of analgesia did differ in both groups. Mean duration of analgesia in Group A was 326.40 + 30.39 mins and in Group B was 302.40 + 12.00 mins. Time for two segment regression did differ in both the groups. The patients in both the groups showed minimal side effects, like nausea, vomiting and pruritis. The incidences of side effects were statistically insignificant. Both intrathecal clonidine and intrathecal tramadol act synergistically to potentiate bupivacaine induced sensory spinal block. Excellent surgical anesthesia and an extended analgesia was observed in postoperative period with minimum side effects were observed in both groups. Conclusions: Study has demonstrated that addition of Intrathecal Clonidine to bupivacaine, even in very small doses, significantly improves the onset and duration of sensory and motor block with relative hemodynamic stability. The 37.5 mcg dose provides maximum benefit and minimum side effects. It is recommended over Intrathecal Tramadol.