Analysis of intrathecal clonidine as an adjuvant in the subarachnoid block on post-operative analgesia and safety profile in obstetric surgeries: A randomised controlled trial

Abstract

Background: Clonidine has long been considered an 'off-label' medication for use in obstetrics. Different doses of clonidine are studied and it is found that higher doses are associated with sedation and haemodynamic instability. Hence, we analysed a mini dose of intrathecal clonidine of 30 μg for its impact primarily on post-operative analgesia and secondarily on the quality of spinal anaesthesia, haemodynamics, sedation and neonatal outcomes in caesarean sections.Methods: One hundred participants were randomised them to receive the interventions. Group B received 11 mg of 0.5% hyperbaric bupivacaine (2.2 mL) and Group C received 10 mg of 0.5% hyperbaric bupivacaine with 30 μg of clonidine (2.2 mL). Motor, sensory and haemodynamic characteristics with time to rescue analgesics were observed in both the groups and analysed using univariate analysis.Results: Time to rescue analgesics (P < 0.001), visual analogue scores in the post-operative period and time to grade 0 Bromage (P = 0.002) were statistically significant in Group C. Time to T6 dermatomal level and time to grade 4 Bromage were similar in both the groups. Apgar scores were comparable and no adverse events were noted in both the groups.Conclusions: A low dose of intrathecal clonidine (30 μg) can prolong the duration of post-operative analgesia in caesarean section with comfortable maternal sedation and good neonatal outcome without significant complications.(Clinical Trials Registry- India, number CTRI/2018/08/015250)