Comparative Evaluation of the Efficacy of Intrathecal Fentanyl, Clonidine and Fentanyl-Clonidine Combination as an Adjuvant to Bupivacaine for Infra-Umblical Surgery

Abstract

Background: The aim of this study was to evaluate the level of sensory block, onset and duration of motor block, post-operative analgesia, and adverse effects of combination of clonidine and fentanyl given intra-thecally with hyperbaric bupivacaine. Material and Methods: Ninety patients were randomized into three groups of group BC (n=30): hyperbaric 0.5% bupivacaine, clonidine, and 0.9% NaCl intra-thecally; group BF (n=30): hyperbaric 0.5% bupivacaine, fentanyl, and 0.9% NaCl intra-thecally; group BFC (n=30): hyperbaric 0.5% bupivacaine, 0.3 ml of clonidine, and fentanyl intra-thecally. Results: Either adjuvant, fentanyl or clonidine when added to intra-thecal bupivacaine prolongs the motor block and decreases the requirement of rescue analgesic in 24 hours but time to first rescue analgesic request is more prolonged in clonidine as compared to fentanyl. Clonidine is superior to fentanyl in prolonging the sensory block. Combination of intra-thecal fentanyl and clonidine as compared to fentanyl alone, as adjuvant to bupivacaine, is superior in prolonging the sensory block, motor block and time to first rescue analgesic request. Combination of intra-thecal fentanyl and clonidine as compared to clonidine alone, as adjuvant to bupivacaine, produces similar sensory block but is superior in prolonging the motor block and time to first rescue analgesic request. Conclusion: The combination of fentanyl and clonidine, as adjuvant to intra-thecal bupivacaine, is superior for surgical procedures of long duration and those procedures which mandate muscle relaxation.