COMPARATIVE STUDY OF DURATION OF ANALGESIA AND HAEMODYNAMIC CHANGES IN EPIDURAL ANAESTHESIA WITH LIGNOCAINE (2%) WITH LIGNOCAINE (2%) PLUS CLONIDINE FOR LOWER ABDOMINAL AND LOWER LIMB SURGERIES.

Abstract

Background: Epidural      anaesthesia is one of the most common regional anaesthetic techniques used for lower abdominal and lower limb surgeries. Epidural anaesthesia provides effective surgical anaesthesia and can also achieve the extended duration of surgical needs, provides prolonged postoperative analgesia, lowers the incidence of hemodynamic changes. The quality and duration of analgesia is improved when a local anaesthetic is combined with alpha-2 adrenergic agonist as neuraxial adjuvants. Aim: The aim of our study is to compare the duration of analgesia and haemodynamic changes when Clonidine used as an adjuvant to epidural Lignocaine in lower abdominal and lower limb surgeries. Materials and Methods: A prospective randomized double blinded study was conducted in 60 patients of either sex between the ages of 20 and 60 years of (American Society of Anaesthesiologists)  ASA I/II grade who underwent lower abdominal and lower limb surgeries. The patients were randomly allocated into two groups (30 in each group); groupI received 20 ml Lignocaine  (2%) with equivalent amount of distilled water to compensate for the volume of other group drug epidurally. Group II received 20 ml Lignocaine (2%) with Clonidine 1µg/kg epidurally. Onset of sensory analgesia using bilateral pin-prick method, time to two dermatome regression of sensory level, time to first demand for analgesia, intra operative hemodynamic parameters and complications were observed. Statistical analysis was done by chi-square test for qualitative data and unpaired student t-test for quantitative data using statistical package for social science (SPSS) version 19 for windows and value of P < 0.05 was considered significant and P < 0.001 as highly significant. Results: The demographic profile and cardio-respiratory parameters were comparable and statistically non-significant in both the groups. The side effect profile was also comparable with a little higher incidence of nausea and dry mouth in both the groups which was again a non-significant entity (P > 0.05) . Group ll  had rapid onset of sensory blockade (p<0.05), better haemodynamic stability and prolonged duration of intraoperative (p<0.05) and postoperative analgesia (p<0.05). Conclusion:  Clonidine is a better neuraxial adjuvant to epidural Lignocaine for providing better haemodynamic stability, early onset and long duration of sensory analgesia and, longer post-operative analgesia. Key words: Clonidine, Epidural block, Lignocaine.