Comparison of addition of fentanyl or clonidine to Intrathecal bupivacaine versus Intrathecal bupivacaine alone for lower limb surgeries in elderly patients: A prospective, randomised study: Intrathecal fentanyl/clonidine ± bupivacaine for surgery in elderly

Abstract

Orthopaedic long bone fracture surgeries in elderly patients have their own inherent risks during anaesthesia. We aimed to compare the effect of adding clonidine or fentanyl to low dose intrathecal bupivacaine as opposed to intrathecal bupivacaine alone. Materials and methods: A prospective, double-blind study was conducted in ninety elderly patients undergoing lower limb surgery under spinal anaesthesia. After randomly allocating the patients to three groups, Group BC [Bupivacaine + Clonidine]: 9 mg bupivacaine (0.5%) + clonidine 15 µg + saline, Group BF [ Bupivacaine + Fentanyl] : 9 mg bupivacaine (0.5% ) + fentanyl 20 µg, Group BS [Bupivacaine + Saline] : 9 mg bupivacaine (0.5%) + saline. The time for onset of sensory and motor block, highest sensory level achieved, time taken to achieve peak sensory and motor blockade, duration of analgesia and side-effects were compared between the three groups. The relevant statistical analyses were done. Results: The time taken for the sensory level and motor block to recede was the longest in group BC. The duration of analgesia was maximum in the group BC group and minimum in group BS. Incidence of hypotension and use of ephedrine was maximum in Group BC. Conclusion: Fentanyl or clonidine added to low dose intrathecal bupivacaine for lower limb surgery in the elderly significantly increases the duration of analgesia compared with intrathecal bupivacaine alone, clonidine more than fentanyl.