Epidural Clonidine as an Adjuvant to Local Anesthetic in Lower Abdominal and Lower Limb Surgeries: A Randomised Controlled Study

Palak Arora,Madhusudan Upadya,Jesni Joseph,Sonal Bhat

doi:10.2174/2589645802014010001

Abstract

Background: Acute pain leads to adverse physiological and psychological disturbances. Hence, this study was done to evaluate and compare the onset and duration of sensory anesthesia, motor paralysis and duration of analgesia using 0.5% plain bupivacaine, with clonidine (2μg/kg) in patients posted for lower abdominal and lower limb surgeries under epidural anaesthesia. Materials and methods: 62 Patients posted for elective lower abdominal, gynaecological and lower limb surgeries under epidural anesthesia, aged 18 to 60 years, height more than 150 cms of ASA physical status 1 or 2 were included. All patients were randomized into two groups of 31 individuals each. Results: Clonidine in the dose of 2μg/kg added to bupivacaine injected into epidural space significantly prolonged the duration of analgesia when compared to bupivacaine alone. No effect on the onset of sensory and motor blockade was observed. However, it increases the duration of motor blockade. Clonidine also has effect on sedation level, pulse rate and mean arterial blood pressure. Conclusion: Clonidine causes increased sedation; fall in pulse rate and mean arterial blood pressure, which however, did not require active intervention in this study.

Highlights

Attenuation of postoperative pain, especially with certain types of analgesic regimens, may decrease perioperative morbidity and mortality [1]
Clonidine in the dose of 2μg/kg added to bupivacaine injected into epidural space significantly prolonged the duration of analgesia when compared to bupivacaine alone
After patients were transferred to the operating room, an Intravenous (IV) access was secured in the non-dominant upper limb using an 18G IV cannula. 10-15 ml/kg of IV crystalloid solution was given over 15 minutes just before administering epidural anesthesia

Summary

Introduction

Attenuation of postoperative pain, especially with certain types of analgesic regimens, may decrease perioperative morbidity and mortality [1]. Acute pain results in potentially life-threatening problems [2]. Epidural anesthesia with local anesthetics, reduces physiologic responses to surgery and provides superior pain relief [3]. Have been tried with local anesthetics in the epidural space, to enhance analgesia while minimizing side effects [4]. Clonidine being a partial α2 adrenergic agonist has antihypertensive effects and can potentiate effects of local anesthetics. This study was done to evaluate and compare the onset and duration of sensory anesthesia, motor paralysis and duration of analgesia using 0.5% plain bupivacaine, with clonidine (2μg/kg) in patients posted for lower abdominal and lower limb surgeries under epidural anaesthesia

Methods

Results

Discussion

Conclusion