Intrathecal Administration of Bupivacaine and Bupivacaine With Different Doses of Clonidine For Post-operative Analgesia in Lower Abdominal and Lower Limb Surgeries ? A Comparative Study

摘要

Local anesthetic agent like bupivacaine used for spinal anaesthesia in surgeries of lower half of the body provides short-term analgesic effect in initial postoperative period. Adjuvant intrathecal clonidine is recommended for additional analgesic effect. This study was conducted to find out efficacy of clonidine in 50 microg and 75 microg doses in combination with bupivacaine for postoperative analgesia in lower abdominal and lower limb surgeries when administered intrathecally. The present prospective, randomized study was conducted on 90 patients of ASA grade I and II, aged 18-60 years of either sex scheduled for lower abdominal and lower limb surgeries in ASCOMS, Sidhra, Jammu.Patients were equally distributed in three groups - A, B and C. Group A patients received 15 mg bupivacaine alone, Group B patients received 15 mg bupivacaine and 50 .g clonidine and Group C patients received 15 mg bupivacaine and 75 .g clonidine. Postoperatively after the conclusion of surgery, analgesia and seda- tion scores were recorded at 1, 2, 3, 4, 6, 12, 24 and 48 hours. At the end of 48 hours, the patients were evaluated for the quality of analgesia, sedation, amnesia and the side effects. The requirement of the rescue analgesic during the period was calculated, recorded and compared at the end of surgery. Data regarding the various parameters was statistically analysed using Anova test. A p value of 0.05 was considered as statistically significant. Female patients dominated all the three groups. The groups were comparable with respect to gender, age and weight. Mean number of rescue analgesics required were significantly less in Group C (0.6) when compared to Group B (1.8) and Group A (2). Moreover, intraoperative mean heart rate in Group A was significantly more when compared to Group B and Group C. Moreover, intraoperative mean systolic, diastolic and arterial blood pressure respectively were significantly more in Group A and Group B as compared to Group C. VAS score was significantly lower in Group C as compared to Groups A and B. Sedation and amnesia were significantly more in Groups B and C as compared to Group A. Rescue analgesia was required in a significantly higher number of patients in Groups A and B as compared to Group C. Addition of clonidine 75 mg to 3 ml of 0.5% bupivacaine provided significantly better pain relief in lower limb and lower abdominal surgeries, less consumption of analgesics, minimal sedation and amnesia without any major side effects.