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A Comparative Study of Epidural Dexmedetomidine and Clonidine as Adjuvant to 0.2% Isobaric Ropivacaine for Post Operative Analgesia in Lower Limb Orthopaedic Surgeries

Naramaneni Santhi, Senior Resident, Department of Anaesthesiology, Dr. D.Y. Patil Medical College and Research Center, Dr. D.Y. Patil Vidyapeet, Pimpri, Pune, Maharastra 411018, India. , Chhaya M. Suryawanshi1 , Naramaneni Santhi2 , Sai Nagendra3 , Shilpy Jaiswal4 , Sai Sowmya Garlapati5 , Shreyank Solanki6

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Indian Journal of Anesthesia and Analgesia 5(8):p 1287-1293, August 2018. | DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.5818.6

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Abstract

Background: Various adjuvants are being used with local anesthetics for prolongation of analgesia like opioids, but the onset and duration of analgesia is improved when a local anesthetic is combined with alpha2 adrenergic agonist. Though, the effects of clonidine on local anesthetics have been extensively studied, there are limited studies demonstrating the effects of epidural dexmedetomidine on local anesthetics.

Aims and objectives: To compare the efficacy, onset and duration of postoperative analgesia and side effects of clonidine and dexmedetomidine when used epidurally as an adjuvant to ropivacaine in patients undergoing lower limb orthopedic surgeries.

Settings and Design: This study was designed to compare the efficacy, onset and duration of postoperative analgesia and side effects of clonidine and dexmedetomidine when used epidurally as an adjuvant to ropivacaine in patients undergoing lower limb orthopedic surgeries.

Methods and Material: Patients were randomized into two groups- group ropivacaine with dexmedetomidine (RD) received 20 ml of 0.2% ropivacaine with 1 g/kg dexmedetomidine epidurally and group ropivacaine with clonidine (RC) received 20 ml of 0.2% ropivacaine with 2 g/kg clonidine. Onset and duration of analgesia and Ramsay sedation score and hemodynamic parameters were monitored and side effects if any noted.

Statistical analysis used: mean±standard deviation for quantitative continuous data and compared by unpaired t-test.

Result: The onset of analgesia (RD-4.4±0.67min, RC-6.3±0.74min) and duration of analgesia (RD-665.16±29.8min, RC-462.16±29.8min) were found to be significantly better in dexmedetomidine group. Better sedation score was seen in dexmedetomidine group.

Conclusion: Epidural dexmedetomidine (1mcg/kg) and clonidine (2mcg/kg) with ropivacaine 0.2% had good efficacy however the dexmedetomidine provided faster and prolonged duration of postoperative analgesia and good sedation compared to clonidine.

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DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.5818.6

Keywords

Epidural; Analgesia; Ropivacaine; Clonidine; Dexmedetomidine.

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