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A Comparison Study Quality of Anaesthesia for Lower Limb Orthopaedic Surgery: Bupivacaine with Adjuvant Clonidine versus Bupivacaine with Adjuvant Midazolam

Sejal S Jadav , Mahesh M Patel1 , Sejal S Jadav2 , Darshna M Patel3

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Indian Journal of Anesthesia and Analgesia 6(4):p 1161-1164, July-August 2019. | DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.6419.15

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Mahesh M Patel, Sejal S Jadav, Darshna M Patel. A Comparison Study Quality of Anaesthesia for Lower Limb Orthopaedic Surgery: Bupivacaine with Adjuvant Clonidine versus Bupivacaine with Adjuvant Midazolam. Indian J Anesth Analg. 2019;6(4):1161-1164.

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Abstract

Background: Spinal anesthesia is the most commonly used anesthesia for orthopedic surgery. Despite of using long acting local anesthetic like Bupivacaine, the duration of anesthesia is short. Therefore, various drug combinations like Clonidine, Ketamine, Opioids etc. have been tried to prolong duration of analgesia. Methodology: This study was conducted among 60 participants GMERS Hospital, Valsad. Patients were randomly allocated to 2 groups. Thirty subjects were in each group who received either 0.5% heavy Bupivacaine 3 ml (15 mg) + Clonidine 0.3 ml (45 µg) (Group A) or 0.5% heavy Bupivacaine 3 ml (15 mg) + Midazolam 0.2 ml (1 mg) + 0.9% normal saline 0.1 ml (Group B). Time required for sensory block, motor blockade, level of sedation and post operatively pain measurement was assessed. Result: The present study showed that significant decrease in mean arterial pressure and heart rate at 30, 45 and 60 min in patients with adjuvant clonidine as compared to midazolam. Mean time for sensory onset, sensory regression to S2 from highest sensory level, two segment sensory regression, total duration of motor blockade and onset of grade-3 motor blockade in patient with adjuvant Clonidine was significantly higher as compared to adjuvant Midazolam. Post operatively there was no significant difference in mean postoperative systolic blood pressure, diastolic blood pressure, pulse rate, saturation and respiratory rate. Sedation score was also higher in patients with adjuvant Clonidine group. Most common reported adverse events with Clonidine was hypotension and bradycardia. Conclusion: Adjuvant Clonidine 45 μg intrathecal hyperbaric Bupivacaine (0.5%) significantly prolongs duration of motor and sensory block. It provides adequate hemodynamic stability, prolongs postoperative analgesia without any significant side effects.

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Mahesh M Patel, Sejal S Jadav, Darshna M Patel. A Comparison Study Quality of Anaesthesia for Lower Limb Orthopaedic Surgery: Bupivacaine with Adjuvant Clonidine versus Bupivacaine with Adjuvant Midazolam. Indian J Anesth Analg. 2019;6(4):1161-1164.

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DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.6419.15

Keywords

Bupivacaine; Clonidine; Motor blockade; Analgesia

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