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Intrathecal Clonidine as an Adjuvant to Isobaric Levobupivacaine in Gynaecological Surgeries: A Randomized Control Trial

Irudhaya Joseph Raajesh, Professor and Head, Department of Anaesthesiology and Critical Care, Indira Gandhi Medical College and Research Institute, Puducherry-605009, India. , Bhavani Vaidiyanathan1 , Irudhaya Joseph Raajesh2

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Indian Journal of Anesthesia and Analgesia 4(3):p 789-793, July - September 2017. | DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.4317.39

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Abstract

Postoperative pain management is one of the vital duty of an anaesthesiologist apart from managing the patient intraoperatively. Patients presenting for gynaecological surgeries receive subarachnoid block with hyperbaric bupivacaine. Levobupivacaine the pure S-enantiomer of racemic bupivacaine, is a new long-acting local anesthetic that has recently been introduced in the clinical practice with predominant sensory analgesia. By and large opioids are used as adjuvants intrathecally, but their complications at times lead to few unwanted side effects. Intrathecal clonidine has been evaluated as an alternate to neuroaxial opoid for control of pain and has proven to be a potent analgesic This prospective, randomized, double-blind study compared the clinical efficacy, motor block and haemodynamic effects and postoperative analgesia of using 3mL of 0.5% isobaric levobupivacaine plus 0.2ml of 0.9% normal saline (Group LB) Vs 3 mL of 0.5% levobupivacaine with clonidine 30 micrograms (Group LC) for spinal anaesthesia in gynaecological surgery. Results: Sensory onset time, (5.12±1.92min) was faster in group LC but no difference in the motor block onset time was found between the groups. Duration of sensory and motor blockade and two segment regression time were significantly lower in levobupivacaine (LB) compared to Levobupivacaine clonidine (LC) group. In group LC, mean arterial pressure was lower than group LB, starting from 10 min until 30 min after injection (p < 0.05). Bradycardia was noted in 27% of group LC whereas 3% in LB group. Anaesthesia was adequate and patient satisfaction was good in all cases. Side-effects were minor and infrequent in both groups. Conclusion: We conclude that 3 mL of 0.5% levobupivacaine with clonidine 30 micrograms is more effective than 3 mL of 0.5% levobupivacaine alone in spinal anaesthesia for gynaecological surgeries.

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DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.4317.39

Keywords

Levobupivacaine; Spinal Anaesthesia; Clonidine; Postop Pain. 

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