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Study of Clonidine vs Fentanyl Intrathecally with 0.5% Bupivacaine in Vaginal Hysterectomy: A Comparative Study

Pradnya Milind Bhalerao , Ganesh Laxman Khandarkar1 , Pradnya Milind Bhalerao2 , Rajashekar S3

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Indian Journal of Anesthesia and Analgesia 6(5):p 1615-1622, September-October 2019. | DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.6519.19

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Ganesh Laxman Khandarkar, Pradnya Milind Bhalerao, Rajashekar S et al. Study of Clonidine vs Fentanyl Intrathecally with 0.5% Bupivacaine in Vaginal Hysterectomy: A Comparative Study. Indian J Anesth Analg. 2019;6(5 Part-1):1615-1622.

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Abstract

Bupivacaine is the most common drug used in spinal anesthesia in vaginal hysterectomy which gives adequate anesthesia for the procedure. Clonidine is α2 agonist used to prolong the duration of intrathecally administered local anesthetic and has potent antinociceptive properties. Fentanyl not only improves the quality of intra-operative analgesia but also reduces the need of supplemental sedation. In the present study, we tried to find out whether quality of of anesthesia is better with low dose bupivacaine and clonidine or with low dose bupivacaine and fentanyl. Methods: Prospective, randomised double-blind, controlled study was conducted in a tertiary care institution. 80 patients ASA Grade I and II scheduled for vaginal hysterectomy were randomly allocated into two groups by using computer generated random numbers. Group BC (n = 40) received 0.5% Hyperbaric bupivacaine 2.8 ml (14 mg) + 25 mcg Clonidine and Group BF (n = 40) received 0.5% hyperbaric bupivacaine 2.8 ml (14 mg) + 30 mcg Fentanyl intrathecally. Time for onset of sensory and motor blockade, time to achieve maximum sensory and motor blockade, time for segment regression up to L1, side effects, perioperative and post-operative analgesic requirements were assessed. Results: Mean duration of onset to peak sensory block (5.45 ± 0.50 min), onset to peak motor block (7.05 ± 0.22 min) was significantly higher in group BC as compared to group BF (6.90 ± 0.38 min) and (8.67 ± 0.47 min) respectively. Significant difference in mean duration of sensory block and motor block (189.80 ± 6.49 min, 247.28 ± 8.42 min) in group BC and group BF (150.23 ± 4.23, 197.08 ± 6.25 min) were noted. Duration of post-operative analgesia was significantly higher in group BC (495.93 ± 22.43 min) as compared to group BF (269.33 ± 17.98 min). There was significant difference between VAS score in group BC and group BF except 4th hr and 18th hr. All patients were hemodynamically stable and no significant difference in post-operative sedation and adverse effects was observed. Conclusion: Clonidine and fentanyl are good adjuvant drugs and their use intrathecally as an additive to bupivacaine extends the duration of spinal anesthesia significantly, lowering the need to administer general anesthesia if duration of surgery is prolonged. Further they also provides excellent post-operative analgesia. Clonidine is better adjuvant with bupivacaine in view of better sensory and motor blockade, prolonged post-operative analgesia.

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Ganesh Laxman Khandarkar, Pradnya Milind Bhalerao, Rajashekar S et al. Study of Clonidine vs Fentanyl Intrathecally with 0.5% Bupivacaine in Vaginal Hysterectomy: A Comparative Study. Indian J Anesth Analg. 2019;6(5 Part-1):1615-1622.

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DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.6519.19

Keywords

Clonidine; Fentanyl; Analgesia; Vaginal hysterectomy.

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