Intrathecal clonidine for perioperative pain relief in abdominal hysterectomy

Abstract

Background: Two different doses of intrathecal clonidine with hyperbaric bupivacaine fentanyl combination is compared in women undergoing abdominal hysterectomy to get best beneficial effects with minimal incidence of side effects/complications. Methods: 90 patients undergoing abdominal hysterectomy under spinal anesthesia, were randomized to 3 groups, BFC0: received 3 ml hyperbaric bupivacaine 0.5% + 25μg fentanyl, BFC30: received 3 ml hyperbaric bupivacaine 0.5% + 25μg fentanyl + 30μgm clonidine and BFC60: received 3 ml hyperbaric bupivacaine 0.5% + 25μg fentanyl + 60μgm clonidine. Time to reach peak sensory levels, sensory and motor regression times, intraoperative pain score and time for first analgesic requirement, hemodynamic changes, fluid and vasopressor requirement were recorded. Results: Addition of clonidine has not increased the rapidity of spread of sensory block to T4. Duration of motor block and time to regression to L1 is significantly less in BFC0, (167.78±25.09min and 213.59±22.99min respectively) compared to BFC30 (248.33±26.07 min and 297.33±25.96 min respectively) and BFC60 (260.18 ± 47.64min and 306.43±44.76min respectively). In patients of BFC0 intraoperative vas score (1.3±1.2) was significantly higher and demanded analgesics earlier (241.3 ± 27.76 min) compared to others. Fall in BP was observed in a dose dependent manner. Conclusions: Adding small doses of clonidine to bupivacaine-fentanyl combination improves the quality of perioperative analgesia in a dose dependent manner. However, 60μg clonidine shows significant hemodynamic changes. Hence, 30μg of intrathecal clonidine added to bupivacaine (15mg) fentanyl (25μg) combination is the preferred choice.

Keywords

• α2-adrenoreceptor agonist
• clonidine
• intrathecal adjuvants
• spinal anesthesia