Analysis of intrathecal clonidine as an adjuvant in the subarachnoid block on post-operative analgesia and safety profile in obstetric surgeries: A randomised controlled trial

Abstract

Background: Clonidine has long been considered an 'off-label' medication for use in obstetrics. Different doses of clonidine are studied and it is found that higher doses are associated with sedation and haemodynamic instability. Hence, we analysed a mini dose of intrathecal clonidine of 30 μg for its impact primarily on post-operative analgesia and secondarily on the quality of spinal anaesthesia, haemodynamics, sedation and neonatal outcomes in caesarean sections. Methods: One hundred participants were randomised them to receive the interventions. Group B received 11 mg of 0.5% hyperbaric bupivacaine (2.2 mL) and Group C received 10 mg of 0.5% hyperbaric bupivacaine with 30 μg of clonidine (2.2 mL). Motor, sensory and haemodynamic characteristics with time to rescue analgesics were observed in both the groups and analysed using univariate analysis. Results: Time to rescue analgesics (P < 0.001), visual analogue scores in the post-operative period and time to grade 0 Bromage (P = 0.002) were statistically significant in Group C. Time to T6 dermatomal level and time to grade 4 Bromage were similar in both the groups. Apgar scores were comparable and no adverse events were noted in both the groups. Conclusions: A low dose of intrathecal clonidine (30 μg) can prolong the duration of post-operative analgesia in caesarean section with comfortable maternal sedation and good neonatal outcome without significant complications. (Clinical Trials Registry- India, number CTRI/2018/08/015250)

Keywords

• analgesia caesarean section
• clonidine
• spinal anaesthesia
• alpha 2-adrenergic agonist