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Low Dose Bupivacaine with Clonidine for Unilateral Spinal Anesthesia in Lower Limb Surgeries

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Introduction: Unilateral spinal anaesthesia has been extensively studied for short duration elective lower limb surgeries with favorable results i.e when block is desired on operative side only with absence of block on non- operative side. Unilateral block minimizes cardiovascular effects, avoids motor block of nonoperative limb thereby early ambulation and early discharge. Aim: The aim of this study was to determine the sensory and motor block characteristics and haemodynamic variables (HR, MAP, RR) by comparing 7.5 mg of 0.5% hyperbaric bupivacaine used alone and along with 30g clonidine. Methods: It was a prospective, double blind , hospital based study undertaken at Department of Anaesthesiology, Gandhi Medical College, Bhopal after approval of the Institutional Ethics Committee. 60 patients of either sex aged 20-60years with ASA grade I and II scheduled for elective lower limb surgery with informed consent were randomly allocated into two groups. All patients received subarachnoid block with 7.5 mg of 0.5% hyperbaric bupivacaine. In group BC 30 g of clonidine and in group BS 0.2 ml of Normal Saline was added to bupivacaine and the volume was kept similar (1.7 ml) for each group. Statistical Analysis Used: Chi-Square (c2) test and Unpaired Student’s t-test Results: Although there was not much significant difference between the haemodynamic parameters in both the groups, the onset of sensory block (6.0±0.58 mins in group BS and 3.9±0.48 mins in group BC) and the onset of motor block (10.08±0.54 mins in group BS and 7.03±0.57 mins in group BC) was significantly earlier and the average duration of analgesia and motor block was significantly prolonged in patients receiving clonidine as an adjuvant along with bupivacaine. Likewise, the time for the first rescue analgesic request (258±20 & 331±23 mins respectively in groups BS & BC, p<0.0001) was delayed in patients receiving clonidine as an adjuvant. Conclusion: From our study we conclude that 7.5mg of 0.5% hyperbaric bupivacaine used along with clonidine is superior than 7.5mg of 0.5% bupivacaine used alone in prolonging duration of analgesia and motor block while maintaining the unilaterality of spinal block and haemodynamic stability.

Perspectives

Introduction: Unilateral spinal anaesthesia has been extensively studied for short duration elective lower limb surgeries with favorable results i.e when block is desired on operative side only with absence of block on non- operative side. Unilateral block minimizes cardiovascular effects, avoids motor block of nonoperative limb thereby early ambulation and early discharge. Aim: The aim of this study was to determine the sensory and motor block characteristics and haemodynamic variables (HR, MAP, RR) by comparing 7.5 mg of 0.5% hyperbaric bupivacaine used alone and along with 30g clonidine. Methods: It was a prospective, double blind , hospital based study undertaken at Department of Anaesthesiology, Gandhi Medical College, Bhopal after approval of the Institutional Ethics Committee. 60 patients of either sex aged 20-60years with ASA grade I and II scheduled for elective lower limb surgery with informed consent were randomly allocated into two groups. All patients received subarachnoid block with 7.5 mg of 0.5% hyperbaric bupivacaine. In group BC 30 g of clonidine and in group BS 0.2 ml of Normal Saline was added to bupivacaine and the volume was kept similar (1.7 ml) for each group. Statistical Analysis Used: Chi-Square (c2) test and Unpaired Student’s t-test Results: Although there was not much significant difference between the haemodynamic parameters in both the groups, the onset of sensory block (6.0±0.58 mins in group BS and 3.9±0.48 mins in group BC) and the onset of motor block (10.08±0.54 mins in group BS and 7.03±0.57 mins in group BC) was significantly earlier and the average duration of analgesia and motor block was significantly prolonged in patients receiving clonidine as an adjuvant along with bupivacaine. Likewise, the time for the first rescue analgesic request (258±20 & 331±23 mins respectively in groups BS & BC, p<0.0001) was delayed in patients receiving clonidine as an adjuvant. Conclusion: From our study we conclude that 7.5mg of 0.5% hyperbaric bupivacaine used along with clonidine is superior than 7.5mg of 0.5% bupivacaine used alone in prolonging duration of analgesia and motor block while maintaining the unilaterality of spinal block and haemodynamic stability.

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This page is a summary of: Evaluation of Low Dose Bupivacaine with Clonidine for Unilateral Spinal Anesthesia in Lower Limb Surgeries, Indian Journal of Anaesthesia and Analgesia, January 2018, Red Flower Publication Private, Ltd.,
DOI: 10.21088/ijaa.2349.8471.5318.15.
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