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Effect of Oral Clonidine as a Premedication in Patients Receiving Spinal Anaesthesia with Hyperbaric
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Why is it important?
Background: Spinal anaesthesia is the most commonly used technique for infraumbilical surgeries. Hyperbaric Bupivacaine has limited duration of action. Clonidine has been used to prolong the duration of local anaesthetic. Hence, we studied the effects of oral clonidine premedication on spinal anaesthesia with hyperbaric Bupivacaine vs placebo with reference to sedation, onset and duration of sensory and motor blockade including its effects on hemodynamic status and also on postoperative analgesic requirement. Objectives: To study the effect of oral clonidine premedication on spinal bupivacaine anaesthesia with respect to - The onset time, duration of sensory and motor blockade, Effect on haemodynamic status, Sedation, Duration of analgesia, Need for further analgesics in the first 24 hours postoperatively. Materials & methods: 60 adult (18-65 yrs) ASA physical status class I and II patients scheduled for lower abdominal, perineal and lower limb surgeries under spinal anaesthesia were recruited into the study. Patients were randomized to receive either 150 µg clonidine or placebo tablet using a random number table. Prespinal heart rate, blood pressure, oxygen saturation and sedation score recorded. Subarachnoid block performed with 3.0 ml of 0.5% hyperbaric Bupivacaine. Sensory & motor block assessed along with hemodynamic parameters and interventions required intraoperatively. Postoperatively heart rate, systolic and diastolic blood pressure, time of first request of analgesic and number of analgesics required in 24 hours were recorded and statistically analysed with p value < 0.05 considered as significant. Results: Clonidine group had higher incidence of sedation, faster onset of sensory block without any effect on the onset of motor block, prolonged duration of both sensory and motor block, reduction in blood pressure and heart rate with minimal requirement of haemodynamic interventions, reduced analgesic requirement in the early postoperative period compared to the Placebo group. Conclusion: Oral clonidine premedication in patients receiving hyperbaric bupivacaine spinal anaesthesia produces moderate sedation, hastens the onset of sensory block, prolongs the duration of sensory and motor block. Although causes reduction in blood pressure and heart rate, the haemodynamic interventions required is minimal. It also reduces analgesic requirement in early postoperative period.
Perspectives
Background: Spinal anaesthesia is the most commonly used technique for infraumbilical surgeries. Hyperbaric Bupivacaine has limited duration of action. Clonidine has been used to prolong the duration of local anaesthetic. Hence, we studied the effects of oral clonidine premedication on spinal anaesthesia with hyperbaric Bupivacaine vs placebo with reference to sedation, onset and duration of sensory and motor blockade including its effects on hemodynamic status and also on postoperative analgesic requirement. Objectives: To study the effect of oral clonidine premedication on spinal bupivacaine anaesthesia with respect to - The onset time, duration of sensory and motor blockade, Effect on haemodynamic status, Sedation, Duration of analgesia, Need for further analgesics in the first 24 hours postoperatively. Materials & methods: 60 adult (18-65 yrs) ASA physical status class I and II patients scheduled for lower abdominal, perineal and lower limb surgeries under spinal anaesthesia were recruited into the study. Patients were randomized to receive either 150 µg clonidine or placebo tablet using a random number table. Prespinal heart rate, blood pressure, oxygen saturation and sedation score recorded. Subarachnoid block performed with 3.0 ml of 0.5% hyperbaric Bupivacaine. Sensory & motor block assessed along with hemodynamic parameters and interventions required intraoperatively. Postoperatively heart rate, systolic and diastolic blood pressure, time of first request of analgesic and number of analgesics required in 24 hours were recorded and statistically analysed with p value < 0.05 considered as significant. Results: Clonidine group had higher incidence of sedation, faster onset of sensory block without any effect on the onset of motor block, prolonged duration of both sensory and motor block, reduction in blood pressure and heart rate with minimal requirement of haemodynamic interventions, reduced analgesic requirement in the early postoperative period compared to the Placebo group. Conclusion: Oral clonidine premedication in patients receiving hyperbaric bupivacaine spinal anaesthesia produces moderate sedation, hastens the onset of sensory block, prolongs the duration of sensory and motor block. Although causes reduction in blood pressure and heart rate, the haemodynamic interventions required is minimal. It also reduces analgesic requirement in early postoperative period.
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This page is a summary of: Effect of Oral Clonidine as a Premedication in Patients Receiving Spinal Anaesthesia with Hyperbaric Bupivacaine, Indian Journal of Anaesthesia and Analgesia, January 2019, Red Flower Publication Private, Ltd.,
DOI: 10.21088/ijaa.2349.8471.6119.7.
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