Evaluation of Clonidine as an Additive to Bupivacaine for Central Neuraxial Blockade

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Evaluation of Clonidine as an Additive to Bupivacaine for Central Neuraxial Blockade

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Context: Advantages of Epidural anesthesia over spinal anesthesia like lesser incidence of hemodynamic instability and postdural puncture headache are offset by delayed onset time and unreliable motor blockade. Clonidine has been used as an additive in epidural and spinal anesthesia to prolong the duration of action. Aims: To compare the effect of Clonidine as an Additive in Epidural and Spinal Anesthesia. Settings and Designs: We designed this study to compare the effect of clonidine in epidural and spinal anesthesia in 75 adult patients scheduled for lower abdominal surgeries. Materials and Methods: Seventy five adult patients were randomized to receive intrathecal 0.5% hyperbaric Bupivacaine, 3 ml (Group ITB), 0.5% hyperbaric Bupivacaine + 30 μg clonidine, 3 ml (Group ITBC) or 16 ml 0.5% Bupivacaine with 75 μg clonidine at L3-L4 inter vertebral space, 16 ml (Group EDBC). Onset time of sensory blockade, duration and degree of sensory and motor blockade, heart rate, blood pressure and sedation were noted periodically. Statistical Analysis: Analysis was done by one way ANOVA (variables over time), Turkey’s posttest (parametric variables), Kruskal-Wallis test (Nonparametric variables). Results: Group EDBC had similar onset time of Group ITB. Sensory blockade was increased by 37% in EDBC and 27% in ITBC compared to ITB (212.2 ± 12.4 min, 230.4 ± 13.6 min and 166.8 ± 8.5 min respectively). EDBC had motor blockade similar to that of ITB. Hypotension and bradycardia were more severe in ITBC. Conclusions: Epidural bupivacaine with clonidine has better hemodynamic stability compared to intrathecal bupivacaine with similar sensory and motor blockade characteristics.

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