To Compare The Efficacy Of Intrathecal Clonidine And Intrathecal Fentanyl As An Adjuvant To Hyperbaric Bupivacaine For Infra-Umbilical Urological Surgeries

Abstract

Back ground: Local anesthetics and intrathecal opioids work together synergistically to increase the sensory block without enhancing the sympathetic block.Research to create non-opioid analgesics has been spurred by catastrophic delayed respiratory depression caused by opioidsImportant drawback is ,shorter duration of action with bupivacaine and postoperative analgesia requirement and hemodynamic state. Our study was conducted to determine the effectiveness of clonidine andfentanyl as an adjuvant with hyperbaric bupivacaine for post- operative analgesia in urologicalsurgery based on the aforementioned facts.

Materials and methods:This prospective randomized placebo-controlled, double blinded study was conducted on 60 patients at tertiary care center for 18 months. They were divided into 2 groups consisting of 30 in each. Group A received intrathecal 0.5% hyperbaric Bupivacaine, 12.5mg(2.5ml) + inj. Clonidine 60mcg and Group B received intrathecal 0.5% hyperbaric Bupivacaine, 12.5mg (2.5ml) + inj. Fentanyl 25mcg. The time of onset and duration and level of sensory and motor block, time to complete sensory and motor block recovery and duration of spinal anaesthesia, intraoperative and

postoperative hemodynamics and side effects if any were noted.Motor blockade was assessed using modified Bromage scale, Intra and post-operative sedation will be assessed using Ramsay Sedation Score and post-operativepain was assessed using Visual Analogue Scale (VAS)

Results:The time of onset of sensory and motor block was delayed in group A but the duration of sensory and motor block was more compared to group B and the difference was statistically significant (p<0.05). Duration of analgesia was also prolonged in group A. Hemodynamic stability wasbetter in group B and incidence of side-effects was more in group A

Conclusions:Fentanyl has a shorter duration of sensory and motor blockade and is also linked to a lesser incidence of side effects, whereas clonidine has longer duration of sensory and motor block and higher incidence of side effects.However clonidine can be used as an better adjuvant with bupivacainein long duration surgeries and fentanyl can be used as an better adjuvant with bupivacaine in shirt duration surgeries. Both medications do not result in persistent motor block, or respiratory depression.