Comparative Evaluation of Intravenous Dexmedetomidine and Clonidine on the Extent and Duration of Bupivacaine Spinal Anaesthesia: A Randomised Control Trial
Published: March 1, 2020 | DOI: https://doi.org/10.7860/JCDR/2020/43496.13596
Akoijam Nikhil Singh, Amol Singam
1. Junior Resident, Department of Anaesthesia, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India.
2. Professor and Head, Department of Anaesthesia, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India.
Correspondence
Dr. Amol Singam,
JNMC, Swanagi, Wardha, Maharashtra, India.
E-mail: nicksak1990@gmail.com; dramolsingam@gmail.com
Introduction: Several methods have been tried in recent years to alleviate post-operative pain, with partial or greater success. Alpha 2 adrenergic agonists have analgesic property when used as an adjuvant to regional anaesthesia. Clonidine is a partial a2-adrenoceptor agonist used intrathecally with a proven record of efficiency and safety. Dexmedetomidine is a selective a2-adrenoceptor agonist. Some studies have shown that intravenous dexmedetomidine is better than intravenous clonidine to provide better intraoperative analgesia during bupivacaine spinal anaesthesia.
Aim: To compare and evaluate the efficacy of intravenous dexmedetomidine with clonidine on the onset and duration of sensory and motor block following intrathecal bupivacaine.
Materials and Methods: In this randomised, double-blind clinical study, a total of 100 patients aged 20-60 years, American Society of Anaesthesiologists physical Status I or II scheduled for elective surgery under spinal anaesthesia were taken. These patients were randomly allocated to two equal groups of 50 with the help of a computer generated table of random numbers to receive the drugs after ethical approval. Group A received dexmedetomidine 0.5 µg/kg iv and Group B received clonidine 1 µg/kg iv. Time for the onset of sensory and motor blockade and duration of analgesia was noted. Haemodynamic changes, duration of post-operative analgesia and side-effects were also recorded. Data were analysed using chi-square test and the value of p<0.05 was considered statistically significant.
Results: Onset of sensory block was significantly shorter in Group A (2.60±1.12 minutes) as compared to Group B (3.45±1.50 minutes). Thus, dexmedetomidine has faster onset of sensory blockade than clonidine. Onset of motor blockade was significantly shorter in Group A (3.52±0.45 minutes) as compared to Group B (4.20±1.46 minutes). Thus, dexmedetomidine has faster onset of motor blockade than clonidine. Time for first analgesic request was 250.46±52.10 minutes in Group A and 180±50.28 minutes in Group B, thus post-operative analgesia was longer in Group A. The mean intraoperative RSS was higher in Group A, thus indicating that dexmedetomidine provides better sedation than clonidine.
Conclusion: Premedication with intravenous dexmedetomidine is better than intravenous clonidine to provide early onset of sensory analgesia, prolonged post-operative analgesia and adequate sedation.
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