European Journal of Molecular & Clinical Medicine

The provision of adequate analgesia is necessary after any surgery and is all the more important in children. Pain after surgery is inevitable. It has been recognized for some time that management of acute pain, especially postoperative pain, has been consistently and systematically inadequate, situation being worse in children.
Methodology: After careful pre-anaesthetic check-up children posted for elective sub-umbilical surgeries between age groups of 3-8yrs of ASA I & II were randomly divided into 2 equal groups. Group L received levobupivacaine 0.25% 1ml/kg + 2mcg/kg clonidine and Group R received ropivacaine 0.25% 1ml/kg + 2mcg/kg clonidine. Following intrathecal administration of these drugs, intraoperative hemodynamic changes, postoperative pain relieving quality and rescue analgesia were studied. Hemodynamic parameters were monitored in the intraoperative and postoperative period. Incidence of side effects were also noted.
Conclusion: Addition of clonidine as an adjuvant to both the groups were significantly increase in Post-operative analgesic quality with perioperative hemodynamic stability with minimum side effects. Thus making it evident the clonidine as an adjuvant to Ropivacaine and levobupivacaine can be safely used for single shot caudal block in children undergoing elective subumbilical surgeries.

Epidural anesthesia have important role for surgeries of lower abdomen, pelvis and lower limbs as they offer excellent operating conditions and are relatively safe for patients. This is especially useful in patient who are at risk of pulmonary aspiration
Materials & methods: The  study  comprised  of  60  ASA grade  I and II patients,  of either sex,  age  group  20-70  years and weight  40-75 kg. undergoing elective  surgeries  on  lower  limbs,  pelvis  or  abdomen  with  no  contraindication to epidural  anesthesia were selected. All patients were admitted in Gynecology, Surgery and Orthopedics ward, was conducted in the Department of Anesthesiology ANMMCH Gaya.
Conclusion-: clonidine  will  definitely expand scope  and  improve  the reliability  and  efficacy  of  epidural  anesthesia.  The  major  clinical  place  of  clonidine  is  as  on  adjuvant  to other  analgesics and  local anesthestic  as shown  in  number  of  studies

As stated by Hippocrates - “Divine is the task to relieve pain”
Relief of pain during surgery is one of the components of balanced anaesthesia but this pain relief should be extended to the postoperative period also. According to Perkins and co-workers poorly managed acute pain like postoperative pain can lead to the occurrence of chronic pain.
Materials and Method: This clinical study was conducted on 156 adult patients of ASA physical status I to III in the age group of 18-60 years of either sex posted for elective lower abdominal or lower limb surgeries under spinal anaesthesia after taking informed consent at a tertiary hospital Vijayapur.
Results: Statistical tests used: anova, chi square test and tukey test.
Discussion: Spinal anaesthesia is currently wide spread popular anaesthetic technique available today. It has the definitive advantage that profound nerve block can be produced in a large part of the body by the relatively simple injection of a small amount of local anaesthetic.
Conclusion: Acute pain following surgical procedures is unique to the clinical practice of pain medicine. It is one of the few opportunities in which the cause of pain is known before its occurrence, the pain is reliably expected to occur and can be annulled effectively

In anaesthesia, circulatory stimulation during tracheal intubation are caused by the stimulation of laryngeal and tracheal tissues from both direct laryngoscopy and placement of the ET tube in the trachea. These stimuli often evoke sympathoadrenal responses characterized by changes in Blood pressure, Heart rate, Cardiac rhythm, ST segment changes, and may lead to pulmonary oedema and rupture of cerebral aneurysm. In the present study that was carried out in the Institute, we compared the efficacy of Oral Clonidine versus Intravenous Fentanylin attenuating the cardiovascular stress response to laryngoscopy and tracheal intubation.
Material and Methods: The present Prospective and Comparative study was carried out at a Tertiary Care Hospital amongst 100 patients those who were randomly allocated to two groups, Group C: Patients in this group received- 5 microgram/kg of Oral Clonidine with 2 sips of water 90 minutes prior to surgery. Group F: Patients in this group received 100ml of normal saline over 10 minutes and 2 microgram /kg of fentanyl in 5ml of normal saline, 5 minutes prior to laryngoscopy and intubation.
Results: Out of 100 subjects, 32% subjects were in the age group 21 to 30 years and 22% in 41 to 50 years. The mean heart rate during Laryngoscopy in the groups Fentanyl and Clonidine were 108.58 and 91.56 respectively. The mean SBP during Laryngoscopy in the groups Fentanyl and Clonidine was 139.84 and 124.78 respectively and the mean SBP at 1 minute after intubation was 137.14 and 121.94 respectively. The mean DBP during laryngoscopy in the groups Fentanyl and Clonidine were 91.18 and 82.68. and at 1 minute after intubation, it was 88.36 and 78.52 respectively. The mean MAP at 1 minute after intubation in the groups Fentanyl and Clonidine were 101.54 and 92.98 respectively
Conclusion: Oral Clonidine 5 μg/kg proved to keep the hemodynamics in stable manner during laryngoscopy and endotracheal intubation and up to 30 mins post-intubation. Fentanyl in the dosage of 2 μg /kg given 5 minutes before laryngoscopy and intubation attenuated the hemodynamic changes, but was not equally effective in reducing the increase in heart rate and blood pressure.  

Alpha two agonists such as clonidine and dexmedetomidine have been popular in anaesthesia practice as adjuvants to provide sedation, anxiolysis, analgesia and controlled hypotension. Dexmedetomidine is eight times more selective for alpha 2 receptors than clonidine. Aim: The present study was undertaken to compare effects of clonidine and dexmedetomidine on haemodynamic stability, anaesthetics requirement and recovery profile in spine surgeries under general anaesthesia. Material and Method: A total 100 patients of American Society of Anaesthesiologists (ASA )grade I and II, age between 18 to 60 years, who were schedule for thoracic and lumbar spine surgery under general anaesthesia were included in the study. They were randomized in two groups of 50 patients in each. Group A received injection clonidine 2ug/kg bolus IV over 10 min followed by normal saline infusion and group B received injection dexmedetomidine 1ug/kg bolus IV over 10 minutes followed by dexmedetomidine infusion of 0.5ug/kg/hr. Assessment of haemodynamic parameters, anaesthetic requirement and recovery profile was done. Results: With clonidine and dexmedetomidine the intraoperative haemodynamic parameters remained stable without any statistical difference. Both the drugs were equally effective in reducing anaesthetic agent’s requirement and in reducing blood loss while comparable with respect to recovery profile and adverse effects. Group B had lesser extubation time (9.72±4.1 minutes) than group A (11.44±4 minutes) which was statistically significant however it was not clinically significant ,whereas the time to achieve aldrete score of > 9 was comparable between two groups. Conclusion: Dexmedetomidine and clonidine have similar effects on haemodynamic stability, anaesthetics requirement and recovery profile.

Introduction: Spinal anesthesia has been the choice of anesthesia for infraumblical surgeries. Aim: to evaluate the efficacy of adding clonidine (30µg) or dexmedetomidine (5µg) to 0.75% isobaric ropivacaine for administration of subarachnoid lumbar block in lower limb surgical procedures.
Methods: The Hospital based comparative, randomized, double blind, study was done on 120 patients (ASA grade 1-2) undergoing lower limb surgeries at S.M.S. Medical College and attached group of hospitals, Jaipur, after taking permission from the institutional ethical committee and review board. 120 patients were randomized into three groups of 40 each by sealed envelope method as follow: GROUP RS (0.75% Ropivacaine + 0.5 ml Isotonic saline), GROUP RC (0.75% Ropivacaine + 30µg Clonidine), GROUP RD (0.75% Ropivacaine + 5µg Dexmedetomidine).
Results: The mean time taken to achieve maximum sensory level was 18.40 minutes, 11.70mins and 18.80mins in groups RS, RC and RD, respectively (p<0.05). Mean time taken for sensory block to regress to L1 sensory level was 227.50minutes, 202.30minutes and 159.40minutes in groups RC, RD and RS, respectively(p<0.05). The time between the administration of subarachnoid block and request for rescue analgesic was 193.10 minutes, 347.60 minutes and 381.30 minutes in groups RS, RC and RD, respectively (p<0.05).
Conclusion: We conclude that both drugs, Clonidine and dexmedetomidine can be safely added as adjuvant to intrathecal Ropivacaine for lower limb surgeries, in view of similar sensory and motor block characteristics.

Significant postoperative discomfort is a side effect of total knee arthroplasty (TKA), which restricts postoperative movement, which is essential for restoring joint function. Pain is possibly the most dreaded thing in the world. It warns the body of illness. The intensity and length have an effect on quality of life. In orthopaedics, pain following total knee arthroplasty (TKA) is a major concern. Although continuous epidural analgesia and opioids continue to be the main options for postoperative pain treatment following TKA, they have negative side effects include drowsiness, nausea, and hypotension. An intricate and technically challenging technique requiring close monitoring is epidural catheterization. Local anaesthetic solution infiltration significantly reduces pain at the site. The learning curve is minimal, there are no long-term negative effects, no infections, no motor block at all, early mobilisation, and cost effectiveAn intricate and technically challenging technique requiring close monitoring is epidural catheterization. Local anaesthetic solution infiltration significantly reduces pain at the site. It has a minimal learning curve, no infection, no systemic side effects, no motor block at any level, early mobilisation, and is cost-effective. The use of ropivacaine and clonidine together as a LIA has not been extensively studied.
Methodology: At a tertiary care facility, a prospective study was conducted on 40 patients having total knee replacement surgery. A thorough evaluation of the airway, respiratory system, and cardiovascular system was done during the pre-anesthesia check-up. The simplest laboratory data were examined. The VAS was explained to patients, and it was assessed before surgery while the operated-on knee was at rest and while it was moving.
Results & Conclusion: The average age was 63.45 + 8.6 years, as we saw. Thirteen (32.5%) of the 40 patients were male, and 27 (67.5%) were female. In the first 24 hours following total knee replacement surgery, ropivacaine and clonidine have proven to be particularly efficient painkillers. We came to the conclusion that the need for opioid has diminished with the use of local infiltrative anaesthetic, or the combination of ropivacaine and clonidine. Tachycardia and hypertension effects on the cardiovascular system have also diminished. Early mobilisation also helped the patient, who benefited.

Regional nerve blocks with local anesthetics provide intra operative anesthesia as well as Postoperative analgesia. Our study has been undertaken to compare the onset time, duration and analgesic efficacy of clonidine with dexmedetomidine when added as adjuvant to bupivacaine(0.25%) for brachial plexus block by supraclavicular approach.
Methods: 60 patients aged 18-65 years belonging to ASA PS –I & II of both sexes undergoing elective upperlimb surgeries under Brachialplexus block were included in our study. Patients satisfying the inclusion criteria were allotted into 2 groups of 40 each. Group 1: Bupivacaine 0.25%( 35 cc) + clonidine 1 mcg/kg, Group 2: Bupivacaine 0.25%( 35 cc) +dexmedetomidine 1mcg/kg.
Results: The mean time for onset of sensory block in group A was (20.23 ±1.104 ) mins and that observed in group B was (14.83±1.744) mins. The mean time for onset of motor block in group A was( 18.43 ±1.135) mins and (12.67±1.539) mins in group B. . Mean duration of sensory block in group A was (476.77±9.313) mins and in group B was (730.13±52.208) mins. The mean duration of motor block in group A was (420.60±8.896 )mins and in group B was( 649.6±45.040 )mins. The mean duration of analgesia in group A was (522.23±11.047) and in group B was (757.13± 44.044) All the above differences were statistically significant with a p value < 0.05%. 

Surgery is an event that causes anxiety among the majority of patients. In addition, laryngoscopy and intubation cause disturbance in the heart rate and blood pressure rhythm. Together preoperative anxiety and intubation can prove harmful for some patients.
Aim: To observe the clinical effects of Clonidine on anxiety & cardiovascular parameters (pressor response) during direct laryngoscopy and tracheal intubation.
Material and Methods: A single-centre, parallel-group, two-arm, 1:1, double-blind, placebo-controlled, randomised, intervention study. A total of 100 participants: 50 in the clonidine group and 50 in the placebo group were enrolled in the present study. Participants in the clonidine group were given oral clonidine at a dose of 200 micrograms 90 minutes before induction.
Results: The increase in heart rate and mean arterial blood pressure was significantly less among patients given clonidine in comparison to placebo. In addition, participants given Clonidine showed fewer fluctuations in their heart rate and blood pressure throughout the surgery. Participants given Clonidine were more less anxious before surgery in comparison to those given the placebo. None of the participants given Clonidine had any adverse effect.
Conclusion: Clonidine is effective at attenuating the haemodynamic response to laryngoscopy and intubation. In addition, Clonidine has an anxiolytic action.

Background: Multiple agents are used for laparoscopic cholecystectomy since laparoscopic cholecystectomy is routinely performed surgery and desirable to have a stable intraoperative hemodynamic status by avoiding hypotension, hypertension or tachycardia. The search for ideal agent is still ongoing, alpha -2 adrenergic agonist have created interest in manner. So, the present study was conducted to compare the beneficial effect of clonidine and dexmedetomidine during laparoscopic cholecystectomy in maintain perioperative cardiovascular stability.
Methods: The present double blind randomized, prospective clinical study was carried out among patients scheduled for elective laparoscopic cholecystectomy under general anaesthesia for a duration of 2 years. The sample size was calculated as 90 using formula: n=4pq/d² and were divided equally into groups A (control), group B (clonidine) and group C (dexmedetomidine). Preanesthetic assessment of all the selected patients were done with complete history, general examination, airway assessment, systemic examination along with laboratory investigations. During perioperative period, hemodynamic parameters such as heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were recorded various intervals.
Results: Increase in heart rate was statistically insignificant in all the groups at baseline (B) and just after induction (D0).After infusion of drugs, increase in heart rate was significantly lower in all the intervals in Dexmedetomidine group and Clonidine group comparing with Control group.On comparing dexmedetomidine group with clonidine group, insignificant fall (p>0.05) in DBP were observed at all intervals except at 30 minutes after pneumoperitoneum (APN30) and after reversal(DBP_AR).While comparing Dexmedetomidine group with clonidine group, insignificant fall (p>0.05) in SBP and MAP were observed at all intervals except at 50 minutes after pneumoperitoneum (APN50).While comparing Clonidine with Dexmedetomidine, significantly decrease heart rate was observed in dexmedetomidine group.
Conclusion: Creation of pneumoperitoneum in laparoscopic abdominal surgeries produces significant increase of heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP). During pneumoperitoneum in laparoscopic abdominal surgeries both intravenous clonidine and intravenous dexmedetomidine results to attenuate in all hemodynamic parameters (HR, SBP, DBP and MAP) During pneumoperitoneum in laparoscopic surgeries heart rate is better controlled by dexmedetomidine.

Background: Hemodynamic response is considerable after laparoscopic procedures. Both magnesium and clonidine are known to reduce the hemodynamic response to pneumoperitoneum and block catecholamine and vasopressin production. The goal of this randomised, placebo-controlled trial is to determine which medication reduces the hemodynamic stress response to pneumoperitoneum the most effectively.

Background: To compare the efficacy standards and clinical status of two α-2 agonists dexmedetomidine and clonidine as adjuvant to bupivacaine in undergoing surgical procedures of lower limb and infraumbilical region. To estimate adjuvants analgesic property that provides superior anaesthetizing properties with sedation, haemodynamic stability in neuraxial anaesthesia.

Objective: Adjuvants prolong the action of intrathecal local anesthetic agents. They have shown to have significant analgesic effects in the postoperative period much after the regression of the sensory and motor blockade. Our objective of the current study was to compare the hemodynamic profile and adverse effects (nausea, pruritus, sedation and respiratory depression) in two groups of adult patients undergoing infra-umbilical and lower limb surgery under spinal anesthesia using either intrathecal clonidine or intrathecal fentanyl as an adjuvant to intrathecal bupivacaine (0.5% heavy).
 
Materials and Methods: It was a prospective randomized study in which eighty patients posted for lower limb orthopedic surgery were divided into two groups of forty each. Group A – Received intrathecal hyperbaric bupivacaine (2.5 ml) +50 µg clonidine (diluted to 0.5 ml). Group B – Received intrathecal hyperbaric bupivacaine (2.5 ml) + fentanyl 25 µg (diluted to 0.5 ml). Duration of postoperative analgesia, sensory and motor block characteristics, hemodynamic parameters, and side effects were recorded and analyzed.

Results: Both the groups were comparable in demographic data, hemodynamic parameters, but the duration of sensory and motor blockade and duration of analgesia was significantly longer in Clonidine group when compared with the Fentanyl group, with a mild increase in sedation score.
Conclusion: Addition of 50 μg clonidine to intrathecal bupivacaine offers longer duration of postoperative analgesia than 25 μg of fentanyl but with higher sedation. Both the drugs offer similar surgical conditions and prolongs postoperative analgesia (clonidine more than fentanyl), so we suggest fentanyl as better choice when sedation is not desirable and clonidine is recommended where sedation is acceptable.

Background and objectives: The provision of adequate analgesia is necessary after any surgery and is all the more important in children. Pain after surgery is inevitable. It has been recognized for some time that management of acute pain, especially postoperative pain, has been consistently and systematically inadequate, situation being worse in children. Bupivacaine has been for long used in caudal for post-operative analgesia but had back drop considerations of toxicity in large doses thus making it necessary to be able to use an alternative drug like Ropivacaine and levobupivacaine with lower toxicity but similar analgesic capability.
Methodology: After careful pre-anaesthetic check-up children posted for elective sub-umbilical surgeries between age groups of 3-8yrs of ASA I & II were randomly divided into 2 equal groups. Group L received levobupivacaine 0.25% 1ml/kg + 2mcg/kg clonidine and Group R received ropivacaine 0.25% 1ml/kg + 2mcg/kg clonidine. Following intrathecal administration of these drugs, intraoperative hemodynamic changes, postoperative pain relieving quality and rescue analgesia were studied. Hemodynamic parameters were monitored in the intraoperative and postoperative period. Incidence of side effects were also noted. Conclusion: we noted that Addition of clonidine as an adjuvant to both the groups were significantly increase in Post-operative analgesic quality with perioperative hemodynamic stability with minimum side effects. Thus making it evident the clonidine as an adjuvant to Ropivacaine and levobupivacaine can be safely used for single shot caudal block in children undergoing elective subumbilical surgeries.

Introduction: Both clonidine and dexmedetomidine are alpha-2 adrenergic agonists that have analgesic as well as sedative properties and are being tried as newer adjuvants for analgesia. In addition to this, both have been shown to reduce the requirements of local anesthetics and enhance the analgesic effects without increasing the incidence of side effects.Thus, the present study was undertaken to compare postoperative analgesia according to VAS with dexmedetomidine and clonidine and assessment of Ramsay sedation score after complication of surgery with each drug.

Background: Shivering is a physiological response to core hypothermia to increase metabolic heat generation. Prolonged impairment of thermoregulatory autonomic function under anaesthesia, along with cool operating room temperatures and cold infusion fluids, causes shivering.
Methods: This prospective study included 90 individuals who shivered under spinal anaesthesia during abdominal or orthopaedic surgery. On shivering, patients received a 1 mL intravenous bolus dose of 50 mg tramadol, 1 mg butorphanol, or 150 mcg clonidine. All 3 groups were compared for shivering control, time to cessation, recurrence, hemodynamic changes, axillary temperatures, and side effects. Data was processed using statistical methods.
Results: Butorphanol and tramadol decrease shivering better than clonidine. Butorphanol, tramadol, and clonidine totally decreased rigours in 83%, 73%, and 53% of patients, respectively. Clonidine (3.3±0.9 minutes) took longer than butorphanol and tramadol (2.1±1.0 minutes and 1.8 ±0.5 minutes; P 0.001).
Conclusion: Butorphanol controlled shivering with fewer recurrences than tramadol, but both were better than clonidine with an early onset of action. Both opioids reduce rigours better than α-2 agonists.

Introduction: Laparoscopic surgeries has revolutionized abdominal surgeries, however, this procedure is not risk free. Hence, the present study was designed to evaluate the efficacy of dexmedetomidine versus clonidine in prevention of such hemodynamic changes

Background: One of the challenges for anaesthesiologists is to minimize distress for patients in the operating room (OR) environment and to facilitate a smooth induction of anesthesia.A sedative drug is given before transfer to the OR. The beneficial effects of anxiolytic are sedation, anxiolysis, reduction of postoperative vomiting andpostoperative emergence phenomenon. Clonidine, an α 2-agonist, have been suggested as another option for premedication as effective as midazolam.
Materials and Methods: 50 patients were randomly divided into two groups.To one group Tab. Midazolam 7.5 mg was given while to other group Tab. Clonidine 100 µg was given one hour before induction ofanesthesia.Patients were evaluated and compared for benefits of preoperative oral midazolam and oral clonidine on sedation scores, perioperative hemodynamic parameters and perioperative opioid and analgesic requirement. Independent sample t-test was used and p-value < 0.05 was considered significant.
Results: We found that mean OAA/S sedation score in clonidine group was 11.48 ± 1.12 than in midazolam group13.68 ±1.03withsignificant difference ofp value (p<0.001).There was significant (P < 0.05) attenuation of hemodynamic response to intubation, surgical stress response and extubation with clonidine as compared to midazolam .None of the patients desaturatedin either group. Opioid requirement(72%)was more in midazolam group as compared to clonidine (28%)group. Recovery in clonidine group took slightly longer time 60.00 ± 13.77min as compared to midazolam group 44.40±13.25 min.
Conclusion: Premedication with 100 micrograms of oral clonidine can reasonably be recommended as premedication in ASA I and II patients for all surgeries to provide more sedation, stable hemodynamics intraoperatively, reduction in stress response,less opioid consumption.

Introduction: Spinal anaesthesia is a safe, reliable, inexpensive anaesthetic technique for regional anaesthesia. It also allows early ambulation and early rates of hospital discharges.
Material and methods: Present study was carried at tertiary care Hospital. After receiving ethical approval from the college ethical committee and CTRI registration, 64 patients aged 19 to 65 years old with ASA grade I and II physical status who were undergoing elective infra-umbilical surgeries were included in the study. Patients were randomly allocated in two groups of 32 patients each. Group C: Received 1% Isobaric Chloroprocaine 3 ml (30mg) + clonidine (30 mcg). Group F: Received 1% chloroprocaine 3ml (30 mg) + fentanyl (25 mcg). Total volume = 3.5ml. Sensory block was examined using pin prick method. Quality of motor block was examined and graded using Modified Bromage Scoring. Hemodynamic was monitored and side effects were noted.
Result: Total 64 patients were divided into two groups of 32 each. There were 17 males and 15 females in Group F. While in Group C, male and female participants were 16 each. In group F, mean onset time of sensory blockade was (3.69 ± 0.41min) and mean onset of motor blockade was (5.14 ± 0.65min). In group C, mean onset time of sensory blockade was (3.86 ± 0.28min) and mean onset of motor blockade was (5.31 ± 0.63min). In group F, mean duration of sensory blockade was (74.19 ± 3.14min) and mean duration of motor blockade was (60.24 ± 2.97min). In group C, mean duration of sensory blockade was (110.34 ± 8.45min) and mean duration of motor blockade was (94.88 ± 4.39min). In group F, 1 patient had hypotension and bradycardia while in group C,4 patients had hypotension and 3 had bradycardia. Transient neurological symptoms, respiratory depression and pruritis were not seen in any of the groups.
Conclusion: From our study we conclude that, clonidine as an adjuvant to intrathecal chloroprocaine can be used for infra-umbilical ambulatory surgeries with good sub-arachnoid block quality and lesser side effects.

Introduction: Spinal anaesthesia using hyperbaric bupivacaine with adjuvants such as
clonidine is now the routine and preferred technique for majority of the surgical cases.
Aim: to compare various block characteristics alongwith materno-fetal outcome in
patients scheduled for caesarean section under subarachnoid block (SAB), following
administration of hyperbaric bupivacaine alone and in combination with clonidine
intrathecally.
Methods: In this randomized clinical trial, 90 patients undergoing elective cesarean
section were randomly allocated to two groups. The patients of Group A received
intrathecal 0.5% hyperbaric Bupivacaine (10 mg) + 0.2 mL of normal saline and Group
B received intrathecal 0.5% hyperbaric Bupivacaine (10 mg) + 0.2 mL of clonidine (30
μg). Various block characteristics and materno-fetal outcome were compared between
the groups.
Results: Group B had quicker sensory onset (3.17 ± 1.05 min vs. 3.50 ± 0.94 min), longer
duration of sensory and motor block (209.73 ± 30.70 min and 147.50 ± 23.00 min),
longer time for rescue analgesia demand (298.83 ± 44.68 min) in comparison to Group
A.
Conclusion: Intrathecal clonidine provided better block characteristics and outcome
measures in terms of prolonged sensory as well as motor blockade, longer duration of
analgesia, greater intraoperative relaxation and minimal or no adverse incidences.

Aim: To compare the effects of fentanyl 25microgram and clonidine 30 microgram as
additives to 3 ml of 0.5 % hyperbaric bupivacaine for spinal anaesthesia in lower
extremity orthopedic and urological surgeries.
Materials and methods: This prospective, randomized, double blind study was
conducted on 60 adult patients of ASA physical status 1 & 2 in the age group of 20 years
to 60 years, posted for elective lower limb and urological surgeries under spinal
anaesthesia. Patients belonging to group BF received 3 ml (15 mg) of hyperbaric
bupivacaine (0.5 %) + 0.5 ml (25 microgram) fentanyl. Patients of group B received 3
ml (15 mg) of hyperbaric bupivacaine (0.5 + 0.2 ml (30 microgram) clonidine + 0.3 ml of
normal saline. The following parameters were observed - onset and duration of sensory
block, onset and duration of motor block, durations of complete and effective analgesia
and any side effects associated with these drugs.
Results: The present study showed that the duration of sensory and motor block was
prolonged with the addition of 30 microgram clonidine to intrathecal hyperbaric
bupivacaine as compared to 25 micrograms of fentanyl, same as the duration of
complete and effective analgesia. Both groups were comparable in hemodynamic
stability and there were no significant adverse effects.
Conclusion: Compared to fentanyl 25 microgram, clonidine 30 microgram as additive to
intrathecal hyperbaric bupivacaine for spinal anaesthesia, prolonged the duration of
complete and effective analgesia, which was statistically significant

Background: Spinal anaesthesia is popular and safe anaesthesia technique for various surgeries. Shivering that develops following spinal anaesthesia is common problem due to impairment of thermoregulatory control. Present study was aimed to compare the efficacy and safety of intravenous Tramadol with intravenous Clonidine in controlling shivering in obstetric patients under regional anaesthesia for caesarean section.
Material and Methods: Present study was single-center, prospective, comparative study, conducted in pregnant women, 18-40 years age, ASA grade I & II, developing shivering intra operative or postoperative in emergency or elective section. Drug therapy started as per patient group after delivery of baby
as Group C received Clonidine 0.5mcg per kg i.v while group T- received tramadol 0.5mg per kg i.v. Results: There was no significant difference in pre operative temperature, HR, SBP, DBP and SpO2 in both groups and even after the control of shivering. Mean time required to control the shivering in Tramadol group is 2.77 minutes is significantly less as compared to the Clonidine group which is 5.47 minutes (p< 0.001). Response rate that is the percentage of patients in which shivering controlled in 15 minutes after the treatment is 95% in Tramadol group and 82.5% in Clonidine group. The difference was not significant statistically (P-value 0.155). No side effects were noted in tramadol group, while 3 patients had side effects in clonidine group (3 cases had sedation), difference was not significant statistically.
Conclusion: Tramadol as compared to Clonidine is safe and effective in controlling the shivering in obstetric patients receiving spinal anaesthesia. Side effects were nil with tramadol, while patients received Clonidine were more sedated. Tramadol should be used for management of intra-operative shivering in regional anaesthesia for caesarean section.

Surgeries involving general anaesthesia where airway manipulation occurred during laryngoscopy and endotracheal intubation produces stimulation of epipha1ynx and laryngopharynx giving rise to hae1nodynatnic alteration due to catecholamine surge or response. Haemodynamic changes are accentuated in high risk cardiac patient. After obtaining approval from the institutional ethical committee patients fulfilling the inclusion/exclusion criteria were included in the study after obtaining informed consent. A preanesthetic evaluation of history of surgical and medical illness, drug allergies previous anaesthetic exposure and Baseline investigations of blood, ECG, radiograph of chest and airway examination was done. Patient was kept nil by mouth for at least 8hrs prior to surgery. All patients were premedicated with injection Pantoprazole 40mg (IV) one hour prior to surgery. Preoperative vital parameters like baseline pulse, blood pressure were noted. Systolic blood pressure in significantly lower in Group D patient after 40 minutes of intubation continues to be low at 6th, 8th, 10th, 15th and 20th minutes compared to Group C.

Background:Hyperbaric bupivacaine 0.5% (l0mg) with fentanyl 15mcg(0.3ml) and (2)
Hyperbaric bupivacaine 0.5% (10mg) with clonidine 45mcg. Objectives: The study
compared the onset and duration of action of intrathecal hyperbaric bupivacaine 0.5
percent and fentanyl 15mcg (group-I) to intrathecal hyperbaric bupivacaine 0.5 percent
and clonidine 45 mcg (group-II) in spinal anaesthesia in LSCS. The combination of
bupivacaine with fentanyl or clonidine assists anesthesiologists in alleviating
intraoperative discomfort by delivering superior analgesia to patients without extending
recovery.
Materials and Methods: The study included 80 female patients with ASA grade I (n=40
in each group). The time of onset of sensory and motor block, duration of analgesia, 2-
segment regression, intraoperative discomfort, hemodynamic stability, time to
micturition, visual analogue score, and postoperative analgesic requirements were all
evaluated.
Results: In group II, the onset of sensory and motor block was substantially later than
in group I (p0.001). Hemodynamic alterations did not differ between groups (p>0.05).
Intraoperatively, 1 patient reported pruritis, and 2 patients had postoperative urinary
II78.506.12min and groupII-—121.284.09 min) and regression of sensory level to L2
dermatome (group-I - 142.206.73 min and group II 166.405.79 min) were significantly
longer in group II (p0.001). The duration of analgesia in group II was 210.186.79
minutes, whereas in group II it was 323.5610.53 minutes, which is significant (p0.001).
The VAS scores in group II were considerably lower after 3 hours (p0.05), 6 hours
(p0.001), and 12hours (p0.001).
Conclusion: The addition of intrathecal clonidine 45 mcg to hyperbaric bupivacaine in
spinal anaesthesia gives greater analgesia with less perioperative discomfort, a longer
duration of analgesia, and a reduction in postoperative analgesic requirements.

Introduction: Pain is constant companion for human. There is perhaps nothing as dreaded as pain. Pain is the ultimate teacher. It alerts the body to disease. Depending upon the intensity and duration, it impacts quality of life. Pain after total knee arthroplasty (TKA) is a big concern in orthopaedics. Although opioids and continuous epidural analgesia remains the major option for the postoperative pain management of TKA, they have undesirable side effects like sedation, nausea and hypotension.  Epidural catheterization is skilful and technically demanding procedure with close monitoring. Infiltration of local anesthetic solution minimizes pain at the source superiorly. It has short learning curve, no systemic side effects, no infection, level of motor block is none, early mobilization and cost effective. There is not much study done on combination of Ropivacaine and Clonidine as a LIA.
Material and Methods: A prospective study was carried out among 30 cases undergoing total knee surgery at a tertiary care hospital. During pre-anaesthetic check up detailed assessment of airway, respiratory and cardiovascular system was carried out. Basic laboratory data were reviewed. Informed consent was taken. All patients were kept nil per oral for 8 hours and were pre-medicated with Tab Ranitidine 150mg, Tab Diazepam 5mg orally 12 hours before surgery. Patients were taught the visual analog pain scale (VAS) (0 = no pain, 10 = worst imaginable pain), and VAS was measured preoperatively at rest and on movement of the knee to be operated.
Results: We observed that; mean age was 62.7+9.9 years. Out of 30, 70% were female and 30% were males. Pain control with Ropivacaine and clonidine has been very effective in 1st 24 hours in total knee replacement surgery.
Conclusion: From this study s we concluded that, with the use of local infiltrative anesthesia i.e combination of Ropivacaine & clonidine, requirement of opioid has been decreased. Effects on cardiovascular system like tachycardia, hypertension has also been decreased. It also benefited patient by early mobilization.

Background: The supraclavicular approach to brachial plexus block is the most common peripheral nerve block technique used for upper limb surgeries. Aim of the present study was to evaluate and compare the efficacy of clonidine and dexmedetomidine as an adjuvant to 0.25% bupivacaine in peripheral nerve stimulator guided supraclavicular brachial plexus block in upper limb surgery.
Method: Total 80 patients of ASA grade I and II, age between 25-55 years were enrolled in the study and divided into two groups of 40 each. Group C received 39ml bupivacaine 0.25% (2.5mg/ml) + 1ml clonidine (1µg/ml) and group D received 39ml bupivacaine 0.25% (2.5mg/ml) + 1ml dexmedetomidine (1µg/ml). Parameters were observed include hemodynamic stability, onset time and duration of sensory and motor blockade, duration of analgesia and complications.
Results: Onset of sensory (2.32±1.16min) and motor blockade (5.55±1.50min) was earlier in dexmedetomidine group compared to clonidine group (sensory= 6.52±0.71min and motor= 11.65±1.05min), (p<0.0001). Duration of sensory blockade was 427.75±19.14 minutes in dexmedetomidine group and 226.0±11.72 minutes with clonidine group. Duration of motor blockade was 486.50±28.96 minutes with dexmedetomidine group and 275.25±17.53 minutes with clonidine group. However, the duration of analgesia was 588.25±28.27 minutes with dexmedetomidine group and 341.00±27.34 minutes with clonidine group. Hemodynamic parameters and side effects were comparable between the two drugs.
Conclusion: Dexmedetomidine shortens the onset, prolongs the duration of sensory and motor block, and also provides longer postoperative analgesia as compared with clonidine when used as an adjuvant to bupivacaine in peripheral nerve stimulator guided supraclavicular brachial plexus block.

The sensory unit consists of free nerve endings that lie between the mucosal cells of the airway epithelium. Sensory units appear to be particularly abundant over the arytenoid cartilages and are also found on the laryngeal side of the epiglottis. Study was undertaken in patients planned for elective surgeries under General Anaesthesia. Patient were selected between 18 to 60yrs of Age with ASA 1 and ASA 2 grades. They were divided into 2 groups of 30 each and allocated randomly. All patients were explained about the procedure and its complication and informed consent obtained. There were no significant differences between the two groups with regard to demographic data such as age and weight. The average age in Group-C (clonidine) was 31.90 years and average age in Group D (dexmedetomidine) was 34.80 years.

Background:Decreasing MAP (mean arterial blood pressure) using controlled hypotension, is introduced to improve visibility of the surgical site by reducing blood loss during FESS.
Aims:The present study was conducted to compare and assess the hemodynamic stability and hypotensive efficacy of Clonidine and Dexmedetomidine in FESS.
Materials and Methods:40 subjects were randomly divided into two groups of 20 subjects each. Subjects from Group I received 1 μg/kg dexmedetomidine, whereas, Group II subjects received 2 μg/kg Clonidine. Postoperative complications and Haemodynamic parameters were assessed at baseline, following the loading dose, 1- and 5-minutes following intubation, and every 10 minutes till recovery. These parameters were mean arterial pressure, systolic and diastolic blood pressures, oxygen saturation, and heart rate (HR).
Results:MAP and HR decreased significantly from baseline at all the time intervals of assessment (p<0.001). These values were statistically significant for both intragroup and intergroup for Group I and Group II. Also, statistically non-significant results were seen concerning the visibility of the surgical field. Emergence time was significantly higher for Group I (7.38±0.58 min) than Group II (6.44±0.72 min) with p=0.001. Sedation scores were higher significantly for group I (1.88±1.23) than Group II (1.37±0.12) with p=0.001. VAS scores were significantly lower for Group I (2.24±0.78) than Group II (3.01±0.14) at all time intervals with p=0.001. First rescue analgesia was significantly higher for Group I (110.45±12.25 min) than Group II (84.31±10.06) with the p-value of <0.0001
Conclusion:Present study concludes that, better hemodynamic stability was seen with dexmedetomidine compared to Clonidine. However, decreased blood loss and intraoperative visibility were comparable for both dexmedetomidine and Clonidine. Sedation and prolonged anesthesia were also better with dexmedetomidine.

Background: The induction of anesthesia, laryngoscopy, tracheal intubation and surgical
stimulation often evoke cardiovascular responses characterized by alteration in systemic
arterial blood pressure, heart rate and cardiac rhythm
Aim: Efficacy of low dose of clonidine in attenuating the haemodynamic response to
intubation. Comparing two doses of oral clonidine in attenuating haemodynamic response to
intubation.
Materials and Methods: The study will be conducted on 60 patients who will be undergoing
elective surgery under general anesthesia during the period of 2017 to 2019.
Group CL-1 and Group CL-2 patients were premeditated with oral Clonidine 60 minutes
prior to the surgery.
Randomisation: All the patients included in the study were randomized into 3 groups,
Group CL-1: Patients who received oral Clonidine premedication at the dose of 1 microgram
per kg.
Group CL-2: Patients who received clonidine premedication at the dose of 2microgram per
kg.
Group CS: Patients who received premedication with oral saline.
After shifting the patient inside the operating room noninvasive blood pressure, saturation
probe and electrocardiogram monitoring with 5 leads were attached and baseline values were
recorded.
Duration of laryngoscopy and intubation (from the time laryngoscope inserted till the end
tidal CO2 is seen on the monitor) was noted, grade of laryngoscopy, heart rate, systolic
diastolic and mean blood pressures are noted at the time of induction, just before
laryngoscopy, immediately after intubation and 1,3 and 5mins after intubation by investigator
2.
Results: In the present study when we evaluated the heart rate,SBP,DBP,MAP. There was
least variation HR, SBP, DBP and MAP, in those who received 2 mg clonidine as those who
received 1 mg clonidine as compared to the placebo saline group