European Journal of Molecular & Clinical Medicine

Abstract

Background and Objectives: In the present day practice of Anesthesia, bupivacaine is the most commonly used drug for spinal anesthesia. To improve upon the quality of analgesia and prolong the duration of its action, many adjuvants have been tried. Intrathecal clonidine, an α2 adrenergic receptor agonist has potent central anti-nociceptive properties with analgesic effect at spinal level mediated by post synaptically situated adreno receptor in dorsal horn of spinal cord. Buprenorphine, an opioid, has analgesic effect when given in the sub arachnoid space by acting primarily at the µ receptor in the substanstia gelatinosa of the dorsal horn. It suppresses the excitatory neuropeptide release from C fibers. Low doses of clonidine and buprenorphine have shown effectiveness in prolonging the duration of action and improving the quality of analgesia during spinal anesthesia.
This study was designed to evaluate and compare the above mentioned benefits of adding 150µg buprenorphine and 50µg clonidine to bupivacaine for spinal anesthesia.
Methodology: This is a prospective, randomized comparative clinical study involved 60 ASA grade Ι/ΙΙ patients aged 35-65 years undergoing elective total abdominal hysterectomy at Dr VRK Womens Medical College from September 2021 to April 2022.
Patients were divided into two groups of 30 each:
Group B (Buprenorphine group) patients received intrathecally 0.5% hyperbaric bupivacaine 3.5 ml + 150µg buprenorphine (Total 4 ml) whereas Group C (Clonidine group) patient received intrathecally 0.5% hyperbaric bupivacaine 3.5 ml + 50µg of clonidine (Total 4 ml).
Parameters:
Onset and duration of sensory block and motor block, highest level of sensory blockade, Duration of postoperative analgesia, sedation, vitals and side effects were assessed.
Results: The onset of sensory and motor blockade was faster in the group B compared to group C. Duration of sensory block, motor block and analgesia was significantly prolonged in group B. There was no significant hemodynamic changes in both the groups.
Conclusion: Buprenorphine and Clonidine potentiates bupivacaine spinal anesthesia by increasing the duration and improving the quality of analgesia without significant hemodynamic side effects and with mild sedation.