A COMPARATIVE STUDY OF DEXMEDETOMIDINE AND CLONIDINE AS AN ADJUVANT TO INTRATHECAL BUPIVACAINE IN LOWER ABDOMINAL SURGERIES
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Keywords
Dexmedetomidine, Clonidine, Intrathecal bupivacaine, Spinal anaesthesia, Lower abdominal surgery, Analgesia.
Abstract
Background: α2-adrenergic agonists such as dexmedetomidine and clonidine are widely used intrathecal adjuvants to prolong the quality and duration of spinal anaesthesia. This study compared their efficacy and safety in patients undergoing lower abdominal surgeries.
Methods: Sixty ASA I–II patients scheduled for elective lower abdominal surgeries under spinal anaesthesia were randomly divided into two groups: Group D (n=30) received intrathecal dexmedetomidine (5 µg) with 0.5% bupivacaine, while Group C (n=30) received clonidine (30 µg) with 0.5% bupivacaine. Onset and duration of sensory and motor block, duration of effective analgesia, hemodynamic changes, and side effects were recorded.
Results: Demographic parameters and surgical duration were comparable between groups (p>0.05). The onset of sensory block was significantly faster in Group D (2.6 ± 0.8 min) than in Group C (3.8 ± 1.0 min, p<0.001). Duration of sensory block (245.6 ± 28.3 vs. 198.7 ± 25.4 min, p<0.001) and motor block (210.4 ± 26.7 vs. 172.5 ± 23.8 min, p<0.001) were both significantly longer in Group D. Effective postoperative analgesia was also prolonged with dexmedetomidine (310.5 ± 35.8 vs. 248.6 ± 32.7 min, p<0.001). Hemodynamic profiles were stable in both groups; Group D showed slightly lower MAP values at 10–20 min, though not statistically significant. Side effects were mild and comparable, with hypotension (10% vs. 13.3%), bradycardia (6.6% vs. 3.3%), and nausea/vomiting (6.6% vs. 10%). Mild sedation occurred more frequently with dexmedetomidine (16.6% vs. 6.6%). No respiratory depression was observed.
Conclusion: Intrathecal dexmedetomidine provides faster onset, longer sensory and motor blockade, and significantly prolonged postoperative analgesia compared to clonidine, with stable hemodynamic parameters and minimal side effects. Dexmedetomidine may thus be considered a superior intrathecal adjuvant for lower abdominal surgeries.
References
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15. Gupta R, Verma R, Bogra J, Kohli M, Raman R, Kushwaha JK. A comparative study of intrathecal dexmedetomidine and clonidine as adjuvants to bupivacaine. J Anaesthesiol Clin Pharmacol. 2011;27(3):339-343.
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17. Carollo DS, Nossaman BD, Ramadhyani U. Dexmedetomidine: a review of clinical applications. Curr Opin Anaesthesiol. 2008;21(4):457-461.
18. Al-Mustafa MM, Abu-Halaweh SA, Aloweidi AS, et al. Effect of dexmedetomidine added to spinal bupivacaine for urological procedures. Saudi Med J. 2009;30(3):365-370.
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20. Eisenach JC, De Kock M, Klimscha W. Alpha(2)-adrenergic agonists for regional anesthesia: a clinical review of clonidine and dexmedetomidine. Anesthesiology. 1996;85(3):655-674.
21. Dobrydnjov I, Axelsson K, Samarütel J, Holmström B. Postoperative pain relief following intrathecal bupivacaine combined with intrathecal or oral clonidine. Acta Anaesthesiol Scand. 2002;46(7):806-814.
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23. Sudheesh K, Harsoor SS. Dexmedetomidine in anaesthesia practice: A wonder drug? Indian J Anaesth. 2011;55(4):323-324.
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Dr Diapule Sandeep Kumar
Assistant professor, Department of Anaesthesiology, Mallareddy Medical College for women, Suraram, Hyderabad. Telangana
Dr A Deva Suman Sujith Kumar
Assistant professor, Department of Anaesthesiology, Chettinad Medical college, Chennai, Tamil Nadu.
Dr. G. Santiraju
Professor and HOD, Department of Anaesthesiology, Viswabharthi Medical college, Kurnool, Andhra Pradesh