CLINICAL EVALUATION OF THREE DIFFERENT DOSES OF CLONIDINE (0.5,1,1.5MCG/KG) AS AN ADJUVANT TO 20ML OF ROPIVACAINE (0.375%) IN ULTRASOUND GUIDED CAUDAL EPIDURAL BLOCK IN ADULT PATIENTS UNDERGOING LUMBOSACRAL SPINE SURGERIES - AN OBSERVATIONAL STUDY

Abstract

BACKGROUND: Caudal epidural analgesia is an effective technique for intraoperative and postoperative pain management in lumbosacral spine fixation surgeries. When combined with general anesthesia, it reduces anesthetic requirements, improves recovery, and enhances postoperative analgesia. Ropivacaine, a long-acting amide local anesthetic, offers prolonged sensory blockade with minimal motor effects and reduced toxicity. Clonidine, an α-2 adrenergic agonist, enhances the effects of local anesthetics through spinal receptor modulation and contributes to hemodynamic stability. 1  AIM: The study aimed to observe and evaluate the duration and quality of analgesia of three different doses of clonidine (0.5, 1.0, and 1.5 mcg/kg) as an adjuvant to 20ml of 0.375% Ropivacaine in ultrasound guided caudal epidural block in adult patients undergoing Lumbosacral spine fixation surgeries. MATERIALS AND METHODS:  Study Design:
A prospective, hospital-based observational study.  Study Setting:
Conducted at Narayana Medical College, Nellore. Total cases of 90 patients undergoing elective lumbosacral spine fixation surgeries. Group A: Ropivacaine 0.375% + Clonidine 0.5 mcg/kg Group B: Ropivacaine 0.375% + Clonidine 1.0 mcg/kg Group C: Ropivacaine 0.375% + Clonidine 1.5 mcg/kg To assess quality and duration analgesia, vas score, hemodynamic parameters (HR, BP, SpO₂), patient satisfaction, time to first rescue analgesia, side effects and the number of paracetamol/tramadol doses within the first 24 hours. RESULTS: Group C showed the longest duration of analgesia and the maximum delay in requirement of first rescue analgesia (23.36 ± 0.99 hrs) but was associated with increased sedation and mild hypotension. This group also required the least number of rescue tramadol doses during the first 24 hours postoperatively (0.13 ± 0.33), indicating superior analgesic efficacy. In contrast, Group A had the shortest duration of analgesia with earlier need for rescue analgesia (7.66 ± 0.54 hrs) and the highest requirement for additional rescue analgesic doses, with maximum tramadol consumption in the first 24 hours (2.76 ± 0.66). Group B provided an optimal balance with prolonged analgesia and delayed rescue analgesia requirement (18.33 ± 1.49 hrs), while maintaining stable hemodynamic parameters. The tramadol requirement in this group was significantly lower (1.36 ± 0.49). compared to Group A, reflecting effective postoperative analgesia 2  with fewer adverse effects. Patient satisfaction scores were highest in Group B, followed by Group C and Group A. CONCLUSION: Clonidine effectively enhances ropivacaine analgesia in caudal epidural blocks. Among the doses studied, 1.0 mcg/kg is the most appropriate, offering prolonged analgesia, maintain hemodynamics stable and better patient outcomes. It is a safe and effective choice for adult lumbosacral spine fixation surgeries