COMPARISON OF EFFECTS OF SPINAL ADDITIVES FENTANYL OR CLONIDINE WITH HYPERBARIC BUPIVACCAINE WITH CONTROL GROUP RECEIVING ONLY HYPERBARIC BUPIVACAINE

V. Philitsen; P. Vijaya Ananth

Volume : VI, Issue : II, February - 2017

COMPARISON OF EFFECTS OF SPINAL ADDITIVES FENTANYL OR CLONIDINE WITH HYPERBARIC BUPIVACCAINE WITH CONTROL GROUP RECEIVING ONLY HYPERBARIC BUPIVACAINE

V. Philitsen, P. Vijaya Ananth

Abstract :

Background and goals of study: Bupivacaine is the commonly used local anesthetic in spinal anesthesia and several spinal additives, commonly the opioids are added to enhance the block and duration of spinal anesthesia. Each of the drug added as spinal additive has its own advantages and disadvantages. This study was designed to compare the effects of intrathecal Fentanyl with 0.5 % Hyperbaric Bupivacaine and Clonidine with 0.5% Hyperbaric Bupivacaine with control group of patients who received only 0.5% Hyperbaric Bupivacaine.

Methods: 45 patients were assigned to 3 groups of 15 each. Group A – 15 mg of 0.5% bupivacaine (H) + 0.5ml of Normal Saline; Group B – 15 mg of 0.5% bupivacaine (H) + 25 �g of Fentanyl; Group C – 15 mg of 0.5% bupivacaine (H) + 50 �g of clonidine (corrected to a volume of 0.5ml by adding Normal Saline). Intraoperative hemodynamic parameters, maximum sensory level blocked (until grade 3), time to achieve maximum sensory level, sensory Regression time to L1 (until grade 0), onset of grade 4 motor block, regression time to grade 1 motor block and sedation score were assessed.

Results: Maximum height of dermatomal block and the time to achieve it were similar in all these groups. Sensory regression to L1 is prolonged in the additive groups. Onset of grade 4 motor block was shorter in group B and C. Regression to grade 1 motor block is significantly prolonged in Groups B and C; and Group C is longer than Group B. Hemodynamic variables were relatively lower in clonidine group.

Conclusion: Clonidine qualitatively prolongs the duration of both sensory and motor block of spinal anesthesia with insignificant hemodynamic variation which can be easily managed. Fentanyl also prolongs the spinal anesthesia, but not to the extent of Clonidine, without any significant hemodynamic changes.