IJSR International Journal of Scientific Research 2277 - 8179 Indian Society for Health and Advanced Research ijsr-6-8-11764 Original Research Paper Comparative evaluation of clonidine and fentanyl as adjuvants to intrathecal isobaric ropivacaine for lower limb surgeries – A randomised, double blind prospective study. Kumar Dr. Showkat A Gurcoo Dr. August 2017 6 8 01 02 ABSTRACT

 Background: Ropivacaine is a  safer local anaesthetic  than bupivacaine and lignocaine. To  improve  its  quality of anaesthesia and analgesia, the use of  adjuvants  is recommended. Aim: To compare the efficacy of clonidine and fentanyl as adjuvants to intrathecal isobaric ropivacaine for  lower limb surgeries.  Design: Randomized double–blind  prospective study. Methods: Seventy patients were randomly divided in two groups. Ropivacaine–Clonidine group (RC) received 60 mcg of clonidine with 15 mg of 0.5% isobaric ropivacaine, whereas  ropivacaine–fentanyl group (RF) received 25 mcg of fentanyl with 15 mg of 0.5% isobaric ropivacaine intrathecally. Maximum sensory block  level, time to achieve maximum sensory block, time for sensory block to regress to L1 dermatome, time to achieve maximum degree of motor block and its regression to Bromage I, sedation score, hemodynamic parameters, and side–effects were noted.  Results: The mean  onset of maximum sensory block in RC group was  was slower than in the RF group (p < .05) .The highest dermatomal level achieved in both groups was T 6. The mean time of sensory regression to L–1  was higher in in RC  group (p–value <0.0001).  The mean time to achieve Bromage  grade IV motor block in RC group was higher ( p >0.05). The motor block was of shorter duration and was subject to rapid recovery in RF group. The mean  duration of sensory loss for  RC group  was higher (p=0.0001). Three patient (8.6%) in the clonidine group had hypotension as compared to one patient (2.8%) in the fentanyl group .  Nausea/vomiting and shivering was experienced by one patient each in the fentanyl group. Pruritus was present in three patients (8.6%) in the fentanyl group. Conclusion: Ropivacaine in combination  with clonidine or fentanyl provided adequate subarachnoid block for major surgeries, wherein clonidine has advantage over fentanyl as it increased the duration of subarachnoid block and prolonged the postoperative analgesia.