2. COMPARISON OF INTRATHECAL CLONIDINE AND HYPERBARIC BUPIVACAINE ADMINISTERED AS PREMIXED FORM OR SEQUENTIALLY FOR CEASAREAN SECTION- A RANDOMIZED CONTROLLED STUDY

Madhavi Gaddam

ABSTRACT

Background: Spinal anesthesia is the technique of choice for lower segment caesarean section (LSCS) as general anesthesia has several limitations in parturients. Administration of clonidine premixed with local anesthetic was found to be less effective than when administered in a sequential manner. This study has been designed to compare the impact of low dose clonidine as adjuvant to 0.5% Bupivacaine for spinal anesthesia in a premixed form versus sequentially administered form. Various other factors like intraoperative hemodynamic fluctuations, motor effects, duration of postoperative analgesia and possible side effects are studied. Material & Methods: The study group comprised of 60 term-parturient women posted for elective LSCS. This is a prospective, comparative study between equal sized groups using an open protocol design. Group A received 2ml 0.5% hyperbaric Bupivacaine + 30?g of clonidine as a mixture intrathecally and Group B received 2ml 0.5% Bupivacaine followed by 30 ?g of clonidine in sequential manner. Results: Addition of clonidine either in premixed form or sequential form with hyperbaric bupivacaine intrathecally prolonged the duration of analgesia. Prolongation was significantly extended in the sequential group, thereby reducing postoperative analgesic requirements. The time to two segment regression and motor regression was significantly prolonged by the sequential addition of clonidine. There was a significant difference in the onset of motor blockade with sequential clonidine. Conclusions: Sequential technique hastens the onset of complete sensory and motor block, enhances the duration of sensory and motor block also, the postoperative analgesia without much hemodynamic adverse effects.

Key-words: Intrathecal Clonidine, Bupivacaine, postoperative analgesia.

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