A comparison of fentanyl and clonidine as adjuvants to intrathecal levobupivacaine for spinal anaesthesia and postoperative analgesia in patients undergoing for lower limb surgery
Objective: Analgesic adjuvants, clonidine and fentanyl have decreased the requirements the local anaesthesia and prolonged the effects of the analgesia. The purpose of this study was compare the intrathecal clonidine and fentanyl as adjuvant to levobupivacaine in terms of efficacy, safety and postoperative analgesia in patients undergoing lower abdominal surgeries.
Methods: This prospective study is conducted is sixty lower limb surgery patients, divided into two group C: 2.5ml of 0.5% levobupivacaine with either 30μg of clonidine and group F: 2.5ml of 0.5% levobupivacaine with either 15μg of fentanyl intrathecally. The hemodynamic parameters, onset and duration of sensory and motor block, total analgesia time and side effects were statistically analyzed using unpaired t-tests and Chi-square test.
Results: The onset of sensory and motor were statistically similar in both group F and group C. The duration of sensory and motor block were significantly higher (p <0.001) in group C as compared to group F. The highest level sensory block was comparable in both group (p=0.918). Time reach max level and rescue analgesia were higher in group C (146.33±10.44 and 513.33±22.18 respectively) as compared to group F (139.17±7.09 and 428.50±25.53 respectively).
Conclusions: Intrathecal clonidine and fentanyl as adjuvant to levobupivacaine provide adequate anaesthesia for lower abdominal surgeries. Clonidine as an adjuvant provided prolonged postoperative analgesia as compared to fentanyl.
McLeod GA and Burke D. Levobupivacaine. Anesthesia 2001; 56: 331–341.
McCellan KJ and Spencer CM. Levobupivacaine. Drugs 1998; 56: 355–362.
MacKenzie TA and Young ER. Local anesthetic update. Anesth Prog 1993;40:29–34.
Prakash S, Joshi N, Gogia AR, Prakash S, Singh R. Analgesic efficacy of two doses of intrathecal midazolam with bupivacaine in patients undergoing cesarean delivery. Reg Anesth Pain Med 2006;31:221-226.
Yoganarasimha N, Raghavendra T, Amitha S, Shridhar K, Radha M. A comparative study between intrathecal clonidine and neostigmine with intrathecal bupivacaine for lower abdominal surgeries. Indian J Anaesth 2014;58:43-7.
Benhamou D, Thorin D, Brichant JF, Dailland P, Milon D, Schneider M. Intrathecal clonidine and fentanyl with hyperbaric bupivacaine improves analgesia during cesarean section. Anesth Analg 1998;87:609-613.
Kothari N, Bogra J, Chaudhary AK. Evaluation of analgesic effects of intrathecalclonidine along with bupivacaine in cesarean section. Saudi J Anaesth 2011;5:31-35.
Bajwa SJ, Bajwa SK, Kaur J, Singh A, Singh A, Parmar SS. Prevention of hypotension and prolongation of postoperative analgesia in emergency cesarean sections: A randomized study with intrathecal clonidine. Int j crit illn inj sci 2012;2:63-69.
Elia N, Culebras X, Mazza C, Schiffer E, Tramèr MR. Clonidine as an adjuvant to intrathecal local anesthetics for surgery: Systematic review of randomized trials. Reg Anesth Pain Med 2008;33:159-167.
Wang JK, Nauss LA, Thomas JE. Pain relief by intrathecally applied morphine in man. Anesthesiology 1979;50:149-151.
Selvaraju KN, Sharma SV. Comparison of forced expiratory spirometric flow changes following intrathecal bupivacaine and bupivacaine with fentanyl. South Afr J Anesth Analg 2008;14:33-37.
De Kock M. Site of hemodynamic effects of alpha 2‑adrenergic agonists. Anesthesiology 1991;75:715-716.
Bonnet F, Buisson VB, Francois Y, Catoire P, Saada M. Effects of oral and subarachnoid clonidine on spinal anesthesia with bupivacaine. Reg Anesth 1990;15:211-214.
Sethi BS, Samuel M, Sreevastava D. Efficacy of analgesic effects of low dose intrathecal clonidine as adjuvant to bupivacaine. Indian J Anaesth 2007;51:415-419.
Shah BB, Shidhaye RV, Divekar DS, Panditrao M, Panditrao MM, Suryawanshi C. Effect of addition of clonidine to bupivacaine used for patients undergoing spinal anaesthesia: A randomized, double blind, controlled study. Sri Lankan J Anaesthesiol 2011;19:17-21.
Chung CJ, Choi SR, Yeo KH, Park HS, Lee SI, Chin YJ. Hyperbaric spinal ropivacaine for cesarean delivery: A comparison to hyperbaric bupivacaine. Anesth Analg 2001;93:157–161.
Bromage PR. Philadelphia: WB Saunders; 1978. Epidural analgesia; p. 144.
Lee YY, Mucchal K, Chan CK. Levobupivacaine versus racemic bupivacaine in spinal anaesthesia for urological surgery. Anaesth Intens Care 2003;31:637–641.
Camorcia M, Capogna G, Berrita C, Columb MO. The relative potencies for motor block after intrathecal ropivacaine, levobupivacaine, and bupivacaine. Anaesth Analg 2007;104:904–907.
Akcaboy EY, Akcaboy ZN, Gogus N. Low dose levobupivacaine 0.5% with fentanyl in spinal anaesthesia for transurethral resection of prostate surgery. J Res Med Sci 2011;16:68-73.
Lacassie HJ, Columb MO. The relative motor blocking potencies of bupivacaine and levobupivacaine in labor. Anesth Analg 2003;97:1509–13.
Bajwa BS, Singh AP, Rekhi AK. Comparison of intrathecal clonidine and fentanyl in hyperbaric bupivacaine for spinal anesthesia and postoperative analgesia in patients undergoing lower abdominal surgeries. Saudi J Anaesth 2017;11:37-40.
Routray SS, Raut K, Pradhan A, Dash A, Soren M. Comparison of Intrathecal Clonidine and Fentanyl as Adjuvant to Hyperbaric Bupivacaine in Subarachnoid Block for Lower Limb Orthopedic Surgery. Anesth Essays Res 2017;11:589-593.
Benhamou D, Thorin D, Brichant JF, Dailland P, Milon D, Schneider M. Intrathecal clonidine and fentanyl with hyperbaric bupivacaine improves analgesia during cesarean section. Anesth Analg 1998;87:609–613.
Kothari N, Bogra J, Chaudhary AK. Evaluation of analgesic effects of intrathecal clonidine along with bupivacaine in cesarean section. Saudi J Anaesth 2011;5:31–35.
Bajwa SJ, Bajwa SK, Kaur J, Singh A, Singh A, Parmar SS. Prevention of hypotension and prolongation of postoperative analgesia in emergency cesarean sections: A randomized study with intrathecal clonidine. Int J Crit Illn Inj Sci 2012;2:63–69.
Breen TW, Shapiro T, Glass B, Foster-Payne D, Oriol NE. Epidural anesthesia for labor in an ambulatory patient. Anesth Analg 1993;77:919–924.
Agrawal A, Agrawal S, Asthana V, Payal YS, Sharma J, Gupta V. Comparison of intrathecal fentanyl and sufentanil in addition to bupivacaine for caesarean section under spinal anaesthesia. J Anaesth Clin Pharmacol 2009;25:154–156.
Sharan R, Verma R, Dhawan A, Kumar J. Comparison of clonidine and fentanyl as adjuvant to ropivacaine in spinal anesthesia in lower abdominal surgeries. Anesth Essays Res 2016;10:526-531.
Ogun C, Kirgiz E, Duman A, Kara I, Okesli S. The comparison of intrathecal isobaric ropivacaine and isobaric ropivacaine-clonidine for caesarean delivery. Internet J Anesthesiol 2006;15:1.
Chaudhary A, Bogra J, Singh PK, Saxena S, Chandra G, Verma R. Efficacy of spinal ropivacaine versus ropivacaine with fentanyl in transurethral resection operations. Saudi J Anaesth 2014;8:88–91.
Yegin A, Sanli S, Hadimioglu N, Akbas M, Karsli B. Intrathecal fentanyl added to hyperbaric ropivacaine for transurethral resection of the prostate. Acta Anaesthesiol Scand 2005;49:401–405.
Sethi BS, Samuel M, Sreevastava D. Efficacy of analgesic effects of low dose intrathecal clonidine as adjuvant to bupivacaine. Indian J Anaesth 2007;51:415–419.
Shah BB, Shidhaye RV, Divekar DS, Panditrao M, Panditrao MM, Suryawanshi C. Effect of addition of clonidine to bupivacaine used for patients undergoing spinal anaesthesia: A randomized, double blind, controlled study. Sri Lankan J Anaesthesiol 2011;19:17–21.
Biswas BN, Rudra A, Bose BK, Nath S, Chakrabarty S, Bhattacharjee S. Intrathecal fentanyl with hyperbaric bupivacaine improves analgesia during caesarean delivery and in early post operative period. Indian J Anaesth 2002;46:469–472.
Copyright (c) 2018 International Journal of Biomedical Research
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
- An author must submit Copyright form After acceptance of the article.