A comparative study of hemodynamic changes and adverse effects of intrathecal bupivacaine with fentanyl and intrathecal bupivacaine with clonidine in infra-umbilical abdominal and lower limb surgery

Abstract

Background: Adjuvants prolong the action of intrathecal local anesthetic agents. They have shown to have significant analgesic effects in the postoperative period much after the regression of the sensory and motor blockade. Our objective of the current study was to compared the hemodynamic profile and adverse effects (nausea, pruritus, sedation and respiratory depression) in two groups of adult patients undergoing infra-umbilical and lower limb surgery under spinal anaesthesia using either intrathecal clonidine or intrathecal fentanyl as an adjuvant to intrathecal bupivacaine (0.5% heavy).Methods: This randomized, prospective and observational study was undertaken in the Department of Anaesthesiology and Critical Care, 5 Airforce Hospital, Kanpur from the period of January 2014 to February 2016 on 120 patients fulfilling the inclusion criteria. Study patients were randomly allocated to the two groups Group I: Cases who received intrathecal 0.5% heavy bupivacaine (2.5 ml) + fentanyl (50 mcg/ml) (0.5 ml) (n=60 patients) and Group II: cases who received intrathecal 0.5% heavy bupivacaine (2.5 ml) + clonidine (60 mcg/ml) (0.5 ml) (n=60 patients).Results: Mean age of patients in Group I and Group II was 42.60±5.93 and 42.03±7.16 years, respectively. Mean BMI of patients in Group I and Group II was 22.0±1.92 and 21.54±2.14 kg/m2, respectively. Comparison of baseline hemodynamic parameters (heart rate (bpm), mean arterial pressure (mmhg), respiratory rate (/min) and oxygen saturation (%) did not show a significant difference between two groups.Conclusions: With respect to the side effects like nausea and pruritus, these are significantly more in fentanyl group as compared to clonidine group.