Comparison of pre-mixed and sequentially intrathecal administration of Clonidine with hyperbaric Bupivacaine in caesarean sections
Abstract
Adjuvant and hyperbaric Bupivacaine mixing in a single syringe before injecting the drugs intrathecally is an age old practice. It may cause intraoperative hemodynamic changes. Administering local anesthetic and the adjuvant separately may minimize these side effects. So this study was aimed to compare effect of administering hyperbaric Bupivacaine and Clonidine intrathecally as a mixture and sequentially in cases undergoing caesarean section (CS). This study conducted at a District Hospital of Rajasthan in year 2013. Cases undergoing elective caesarean sections were divided into two groups by chit box method each of two groups consists of 30 cases. One group (Group A) is given mixture of Clonidine (75 mcg) and hyperbaric Bupivacaine 0.5% (10 mg) intrathecally, whereas other Group B received Clonidine (75 mcg) followed by hyperbaric Bupivacaine 0.5% (10 mg) through separate syringes. It was found that duration of analgesia was significantly longer in Group B (466 ± 18.2 min) in which the drug was given sequentially than in Group A (334 ± 16 min). Likewise, the time to achieve highest sensory and complete motor block was significantly less in Group B than Group A. So it can be depicted that administering Clonidine and hyperbaric Bupivacaine in a sequential manner is better than mixing of the two drugs.
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Introduction
Spinal anesthesia has been widely used for caesarean section deliveries because of greater maternal safety, foetal benefits, higher parental satisfaction, and consumer demand.1 However; various adjuvants are added intrathecally with spinal local anaesthetics to improve the quality of anesthesia and analgesia 2 Clonidine, is one of the commonly used opioids, is being used as a safe adjuvant to intrathecal local anesthetic & free of opioid related side effects. 3,4 and is known to increase both sensory and motor block of spinal anesthesia. 3 Studies have shown that Clonidine also has anti-hyperanalgesic effect so reduces the post‑operative analgesic requirement. 4,5,6 Mixing adjuvant with spinal anesthesia in a single syringe before injecting the drugs intrathecally is an old age practice, which may affect the density of both the drugs, hence their spread in cerebrospinal fluid as well as action.7,8,9
Administering spinal anesthesia and the adjuvants separately, it may have some different role than administering both as a mixture. Rational behind using two separate syringes for hyperbaric Bupivacaine & Clonidine administration is to minimize effect on density of both the drugs. Thus this study was planned to compare effect of administering hyperbaric Bupivacaine and Clonidine intrathecally as a mixture and sequentially in cases undergoing caesarean section.
Conclusion
Sequential administration of Clonidine reduces the time to achieve complete sensory and motor block and significantly prolongs along the total duration of analgesia without any significant side effects. Analgesic or vasopressure requirement was almost same whether Clonidine is given in sequential or in mixture with HB. So it can be depicted that sequential administration of Clonidine is better than administering as mixture with hyperbaric Bupivacaine.