Comparative evaluation of intrathecal dexmedetomidine and clonidine as an adjuvant to bupivacaine in gynaecological surgeries

Abstract

: Spinal anaesthesia is commonly used in gynaecological surgeries, with Bupivacaine being the most commonly used anaesthetic. Bupivacaine, on the other hand, has a shorter duration of action.This clinical study was conducted to evaluate the behaviour of intrathecal clonidine and dexmedetomidine as an adjuvant to bupivacaine in augmenting block characteristics in patients undergoing gynaecological procedures.  A randomised controlled trial was conducted to compare intrathecal Dexmedetomidine and Clonidine as adjuvant to Bupivacaine in gynaecological surgeries. A total of 200 patients were divided into 100 groups, each randomly assigned to one of two groups, and intrathecal medication was administered according to the group assigned. The onset and duration of sensory and motor blockade, the highest level of sensory blockade, analgesia duration, and side effects were all evaluated.: Although the time of onset of sensory and motor block in the Dexmedetomidine group was comparable to the Clonidine group, the two-segment regression time was higher in the Dexmedetomidine group as compared to the Clonidine group. The motor block onset according to Bromage grade-3 was 4.1±1.1 minutes and 4.42±1.2 minutes among Dexmedetomidine and Clonidine groups. Throughout the perioperative period, the central tendency values of mean arterial pressures and heart rate remained consistent in both groups. Postoperative analgesia planning and management start from pre-anaesthetic evaluation. So, the analysis revealed that when combined as an intrathecal adjuvant with bupivacaine, dexmedetomidine not only provides better postoperative pain relief than clonidine but also a significantly longer sensory and motor block with preserved hemodynamic stability and lack of sedation.