Published: 2017-09-28

Comparative evaluation of clonidine versus fentanyl as adjuvants for epidural anaesthesia with 0.75% ropivacaine for day care knee arthroscopy: a double-blind study

Manoranjan Kumar Bansal, Kumkum Gupta, Tahir Ahamad Masoodi, V. P. Singh, Bhawana Rastogi, Aqsa Buchh


Background: Day care knee arthroscopy can be performed with general anesthesia, central neuraxial blockade and peripheral nerve blocks. The adjuvants to local anaesthetic may be used to enhance the duration of analgesia without increasing the duration of motor blockade. The present study compared the clinical efficacy of clonidine with fentanyl as adjuvants to epidural ropivacaine (0.75%) for day care knee arthroscopy.

Methods: Sixty adult patients of both gender of ASA physical status I and II scheduled for day care knee arthroscopy under epidural anaesthesia, were randomized into two groups of 30 patients each to receive either 15 ml of 0.75% ropivacaine with 1 ml of clonidine 50 µg (Group RC) or with 1 ml of fentanyl 50 µg (Group RF). Groups were compared for onset and duration of sensory and motor blockade and post-anesthesia discharge score (PADS) as primary end points. Intraoperative hemodynamic changes, time taken to void, total duration of hospital stay and any adverse effects were evaluated as secondary end points.

Results: The onset of complete sensory block to T10 (15.4±4.7 versus 17.5±3.8 minutes) and time to achieve complete motor block (23.7±3.3 versus 26.9±1.4 minutes) was earlier in patients of Group RC. Intraoperative hemodynamic changes were comparable. Time to achieve PADS was earlier in patients of Group RF (6.37±1.08 versus 7.11±0.49 hour) with no statistical significant difference. Total duration of hospital stays (7.81±1.31 versus 8.27± 1.18 hour) was also comparable.

Conclusions: Clonidine and fentanyl, both can be used as epidural adjuvant to 0.75% ropivacaine for day care knee arthroscopy as they could enhance the duration of analgesia without affecting the hospital stay.


Clonidine, Day care surgery, Epidural anesthesia, Fentanyl, Knee arthroscopy, Ropivacaine

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Current controversies in adult outpatient anaesthesia. In: Apfelbaum JL, Editor. American Society of Anaesthesiologists Annual Meeting Refresher Course Lectures. Chicago; 2000:172.

Mingus ML. Recovery advantages of regional anesthesia compared with general anesthesia: adult patients. J Clin Anesth. 1995;7:628-33.

McClellan KJ, Faulds D. Ropivacaine: an update of its use in regional anesthesia. Drugs. 2000;60:1065-93.

Eledjam JJ, Ripart J, Viel E. Clinical application of ropivacaine for the lower extremity. Curr Top Med Chem. 2001;1:227-31.

Agarwal A, Verma RK, Shrivastava S, Ropivacaine- The latest local anesthetic in the Indian market. J Anesth Clin Pharmacol. 2010;26:22-8.

Ozgurel O. Comparison of fentanyl added to ropivacaine or bupivacaine in spinal anesthesia. Reg Anesth Pain Med. 2003;28:23.

Fields HL, Emson PC, Leigh BK, Gilbert RF, Iversen LL. Multiple opiate receptor sites on primary fibres. Nature. 1980;284:351-3.

Cherng CH, Yang CP, Wong CS. Epidural fentanyl speeds the onset of sensory and motor blocks during epidural ropivacaine anesthesia. Anesth Anal. 2005;101:1834-7.

Marshall SL, Chung F. Discharge criteria and complications after ambulatory surgery. Anesth analg. 1997;85:874-85.

Pavlin DJ, Rapp SE, Polissar NL, Malmgren JA, Koerschgen M, Keyes H. Factors affecting discharge time in adult outpatients. Anesth Analg. 1998;87:816-26.

Patel M, Flashburg M, Paskin S. A regional anesthetic technique compared to general anesthesia for outpatient knee arthroscopy. Anesth Analg. 1986;65:185-7.

Mulroy MF, Larkin KL, Hodgson PS, Helman JD, Pollock JE, Liu SS. A comparison of spinal, epidural and general anesthesia for outpatient knee arthroscopy. Anesth Analg. 2000;91:860-4.

Ben-David B, Maryanovsky M, Gurevitch A, Lucyk C, Solosko D, Frankel R, et al. A comparison of mini-dose lidocaine-fentanyl and conventional-dose lidocaine spinal anesthesia. Anesth Analg. 2000;91:865-70.

Wong J, Marshall S, Chung F, Sinclair D, Song D, Tong D. Spinal anesthesia improves the early recovery profile of patients undergoing ambulatory knee arthroscopy. Can J Anaesth. 2001;48:369-74.

Peduto Va, Baroncini S, Montanini S, Proietti R, Rosignoli L, Tufano R, et al. A prospective, randomized, double-blind comparison of epidural levobupivacaine 0.5% with epidural ropivacaine 0.75% for lower limb procedures. Eur J Anesthesiol. 2003;20:979-83.

Fritz WT, George L, Krull N, Krug J. Utilization of a home nursing protocol allows ambulatory surgery patients to be discharged prior to voiding (abstract). Anesth Analg. 1997;84:S6.