Duration of analgesia, sensory and motor blockade and intra operative hemodynamic changes caused by intrathecal bupivacaine, bupivacaine plus clonidine and bupivacaine plus dexmedetomidine in spinal anesthesia: prospective, comparative study

Sankaranand P., Krishna Prasad G. V.


Background: This is comparative study to differentiate the effects of Dexmedetomidine and clonidine on duration of analgesia, motor and sensory blockade and the intraoperative hemodynamic profile when mixed with Bupivacaine.

Methods: Patients aged 15-45 years having ASA 1 and ASA 2 scheduled for elective orthopedic surgeries under spinal anaesthesia were included and divided into 3 groups equally (50 patients each)’ i.e. Group B received only 3.0 ml of 0.5% Bupivacaine (Heavy); Group C received 3.0ml of 0.5% Bupivacaine (Heavy) mixed with Clonidine 30 µg; and Group D administered with 3.0 ml of 0.5% Bupivacaine (Heavy) mixed with 5µg Dexmedetomidine.

Results: Majority of the cases enrolled in the study were knee disorders and the rest being fracture femur, tibia. At preoperative interval mean systolic blood pressure and diastolic blood pressure of Group B was slightly higher than Group C and Group D. At the time when spinal anaesthesia was given, a slight fall in DBP of patients was observed in all Group B, Group C and Group D. Mean heart rate of patients at preoperative interval in patients of Group B, Group C and Group D respectively, with Group C and Group D showing slightly lower mean heart rate as compared with that of the mean heart rate of Group B but the values were not statistically significant. There were no any significant changes in the hemodynamic status.

Conclusions: Both of used combinations provide prolonged sensory and motor blockade, hemodynamic stability, minimal side effects, and excellent intraoperative and postoperative analgesia.


ASA grade I/II, Hemodynamic, Spinal anesthesia

Full Text:



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;33:159-67.

Kanazi GE, Aouad MT, Jabbour-Khoury SI, Al Jazzar MD, Alameddine MM, Al-Yaman R, et al. Effect of low-dose dexmedetomidine or clonidine on the characteristics of bupivacaine spinal block. Acta Anaesthesiol Scand. 2006;50(2):222-7.

Boussofara M, Carlès M, Raucoules-Aimé M, Sellam MR, Horn JL. Effects of intrathecal midazolam on postoperative analgesia when added to a bupivacaine-clonidine mixture. Reg Anesth Pain Med. 2006;31:501-5.

Elizabeth A. Humber and Christopher M. Intrathecal lipophilic opioids as adjuncts to spinal anaesthesia. Regional Anaesthesia Pain Med. 1999;24(3):255-63.

Liu SS. Drugs for spinal anaesthesia: Past, present, and future. Regional anaesthesia Pain Med. 1998;23(4):344-6.

Axelsson K, Gupta A. Local anaesthetic adjuvants: neuraxial versus peripheral nerve block. Curr Opin Anaesthesiol. 2009;22(5):649-54.

Sameenakousar M, Srinivasan KV. Comparison of fentanyl and clonidine for attenuation of the haemodynamic response to laryngocopy and endotracheal intubation. J Clin Diag Res. 2013;7(1):106.

Singh J, Shah RS, Vaidya N, Mahato PK, Shrestha S, Shrestha BL. Comparison of ketamine, fentanyl and clonidine as an adjuvant during bupivacaine caudal anaesthesia in paediatric patients. Kathmandu Univ Med J. 2012;10(39):25-9.

Blaudszun G, Lysakowski C, Elia N, Tramèr MR. Effect of perioperative systemic α2 agonists on postoperative morphine consumption and pain intensity: systematic review and meta-analysis of randomized controlled trials. Anesthesiology. 2012;116(6):1312-22.

Blaine Easley R, Brady KM, Tobias JD. Dexmedetomidine for the treatment of postanesthesia shivering in children. Paediatr Anaesth. 2007;17(4):341-6.

Memiş D, Turan A, Karamanlioğlu B, Pamukçu Z, Kurt I. Adding dexmedetomidine to lidocaine for intravenous regional anesthesia. Anesth Analg. 2004;98(3):835-40.

Bimbaumer L, Abramowitz J, Brown AM. Receptor-effector coupling by G proteins. Biochim Biophys Acta. 1990;1031:163-224.

Metz SA, Halter JB, Robertson RP. Induction of defective insulin secretion and impaired glucose tolerance by clonidine. Selective stimulation of metabolic alpha-adrenergic pathways. Diabetes. 1978;27:554-62.

Nakamura M, Ferreira SH. Peripheral analgesic action of clonidine mediation by release of endogenous enkephalinlike substances. Eur J Pharmacol. 1988;146:223-8.

Tamsen A, Gordh T. Epidural clonidine produces analgesia. Lancet. 1984;2:231.

Strebel S, Gurzeler J, Schneider M, Aeschbach A, Kindler C. Small-dose intrathecal clonidine and isobaric bupivacaine for orthopedic surgery: A doseresponse study. Anesth Analg. 2004;99:1231-38.

Dobrydnjov L, Axelsson K, Thorn SE, Matthiesen P, Klockhoff H, Holmstrom B, et al. Clonidine combined with small-dose bupivacaine during spinal anesthesia for inguinal herniorrhaphy: A randomized double-blinded study. Anesth Analg. 2003;96:1496-1503.

Dobrydnjov L, Axelsson K, Samarutel J, Holmstrom B. Postoperative pain relief following intrathecal bupivacaine combined with intrathecal or oral clonidine. Acta Anaesthesiol Scand. 2002;46:806-14.

De Kock M, Gautier P, Fanard L, Hody J, Lavand home P. Intrathecal ropivacaine and clonidine for ambulatory knee arthroscopy. Anesthesiol. 2001;94:574-8.

Niemi L. Effects of intrathecal clonidine on duration of bupivacaine spinal anaesthesia, haemodynamics, and postoperative analgesia in patients undergoing knee arthroscopy. Acta Anaesthesiol Scand. 1994;38:724-8.

Racle JP, Benkhadra A, Poy JY, Gleizal B. Prolongation of isobaric bupivacaine spinal anesthesia with epinephrine and clonidine for hip surgery in the elderly. Anesth Analg. 1987;66:442-6.

Fogarty DJ, Carabine UA, Milligan KR. Comparison of the analgesic effects of intrathecal clonidine and intrathecal morphine after spinal anaesthesia in patients undergoing total hip replacement. Br J Anaesth. 1993;71:661-4.

Dobrydnjov I, Axelsson K, Samarutel J, Holmstrom B. Postoperative pain relief following intrathecal bupivacaine combined with intrathecal or oral clonidine. Acta Anaesthesiol Scand. 2002;46:806-14.

Yaksh TL, Reddy SV. Studies in the primate on the analgetic effects associated with intrathecal actions of opiates, alpha-adrenergic agonists and baclofen. Anesthesiology. 1981;54:451-67.

Liu SM, Chiu AA, Neal JM, Carpenter RL, Bainton BG, Gerancher JC. Oral clonidine prolongs lidocaine spinal anesthesia in human volunteers. J American Society Anesthesiolog. 1995;82(6):1353-9.

Ota K, Namiki A, Iwasaki H, Takahashi I. Dose-related prolongation of tetracaine spinal anesthesia by oral clonidine in humans. Anesth Analg. 1994;79:1121-5.

Rhee K, Kang K, Kim J, Jeon Y. Intravenous clonidine prolongs bupivacaine spinal anesthesia. Acta Anaesthesiol Scand. 2003;47:1001-5.

Bonnet F, Catoire P, Buisson BV, Saada M, Francois Y. Effects of oral and subarachnoid clonidine on spinal anesthesia with bupivacaine. Regional Anesthesia Pain Med. 1990;15(4):211-4.

Seah YS, Chen C, Chung KD, Wong CH, Tan PP. Prolongation of hyperbaric bupivacaine spinal anesthesia with clonidine. Ma Zui Xue Za Zhi. 1999;29(1):533-7.

Racle JP, Benkhadra A, Poy JY, Gleizal B. Prolongation of isobaric bupivacaine spinal anesthesia with epinephrine and clonidine for hip surgery in the elderly. Anesth Analg. 1987;66(5):442-6.

Chiari A, Lorber C, Eisenach JC, Wildling E, Krenn C, Zavrsky A, et al.Analgesic and hemodynamic effects of intrathecal clonidine as the sole analgesic agent during first stage of labor: a dose-response study. Anesthesiology. 1999;91(2):388-96.

Gupta R, Verma R, Bogra J, Kohli M, Raman R, Kushwaha JK. A Comparative study of intrathecal dexmedetomidine and fentanyl as adjuvants to Bupivacaine. J Anaesthesiol Clin Pharmacol. 2011;27(3):339-43.

Gupta R, Bogra J, Verma R, Kohli M, Kushwaha JK, Kumar S. Dexmedetomidine as an intrathecal adjuvant for postoperative analgesia. Ind J Anaesthesia. 2011;55(4):347.