Background & Aims
Epidural anesthesia is a widely used anesthesia technique commonly for lower extremity and abdominal surgeries. It is beneficial for long duration procedures because as the epidural catheter allows additional administration of local anesthetic.
However, this technique has a slower onset of action and requires a larger volume of local anesthetic.
This study aims to determine if clonidine can hasten the onset and prolong the duration of action of levobupivacaine epidural anesthesia among patients undergoing elective lower limb orthopedic surgery thus allowing the early commencement of surgery and a longer duration as well as to extend the anesthetic time.
Methods
A total of 36 patients of American Society of Anesthesiologist Classification I or II for elective lower limb orthopedic surgery under levobupivacaine epidural anesthesia were purposively enrolled in this study and randomly assigned by match pairing of characteristics to two groups: Group A-Clonidine and Group B-plain normal saline solution.
Group A were given 0.5% levobupivacaine 15cc with 30 ?g (0.2cc) clonidine and group B were given 0.5% levobupivacaine 15cc with 0.2 cc plain normal saline solution. In both groups the onset of levobupivacaine epidural anesthesia (sensory block at T10 dermatomal level/Bromage 1) was noted.
The duration of action as defined by two dermatomal segments regression was assessed using pinprick testing.
Side effects such as hypotension, decrease in respiratory rate, oxygen saturation, and any untoward incidence were noted. All data gathered: statistical mean, median, standard deviation, and T test were analyzed using the SPSS
Results
The mean onset of action of group A-Clonidine group (5.62 minutes) was faster compared to group B-control (11.33 minutes), which was statistically significant (P<0.05). The highest dermatomal level for the clonidine group was at T6 and T7 for the control group.
The duration of action as defined by the mean time to two dermatomal segment regression was longer at 176.7 minutes for the Clonidine group while 60 minutes for the control group, which was statistically significant (P<0.05) .
The patients given clonidine experienced side effects such as sedation, bradycardia (20% decrease in cardiac rate from baseline), and shivering. Hypotension was not observed in both clonidine and control groups.
Conclusions
Clonidine at a dose of 30 ?g when used as an adjuvant to levobupivacaine epidural anesthesia can hasten its onset and prolong the duration of action among patients undergoing elective lower limb orthopedic surgery without significant side effects.
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Presenting Author
Inri I. Villaluna
Poster Authors
Topics
- Evidence, Clinical Trials, Systematic Review, Guidelines, and Implementation Science