2025, Vol. 8, Issue 1, Part A
A comparative study between clonidine, fentanyl, and buprenorphine as adjuvants to intrathecal 0.5% hyperbaric bupivacaine in lower abdominal and lower limb surgeries
Author(s): Rahul Baby Joseph, Noyal Sunny and Prakash DB
Abstract: Background and Objectives: Spinal anesthesia is the most convenient anesthetic technique that offers many advantages over general anesthesia, including reduced stress response and improved post-operative pain relief. Hyperbaric Bupivacaine is routinely used for this purpose because of its high potency and minimal neurological symptoms. The administration of local anesthetics in combination with opioids intrathecally is an excellent technique for managing postoperative pain following abdominal, pelvic, and orthopedic procedures on the lower extremities. This study is designed to compare the clinical effects of the addition of adjuvants fentanyl, clonidine, and buprenorphine to intrathecal hyperbaric bupivacaine for major lower limb and lower abdominal surgeries.
Methods: 90 patients belonging to ASA physical status I & II scheduled for lower abdominal and lower limb surgeries were randomly selected for the study. They were divided into three groups of 30 each. Patients received intrathecal injections as follows: Group BF: Bupivacaine (15 mg) + Fentanyl (25 mcg), Group BC: Bupivacaine (15 mg) + Clonidine (50 mcg), Group BB: Bupivacaine (15 mg) + Buprenorphine (75 mcg). Parameters - onset, and duration of sensory block, onset and duration of motor block, the height of sensory block, hemodynamic parameters, and adverse effects if any were studied.
Results: The three groups had no significant difference in the mean time to onset of peak motor block (p-value 0.314). Still, the onset of the sensory block within group BF was 1.80±0.74 minutes, 1.94±0.49 minutes in group BC, and 2.28±0.46 minutes in the BB group(P value 0.006) indicating the faster onset of action in fentanyl group. The maximum sensory height attained ranged between T6 and T8 in both groups, which was clinically and statistically not significant (p-value 0.390). The mean duration of the sensory block was 306.2±29.21 minutes in Group BF, 358.27±44.68 in Group BC, and 347.08±46.62 minutes in Group BB with p value<0.001 which is statistically significant. The mean duration of the motor block in Group BF was 168.9±13.54, Group BC was 191.7±24.82 and that of Group BB was 177.27±22.53 with p-value <0.001. The quality of intraoperative analgesia, hemodynamic parameters, and side effects were comparable in all three groups.
Conclusion: The addition of Fentanyl (25 µg) was found to have a faster onset and a shorter duration of action which is advantageous where early ambulation is appreciated. Clonidine (50 µg) and Buprenorphine (75 µg) increase the duration of both sensory and motor block with less hemodynamic instability therefore can be a good choice in prolonged lower abdominal and lower limb surgeries.
DOI: 10.33545/26643766.2025.v8.i1a.533
Pages: 01-06 | Views: 41 | Downloads: 24
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How to cite this article:
Rahul Baby Joseph, Noyal Sunny, Prakash DB. A comparative study between clonidine, fentanyl, and buprenorphine as adjuvants to intrathecal 0.5% hyperbaric bupivacaine in lower abdominal and lower limb surgeries. Int J Med Anesthesiology 2025;8(1):01-06. DOI: 10.33545/26643766.2025.v8.i1a.533
