A comparative study of intrathecal clonidine VS dexmedetomidine in caesarean patients

Introduction: Spinal anaesthesia is the most commonly employed technique for Caesarean section. Many drugs such as opioids as intrathecal additives such have been widely studied found to be associated with respiratory depression, pruritis, etc. Upcoming studies on alpha-2 agonists as intrathecal additives have been found promising and will replace opioids soon. Knowledge on the efficacy of the individual a2 agonists over one another is lacking. So the aim of the study is to compare the spinal additive effect of dexmedetomidine and clonidine in pregnant patients for caesarean section. Materials and Methods: Ninety patients belonging to ASA group I and II of age group of 20 – 40 years were included in the study. Patients with PIH, Diabetes, Body weight above 100kg, Height less than 145 cm, Post spinal surgeries, spinal deformity, and known history of Coagulopathy and allergic to study drugs, documented IUGR, intrauterine anomaly and patients those who are not willing for spinal anaesthesia were excluded from the study. They were randomly allocated into three groups of 30 patients each, Group D where the patients received dexmedetomidine 5µg with bupivacaine 10mg, Group C where the patients received clonidine 15µg with bupivacaine 10mg and Group B where the patient received bupivacaine 10mg with 0.9% saline 0.5ml. The duration of the sensory and the motor blockade, two segment regression times, duration of the postoperative analgesia, sedation and neonatal wellbeing with maternal hemodynamic changes were studied. Results: Demographic characteristics and hemodynamic parameters were comparable between the three groups. The onset and maximal sensory block was faster in Dxm and clonidine groups (162±41.40;166±37.57) than control group (254.67±28.73) which was statistically significant. The two segment regression time was significantly shorter in control group (67.53±5.94) than Dxm and clonidine group (103.47±8.08;108±6.90). Dxm and clonidine group showed shorter time (3.40±0.84; 3.13±0.50) to reach Bromage grade 3 motor block than control group (4.52±1.78). The maximum sedation score recorded in both Dxm and clonidine group was 2.The time of onset (minutes) of sedation between Dxm and clonidine groups which was (8.9±2.85;7.43±2.27 ) were statistically insignificant. Conclusion: Addition of intrathecal clonidine 15µg/ dexmedetomidine 5µg to 10mg of bupivacaine in LSCS patients increase the duration of motor and sensory blockade, with little changes in maternal hemodynamics without any changes in neonatal outcome.