Comparison of Clonidine and Tramadolas Adjuvants to Bupivacaine in Epiduralanaesthesia for Lower Limb Surgery: A Randomised Controlled Trial

Background: Epidural anaesthesia is widely used for lower limb surgeries, with adjuvants such as clonidine and tramadol often added to bupivacaine to enhance analgesia. Their comparative efficacy and safety remain a subject of ongoing research. Methods: Ninety ASA I–II adults scheduled for lower limb orthopaedic surgery were randomised into three groups: Group B (bupivacaine), Group BT(bupivacaine + tramadol), and Group BC (bupivacaine + clonidine). Primary outcomes included onset and duration of sensory and motor block, and duration of postoperative analgesia. Secondary outcomes were haemodynamic stability and adverse effects. Results: Both adjuvants significantly prolonged sensory and motor block and postoperative analgesia compared to bupivacaine alone (P<0.01). Tramadol provided the longest analgesia (P=0.03), while clonidine was associated with higher sedation and hypotension rates (P<0.05). Tramadol increased nausea and vomiting. Conclusions: Both adjuvants are effective for prolonging epidural analgesia. Tramadol offers longer pain relief with fewer haemodynamic side effects, whereas clonidine provides greater sedation but increases hypotension risk.