Clonidine versus butorphanol as adjuvant to 0.5% hyperbaric bupivacaine to enhance the onset and duration of subarachnoid blockade with postoperative analgesia during orthopaedic surgeries-A randomized study

Background: Intrathecal adjuvants to local anaesthetic enhance the quality and duration of spinal anaesthesia.The present study was aimed to comparatively evaluate the clonidine and butorphanol as adjuvants to intrathecal hyperbaric bupivacaine for subarachnoid blockade during orthopaedic surgeries.Patients and method: Sixty four adult consented patients of both gender of ASA physical status I and II scheduled for elective orthopaedic surgeries under subarachnoid blockade, were analyzed.All enrolled patients were divided into two groups of 32 patients each to receive either 3.5 ml of 0.5% hyperbaric bupivacaine with 0.2 ml of clonidine 30 µg (Group I) or with 0.2 ml of butorphanol 0.20 mg (Group II).Patients were compared for onset and duration of sensory and motor blockade, intraoperative hemodynamic changes, time to first rescue analgesic and side effects by using Analysis of variance (ANOVA), Mann Whitney U test and chi-square test.Result: The demographic profile of patients was comparable.The onset of sensory block to T10 (3.4 ± 1.7 versus 3.91 ± 2.2 min) and time to achieve complete motor block (11.23 ± 4.7 versus 12.9 ± 3.2 min) was significantly earlier in patients of clonidine Group.The time to first request for analgesia was 278.7 ± 29.6 min in clonidine group and 218.6 ± 21.9 min in patients of butorphanol group.The incidences of bradycardia were more in patients of clonidine group with statistically significant difference while incidences of hypotension, respiratory depression, shivering or any other side effects were negligible.Conclusion: Clonidine is a useful adjuvant to intrathecal hyperbaric bupivacaine during orthopaedic surgeries and can be considered as alternative to butorphanol.