Dexmedetomidine Versus Clonidine as Adjuvants in Epidural Analgesia in Gynecological Laparotomy

Pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. If the management of acute postoperative pain is not done properly, it can lead to the complication such as chronic pain. Epidural anesthesia reduces perioperative stress response in surgery, increasing the surgery outcome. Epidural analgesia is one of the potential acute postoperative pain treatments. The administration of α-2 agonists has analgesic and sedative effect when used as adjuvant in epidural analgesia. The administration of α-2 adrenergic agonists' adjuvant can increase the potential duration of analgesia and reduce the local anesthetic dose needed 30%–40% and can reduce the occurrence of the side effects. Dexmedetomidine is one of the most potent and high selective alpha-2 adrenergic receptor agonists. The use of dexmedetomidine during epidural anesthesia has faster onset and longer motor sensory blockade duration with hemodynamic stability that can be accepted. While clonidine acts as selective partial alpha-2 receptor agonists that cause the analgesic action of alpha-2 receptor in the dorsal of spinal cord. Clonidine has been shown its ability to reduce the local anesthesia needed and improve the pain scores when is combined with bupivacaine 0.125% with or without fentanyl opioid 1–2 μg/mL.