Regional Anesthesia with Clonidin – Old Theme Revisited

Overview

Objective:
To compare the duration of blockade with levobupivacaine and levobupivacaine with clonidine; to compare theduration of analgesia and the consumption of analgesics on the first post-operation day; the follow-up of the occurrenceand severity of adverse effects of subarachnoidal anaesthesia (SAA) with levobupivacaine.Design: prospective, randomised, comparative.Setting: Dept. of Anaesthesiology and Intensive Care; Dept. of Orthopaedic Surgery. University Hospital, Brno-Bohunice.Patients and methods: Fifty-four patients were included in the study (mean age 66.5 years, weight 81.5 kg), undergoing totalendoprosthesis of knee or hip joints. Surgery was performed in SAA. In group A, levobupivacaine was administered (3 ml),in group B levobupivacaine (3 ml) + 0,075 mg of clonidine (0,5 ml) was used. Subarachnoid puncture was performed at theintervertebral space L3/4 or L4/5 using the spinal needle 25G.Patients were monitored in the standard fashion during surgery.Anaesthesia was combined with 2–3 mg of midazolam. The time of subsidence of motor block as well as the time ofadministration of analgesics was documented after surgery and transfer to the orthopaedic ICU.Results: The average time of the onset of motor block (grade 2 according to the Bromage scale) was 6.3 min in both groups:motor block was complete in 47 patients, in 6 patients the block reached grade 2, in 1 patient grade 1. Adverse events:a hypotension with a mean arterial blood pressure drop > 25% occurred in 2 patients (and was corrected with ephedrine),bradycardia occurred in 1 patient (atropine was administered) in group A.A hypotension with a mean arterial pressure drop> 25% occurred in one patient, bradycardia in three in the group B. No other adverse effects were observed. The averageduration of motor block was 212.04 min in group A and 309.26 min in group B, which means that the blockade wassignificantly (P

Key words:
levobupivacaine – subarachnoidal anaesthesia – postoperative analgesia – clonidin– endoprosthesis of joints