The effect of addition of intrathecal clonidine to hyperbaric bupivacaine on postoperative pain after lower segment caesarean section: A randomized control trial

BACKGROUND: Intrathecal clonidine prolongs spinal anesthesia but the optimum dose to be used in cesarean delivery is not yet known. We evaluated the effect of addition of intrathecal clonidine to hyperbaric bupivacaine on postoperative pain after lower segment caesarean section. METHODS: A total of 105 parturients carrying a singleton fetus at term, scheduled to undergo elective LSCS under spinal anesthesia were randomized in a double blind fashion to one of the three groups. Group BF (n=35) received 2 ml of 0.5% hyperbaric bupivacaine+25 μg fentanyl, Group BC(50) (n=35) received 2 ml of 0.5% hyperbaric bupivacaine+50 μg clonidine, Group BC(75) (n=35) received 2 ml of 0.5% hyperbaric bupivacaine+75 μg clonidine. RESULTS: The duration of postoperative analgesia was 184.73±68.64 min in group BF, 360.71±86.51 min in group BC(50) and 760.50±284.03 min in group BC(75), P<0.001. The incidence of hypotension was comparable, P=0.932, whereas the incidence of nausea and pruritis was significantly lower in groups BC(50) and BC(75) as compared to group BF, P<0.001. No other side effects of intrathecal clonidine were detected. Neonatal outcome was similar in all the three groups. CONCLUSIONS: Addition of 75 μg clonidine to hyperbaric bupivacaine in spinal anesthesia for LSCS significantly prolongs the duration of postoperative analgesia without any increase in maternal side effects. There was no difference in neonatal outcome.