Admixture of clonidine and fentanyl to ropivacaine in epidural anesthesia for lower abdominal surgery

CONTEXT AND BACKGROUND: Dose sparing action of one adjuvant for another in regional anesthesia. AIMS AND OBJECTIVES: To evaluate and compare the clonidine-ropivacaine combination with fentanyl-ropivacaine in epidural anesthesia and also to find out whether addition of clonidine can reduce the dose of fentanyl in epidural anesthesia. MATERIALS AND METHODS: 60 patients of ASA grade I and II between the ages of 21 and 55 years, who underwent lower abdominal surgeries, were included randomly into three clinically controlled study groups comprising 20 patients in each. They were administered epidural anesthesia with ropivacaine-clonidine (RC), ropivacaine-fentanyl (RF) or ropivacaine-fentanyl-clonidine (RCF). Per-op and post-op block characteristics as well as hemodynamic parameters were observed and recorded. Statistical data were compiled and analyzed using non-parametric tests and P<0.05 was considered as significant value. RESULTS: The demographic profile of the patients in all the three groups was similar as were the various block characteristics. The reduction of clonidine and fentanyl in the RCF group did not make any significant difference (P>0.05) in the analgesic properties of drug combination and hemodynamic parameters as compared to RC and RF groups. However, there was significant reduction of incidence of side effects in the RCF group (P<0.05) and it resulted in increased patient comfort. CONCLUSIONS: The analgesic properties of the clonidine and fentanyl when used as adjuvant to ropivacaine in epidural anesthesia are almost comparable and both can be used in combination at lower dosages without impairing the pharmacodynamic profile of the drugs as well as with a significant reduction in side effects.