Comparison of Effect of Intrathecal Buprenorphine vs Clonidine as an Adjuvant to Hyperbaric Bupivacaine on Subarachnoid Block Characteristics

Background and aims: There are very few reported clinical trials with direct comparison of buprenorphine and clonidine on subarachnoid block characteristics. The aim of the present study was to compare the effect of buprenorphine 75 μg and clonidine 37.5 μg as an adjuvant to 15 mg of 0.5% bupivacaine in lower limb surgeries with respect to the subarachnoid block characteristics, postoperative analgesia and side-effects. Methods: One hundred patients of 15 to 60 years, either sex and American Society of Anesthesiologist (ASA) I/II undergoing elective lower limb surgeries under planned spinal anesthesia were included and randomly allocated into two equal groups (n = 50 each) to receive 3 ml of intrathecal 0.5% bupivacaine (heavy) with either clonidine 37.5 μg (group C) or buprenorphine 75 μg (group B) to a total volume of 3.25 ml. The patients were evaluated with respect to various sensory and motor block characteristics, duration of postoperative analgesia and adverse effects. Result: Both the groups were comparable with respect to demographic profile. There was significant prolongation in the duration of sensory block (119.26 ± 24.56 vs 79.40 ± 15.67; p = 0.0), motor block (277.90 ± 37.56 vs 198.80 ± 42.21; p = 0.0) and postoperative analgesia (355.80 ± 63.85 vs 283.20 ± 51.84; p = 0.0) in group C compared with group B. There was clinically significant earlier onset of maximum sensory block (9.20 ± 5.69 vs 11.90 ± 4.78; p = 0.018) and motor block (5.10 ± 3.39 vs 11.90 ± 4.78; p = 0.018) in group C compared with group B however the results were statistically significant only for time to attain maximum sensory block. The incidence of shivering was significantly lower in group C compared with group B. Conclusion: Intrathecal 37.5 μg clonidine seems to be an attractive alternative to 75 μg buprenorphine as an adjuvant to spinal bupivacaine in terms of duration of sensory and motor blockade, postoperative analgesia and having less side-effects.

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