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REGIONAL ANESTHESIA

A Dose Response Study of Clonidine with Local Anesthetic Mixture for Peribulbar Block: A Comparison of Three Doses

Department of Anaesthesiology and Intensive Care and Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India

Address correspondence and reprint requests to Rashmi Madan, MD, D-II/33, Ansari Nagar, New Delhi-110029, India. Address e-mail to rmadan{at}medinst.ernet.in or rashmimadan@ hotmail.com.

Clonidine prolongs anesthesia and analgesia of local anesthetics in various neural blocks as well as the duration of retrobulbar block. We assessed the dose-response relationship of clonidine added to lidocaine in peribulbar block. Sixty patients undergoing cataract surgery were given peribulbar block with 7 mL of 2% lidocaine and hyaluronidase with either saline (Control) or clonidine in 0.5-µg/kg (0.5 Clon), 1.0-µg/kg (1.0 Clon), or 1.5-µg/kg (1.5 Clon) doses. The onset and duration of lid and globe akinesia, globe anesthesia and analgesia, postoperative analgesic requirement, and adverse effects (hypotension, bradycardia, hypoxia, sedation, and dizziness) were recorded. The success rate and onset of block were comparable in all groups. The duration of lid and globe akinesia, globe anesthesia and analgesia was significantly (P < 0.01) prolonged in patients receiving 1.0 and 1.5 µg/kg clonidine as compared with the Control group. Perioperative pain scores and analgesic requirement were significantly less in these groups. 0.5 µg/kg clonidine did not increase the duration of anesthesia and analgesia significantly. Hypotension and dizziness were observed more in patients receiving 1.5 µg/kg clonidine as compared with other groups. We conclude that 1.0 µg/kg clonidine with a mixture of lidocaine (2%) significantly prolonged the duration of anesthesia and analgesia after peribulbar block with limited side effects.

IMPLICATIONS: We studied the effect of the addition of 0.5, 1.0 and 1.5 µg/kg clonidine to a lidocaine-hyaluronidase mixture on the onset and duration of peribulbar block and perioperative analgesia. A dose of 1.0 µg/kg produced a significant increase in duration of anesthesia and analgesia with minimal side effects.

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