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REGIONAL ANESTHESIA

Clonidine Combined with Small-Dose Bupivacaine During Spinal Anesthesia for Inguinal Herniorrhaphy: A Randomized Double-Blinded Study

I. Dobrydnjov, MD^*, K. Axelsson, MD PhD^*, S.-E. Thörn, MD PhD^*, P. Matthiesen, MD, H. Klockhoff, MD PhD, B. Holmström, MD PhD^*, and A. Gupta, MD FRCA, PhD^*

Departments of *Anesthesiology and Intensive Care and Surgery, University Hospital, Örebro, Sweden

Address correspondence to I. Dobrydnjov, Department of Anesthesiology and Intensive Care, University Hospital, SE 701 85 Örebro, Sweden. Address e-mail to igor.dobrydnjov{at}orebroll.se

The aim of this randomized double-blinded study was to see whether the addition of small-dose clonidine to small-dose bupivacaine for spinal anesthesia prolonged the duration of postoperative analgesia and also provided a sufficient block duration that would be adequate for inguinal herniorrhaphy. We randomized 45 patients to 3 groups receiving intrathecal hyperbaric bupivacaine 6 mg combined with saline (Group B), clonidine 15 µg (Group BC15), or clonidine 30 µg (Group BC30); all solutions were diluted with saline to 3 mL. The sensory block level was insufficient for surgery in five patients in Group B, and these patients were given general anesthesia. Patients in Groups BC15 and BC30 had a significantly higher spread of analgesia (two to four dermatomes) than those in Group B. Two-segment regression, return of S1 sensation, and regression of motor block were significantly longer in Group BC30 than in Group B. The addition of clonidine 15 and 30 µg to bupivacaine prolonged time to first analgesic request and decreased postoperative pain with minimal risk of hypotension. We conclude that clonidine 15 µg with bupivacaine 6 mg produced an effective spinal anesthesia and recommend this dose for inguinal herniorrhaphy, because it did not prolong the motor block.

IMPLICATIONS: The addition of clonidine 15 µg to 6 mg of hyperbaric bupivacaine increases the spread of analgesia, prolongs the time to first analgesic request, and decreases postoperative pain, compared with bupivacaine alone, during inguinal herniorrhaphy under spinal anesthesia.

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999