Comparision of dexmedetomidine and clonidine with hyperbaric bupivacain in spinal anaesthesia

Anshul Agrawal, Sunita Jain, Ashish Goyal


Background: Alpha-2 adrenergic agonists used as adjuvant to spinal anaesthesia produce substantial sensory and motor blockade of bupivacaine. This study was planned to compare the sensory and motor blockade characteristics of intrathecal combinations of adjuvants dexmedetomidine and clonidine with hyperbaric bupivacaine in the cases who underwent lower limb surgery under spinal anaesthesia.

Methods: This was prospective, randomized, double blind study. 90 patients of age group between 18-60 years, ASA grade I and II were allotted into 3 equal groups. Group B received 15 mg bupivacaine plain, group BD and BC received dexmedetomidine (5mcg) and clonidine (50mcg) as adjuvants to bupivacaine respectively.

Results: The duration of 2 dermatome regression time, sensory blockade and motor blockade were longest in dexmedetomidine group (129.37±4.87; 386±58.43; 353±48.87) in compared to clonidine (109.77±5.95; 296.53±57.19; 269.7±51.2) and bupivacaine group (81.03±6.83; 211.1± 30.47;181.03±20.8). Both drugs do not affect the peak level of sensory blockade, sensory block onset and motor block onset time. Dexmedetomidine and clonidine do not cause sedation in intraoperative and postoperative period.

Conclusions: We conclude that addition of dexmedetomidine and clonidine in spinal anesthesia with hyperbaric bupivacaine increase the duration of ‘2 dermatome regression’ time, sensory and motor blockade and both are more with dexmedetomidine than with clonidine.


Dexmedetomidine, Clonidine, Bupivacaine, SAB

Full Text:



Venn RM, Karol MD, Grounds RM. Pharmacokinetics of Dexmedetomidine infusions for sedation of postoperative patients requiring intensive care. Br J Anaesth. 2002;88:669-75.

Virtanen R, Savola JM, Saano V, Nyman L. Characterization of the selectivity, specificity and potency of medetomidine as an alpha2-adrenoceptor agonist. Eur J Pharmacol. 1998;150:14-9.

Venn RM, Grounds RM. Comparison between Dexmedetomidine and propofol for sedation in the intensive care unit, patient and clinician perceptions. Br J Anaesth. 2001;87:684-90.

Martin E, Ramsay G, Mantz J, Sum-Ping STJ. The role of the alpha2-adrenoceptor agonist Dexmedetomidine in postsurgical sedation in the ICU. J Intensive Care Med. 2003;18(1):29-41.

Kanazi GE, Aouad MT, Jabbour-Khoury SI. Effect of low dose Dexmedetomidine or Clonidine on the charecteristics of Bupivacaine spinal block. Actaanaesthesiol scand. 2006;50:222-7.

Van Tuiji, Van Klei WA, Van Der Werff DBM, Kalkman CJ. The effect of addition of intrathecal Clonidine to hyperbaric Bupivacaine on postoperative pain and morphine requirements after caesarean section: a randomized controlled trial. Br J Anest. 2006;97(3):365-70.

Al-Ghanem SM, Massad IM, Al-Mustafa MM, Al-Zaben KR and Qudaisat IY. Effect of adding Dexmedetomidine versus fentanyl to intrathecal Bupivacaine on spinal block characteristics in gynecological procedures: A double blind controlled study. Am J Applied Sci.2009;6:882-7.

Gabriel JS and Gordin V. Alpha 2 agonist in regional anesthesia and analgesia. Curr Opin Anaesthesiol. 2001;14:751-3.

Mahmoud MAM, Sami AAH, Abdel KAS, Mujalli MM, Bassam AA, Ziad MA, et al. Effect of dexmedetomidine added to spinal bupivacaine for urologic procedure. Saudi Med J. 2009;30(3):365-70.

Sethi BS, Samuel M, Sreevastava D. Efficacy of analgesic effects of low dose intrathecal clonidine as adjuvant to bupivacaine. Indian J Anesthesia. 2007; 51(5):415-9.

Dobrydnjov I, Axelsson K, Matthiesen P, Klockhoff H, Holmstrom B, Gupta A. Clonidine combined with small-dose Bupivacaine during spinal anesthesia for inguinal herniorrhaphy: a randomized double-blind study. Anaesth Analg. 2003;96:1496-503.

Strebel S, Gurzeler JA, Schneider MC, Aeschbach A, Kindler CH. Small-dose intrathecal clonidine and isobaric bupivacaine for orthopedic surgery: A dose-response study. Anaesth Analg. 2004;99:1231-38.

Hala EA, Shafie MA, Youssef H. Dose related prolongation of hyperbaric Bupivacaine spinal anesthesia by Dexmedetomidine. Ain Shams J Anaesthesiol. 2011;4:83-95.

Racle JP, Benkhadra A, Poy JY, Gleizal B. Prolongation of isobaric Bupivacaine spinal anesthesia with epinephrine and clonidine for hip surgery in the elderly. Anaesth Analg. 1987;66:442-6.

Niemi L. Effects of intrathecal Clonidine on duration of Bupivacaine spinal anesthesia, hemodynamics, and postoperative analgesia in patients undergoing knee arthroscopy. Acta Anaesthesiol Scand. 1994; 38:724-8.

De Kock M, Gautier P, Fanard L, Hody JL, Lavand’hommeP. Intrathecal ropivacaine and Clonidine for ambulatory arthroscopy: A dose response study. Anaesthesiol. 2001;94:574-8.