Clonidine versus Tramadol as Adjuvant to Epidural Anaesthesia With 0.5% Bupivacaine for Lower Limb Orthopaedic Procedures

Clonidine vs Tramadol as epidural adjuvants

Abstract

Background: Epidural anesthesia is safe to provide surgical anesthesia and postoperative analgesia. Its efficacy can be improved with diversity of adjuvants. The aim of the study was to compare the clonidine versus tramadol asepidural adjuvant to 0.5% bupivacaine for lower limb orthopaedic procedures.Subjects and Methods:Sixty adultpatientswere enrolled and divided intwo equal groups of 30 patients each to receive 14 mL of 0.5% bupivacaine with either1ml (50g) clonidine (Group I) or 1ml (50mg) tramadol (Group II), through lumbar epidural catheter at L3-L4 intervertebral space.Theonsetanddurationofsensory andmotorblockadewithhighest cephalicspreadandduration ofpostoperative analgesiawereassessedasprimary objectives.Hemodynamic changes, respiration, sedationlevel or any adverse events were assessedassecondaryend points. Results:Mean onset timeand two dermatome sensory regression wascomparable. The meandurationofsensory analgesiawas 216.0846.18mininpatientsof Group I and 251.33 58.5 mininpatientsof Group II withstatistically highly significantdifferencebetween the groups (P=0.000). Mean onset time and duration ofmotorblockade wascomparable. The hemodynamic parameters remained stable, though 4 patients of Group I developedmanageable hypotension. No episode of respiratory depression, shivering, pruritus, nauseaandvomiting was observed.  Conclusion: Tramadol (50mg)asepidural adjuvantto0.5%bupivacainewas better than clonidineforenhancingtheduration of postoperativeanalgesiainpatientsundergoing lower limb orthopedic procedures.