Comparison of Epidural Clonidine and Dexmedetomidine for Perioperative Analgesia in Combined Spinal Epidural Anesthesia with Intrathecal Levobupivacaine: A Randomized Controlled Double-blind Study

BACKGROUND Epidural administrations of α2 agonists are being used as adjuvants as they lead to anxiolysis, sedation, analgesia, and hypnosis. AIM This study aims to evaluate the analgesic effects of epidural α2 agonists-dexmedetomidine and clonidine in conjunction with intrathecal levobupivacaine in combined spinal epidural anesthesia (CSEA). METHODS A prospective, randomized controlled study was done to assess and compare the efficacy and clinical profile of two α2 adrenergic agonists, clonidine, and dexmedetomidine administered epidurally in combination with intrathecal levobupivacaine in CSEA. The study was conducted for 1 year. Sixty adult patients physical status Class I and II undergoing below umbilical surgeries under CSEA were included in the study after a valid consent. Patients were randomly assigned into two groups, to receive either epidural dexmedetomidine (1.5 μg/kg) or clonidine (2 μg/kg) in 10 ml normal saline along with 0.5% isobaric levobupivacaine 15 mg (3 ml). Block characteristics, ability to provide sedation, duration, and quality of analgesia and side effects were studied and compared between the groups. RESULTS The characteristics of intraoperative block were comparable among two groups. As compared to clonidine, dexmedetomidine provided a better sedation and prolonged analgesia, evidenced by the distribution of visual analog scale scores and requirement rescue analgesic among two groups. The side effect profile of the two drugs was comparable. CONCLUSION Dexmedetomidine at 1.5 μg/kg epidurally with intrathecal levobupivacaine is a better adjuvant compared to clonidine at 2 μg/kg epidurally in CSEA because of better sedation, prolonged analgesia, and safe side-effect profile.