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Comparison of intrathecal isobaric levobupivacaine, levobupivacaine- clonidine, with hyperbaric bupivacaine as a control for quality of anaesthesia intraoperative hemodynamics and duration of post-ope

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Original Article

Author Details : V. Bhavani, I Joseph Raajesh

Volume : 3, Issue : 2, Year : 2016

Article Page : 148-154

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Abstract

Patients presenting with uterovaginal prolapse for vaginal hysterectomies will usually be in the age group of above 50years. Effective and prolonged post-operative analgesia will be of paramount importance in this group of patients as it is not uncommon to find associated comorbidities such as hypertension, diabetic mellitus and ischaemic heart diseases in these population.
Pain free postoperative period is mandatory in all post-surgical patients. Effective postoperative analgesia not only improves the patient comfort it also reduces the risk of deep vein thrombosis by early ambulation. Historically opioids are the mainstay of drugs used to treat postoperative pain. Drugs such as morphine and fentanyl are used either as additives to local anaesthetics intrathecally or through intravenous route. Although they are effective analgesics, the side effects such as respiratory depression, nausea and vomiting will produce additional discomfort to patients.
In this study we compared isobaric Levobupivacaine and isobaric Levobupivacaine with clonidine against hyperbaric Bupivacaine in patients undergoing vaginal hysterectomy. Levobupivacaine is the pure S enantiomer of racemic bupivacaine but it is less toxic to cardio vascular system and central nervous system. Intrathecal clonidine has been extensively evaluated as an alternate to neuraxial opoid for control of pain and it had been proven as a potent analgesic. Though its efficacy with hyperbaric bupivacaine has been confirmed by many trials    only very few studies are available which assessed its efficacy with levobupivacaine.
This is a prospective randomized control study, which was carried out in ninety patients who received subarachnoid block for vaginal hysterectomy. Ninety patients were divided into three groups namely Group B, Group LB and Group LC with thirty in each group. Control group (Group B) received 15 mg of hyperbaric bupivacaine  plus 0.2ml of 0.9% normal saline,  Group LB received  15  mg of isobaric levobupivacaine plus 0.2ml of 0.9% normal saline  and Group LC received isobaric Levobupivacaine 15mg along with clonidine 30 micrograms. Onset and duration of sensory and motor blockade were the parameters studied along with perioperative hemodynamic changes.

Keywords: Bupivacaine, Levobupivacaine, Clonidine, Bupivacaine, Spinal anaesthesia

How to cite : Bhavani V, Raajesh I J, Comparison of intrathecal isobaric levobupivacaine, levobupivacaine- clonidine, with hyperbaric bupivacaine as a control for quality of anaesthesia intraoperative hemodynamics and duration of post-ope. Indian J Clin Anaesth 2016;3(2):148-154

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