الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
The simplicity of the technique of spinal anaesthesia and its reliability has made it one of the preferred techniques in lower abdominal surgery.
Unexpected early regression of spinal block or prolonged operation can cause intraoperative pain. Increasing the local anaesthetics dose, addition of opioids or clonidine to local anaesthetics for spinal analgesia would be helpful for prolonging the spinal blockade but may cause haemodynamic instability, nausea, hypotension, respiratory depression and delayed recovery from motor block also, postoperative pain relief is an unresolved issue. One of the methods of providing postoperative analgesia is by prolonging the duration of intrathecal bupivacaine by additives.
The aim of this work was to evaluate, the effect of intrathecal clonidine as an adjuvants to hyperbaric bupivacaine in subarachnoid block in patients undergoing elective cesarean section, as regards the onset, the duration and quality of the block, the haemodynamic changes, the side effects, the post operative analgesia and fetal wellbeing.
Patients were randomly allocated into two equal groups (25 each) using closed envelope technique:
group I: Patients received total volume of 2.5ml mixture that consists of 2 ml of 0.5% hyperbaric bupivacaine (10 mg) and 0.5 ml clonidine (75 μg) given through intrathecal injection.
group II: Patients received total volume of 2.5ml mixture that consists of 2 ml 0.5% hyperbaric bupivacaine (10 mg) and 0.5 ml normal saline given through intrathecal injection.
Preoperative evaluation was done by complete history taking, physical examination and necessary laboratory investigations.
Before starting the spinal anaesthesia basic monitoring was applied to the patients including electrocardiogram (ECG), noninvasive blood pressure and pulse oxymetry. Baseline readings were measured before starting spinal anaesthesia.
Patients received a volume preload in the form of 10 ml/kg normal saline, and then the puncture was performed at L3-4 interspace using a 25 gauge Quinke spinal needle under complete aseptic technique.
After injection, the parturients were immediately placed in supine position. A wedge was placed under the right hip. Oxygen by face mask was given at 5 L/min throughout the procedure. When the sensory block level reached T8 dermatome, surgery was allowed to start.
The following measurements were recorded through intra and postoperative periods:
• Haemodynamic measurements (heart rate, mean arterial blood pressure, arterial oxygen saturation and respiratory rate).
• Sensory blockade (onset of the sensory block, highest sensory level and the time for two-segment regression).
• Motor blockade (onset and duration of the motor block using the modified Bromage score).
• Efficacy of postoperative analgesia (Visual Analogue Scale, time to 1st rescue analgesia and total dose of opioid used).
• Intra and postoperative sedation using the Ramsay sedation scale.
• Perioperative side effects or complications.
All these measurements were recorded and statistically analyzed.
There was no statistically significant difference between the two groups regarding heart rate, mean arterial blood pressure, arterial oxygen saturation and respiratory rate.
Parturients who received clonidine-bupivacaine had earlier onset, higher level of block, slower regression of sensory block with less VAS and an increase in the time for first analgesic request leading to less requirement of postoperative analgesia than parturients who received bupivacaine alone.
Onset of motor block and its regression using modified Bromage score revealed faster onset with longer duration of motor block in the clonidine-bupivacaine group than in bupivacaine only group.
Some of parturients in the clonidine-bupivacaine group were significantly sedated when compared to none in the bupivacaine only group measured by RSS.
There was no statistically significant difference between the two groups regarding perioperative side effects.
There was no statistically significant difference between the two groups regarding Apgar score at 1 and 5 min.