2026· Asian Journal of Medical Research and Health Sciences· Vol 04, pp. 1740-1745· 0 citations
TL;DR
Dexmedetomidine was found to be a superior adjuvant to epidural bupivacaine compared to clonidine due to better sedation, prolonged postoperative analgesia, and effectivehaemodynamic stability with manageable adverse effects.
Abstract
Background:Epidural anaesthesia is commonly used for lower limb surgeries because it provides effectiveintraoperative anaesthesia, prolonged postoperative analgesia, and stable haemodynamics.Alpha-2 adrenergic agonists such as dexmedetomidine and clonidine are frequently used as adjuvants to local anaesthetics to improve the quality and duration of epidural blockade.Methodology:This prospective randomized comparative study was conducted in the Department ofAnaesthesiology, Sree Mookambika Institute of Medical Sciences, Kulasekharam, fromMarch 2025 to April 2026. Patients aged 20–60 years belonging to ASA physical status I and II undergoing elective lower limb surgeries under epidural anaesthesia were included in thestudy. Patients were randomly allocated into two groups. Group D received dexmedetomidine with 0.5% bupivacaine, while Group C received clonidine with 0.5% bupivacaine.Haemodynamic parameters, sedation scores, postoperative pain scores, duration of analgesia, and adverse effects were assessed and compared.Results:Both groups showed stable haemodynamic profiles throughout the study period. However, dexmedetomidine produced a greater reduction in heart rate and mean arterial pressurecompared to clonidine while remaining within safe clinical limits. Ramsay Sedation Scores were significantly higher in the dexmedetomidine group at all observed intervals (p<0.05).Visual Analog Scale scores for postoperative pain were significantly lower in Group D at 120, 240, and 360 minutes, indicating prolonged analgesia. Bradycardia and hypotension wereslightly more common in the dexmedetomidine group but were effectively managed.Conclusion:Dexmedetomidine was found to be a superior adjuvant to epidural bupivacaine compared to clonidine due to better sedation, prolonged postoperative analgesia, and effectivehaemodynamic stability with manageable adverse effects.
Background:Epidural anaesthesia is widely used for lower limb orthopaedic surgeries because of its ability to provide effective intraoperative anaesthesia and prolonged postoperative analgesia. Addition of adjuvants such as dexmedetomidine, clonidine, and fentanyl toepidural local anaesthetics improves block characteristics and haemodynamic stability. This study was conducted to compare the effects of dexmedetomidine, clonidine, and fentanyl on intraoperative haemodynamics when used as adjuvants to epidural ropivacaine.Methodology:This randomized prospective comparative study was conducted in the Department of Anaesthesiology, Sree Mookambika Institute of Medical Sciences, Kulasekharam, from February 2025 to November 2025. A total of 45 ASA grade I and II patients aged 20–60 years undergoing lower limb orthopaedic surgeries under epidural anaesthesia were randomly divided into three groups of 15 each. Group A received ropivacaine with dexmedetomidine, Group B received ropivacaine with clonidine, and Group C received ropivacaine with fentanyl. Intraoperative haemodynamic parameters, onset and duration of sensory and motor blockade, analgesia, and adverse effects were assessed.Results:A statistically significant fall in systolic, diastolic, and mean arterial pressure was observed in Groups B and C from 15 to 120 minutes after epidural block (p<0.05). Dexmedetomidine demonstrated better haemodynamic stability compared to clonidine and fentanyl groups. All three groups provided effective anaesthesia and satisfactory analgesia with manageable adverse effects.Conclusion:Dexmedetomidine, clonidine, and fentanyl are effective epidural adjuvants in lower limb orthopaedic surgeries. Dexmedetomidine showed superior haemodynamic stability and prolonged analgesic effect with minimal adverse effects.
Dr. Sreekala, Dr. Subhasan JV· Asian Journal of Medical Res...· 0 citations
Background: Spinal anesthesia using bupivacaine is widely employed for lower abdominal and lower limb surgeries. However, its limited duration of action often necessitates the use of adjuvants. Dexmedetomidine, a highly selective α2-adrenergic agonist, has shown promising results in prolonging sensory and motor blockade.Aim: To evaluate the efficacy of intrathecal dexmedetomidine as an adjuvant to bupivacaine in spinal anesthesia.Methods: A prospective comparative study was conducted on 80 patients randomly allocated into two groups. Group A received intrathecal hyperbaric bupivacaine alone, while Group B received bupivacaine combined with dexmedetomidine. Outcomes included onset time, duration of sensory and motor block, postoperative analgesia, and hemodynamic parameters.Results: The baseline demographic characteristics were comparable between the two groups, indicating no significant difference (p>0.05). The addition of dexmedetomidine significantly prolonged sensory and motor block duration and improved postoperative analgesia (p< 0.05) without major complications.VAS pain scores were consistently lower in Group B at all postoperative time intervals compared to Group A.Conclusion:Intrathecal dexmedetomidine is an effective and safe adjuvant to bupivacaine, enhancing the quality and duration of spinal anesthesia.
Dr. Syed Zeb Raza, Dr. Devesh Mishra, Dr. Payal Uikey· Asian Journal of Medical Res...· 0 citations
Introduction: Spinal Anaesthesia (SA) is a suitable Regional Anaesthesia (RA) for lower limb surgery, but is limited by its comparatively short analgesic duration. Adjuvants like fentanyl and dexmedetomidine can be administered intrathecally with local anaesthetics like ropivacaine to assist in modulating block parameters, extend the duration of analgesia and decrease systemic administration of opioids.
Aim: To compare and evaluate the safety and efficacy of intrathecal fentanyl and dexmedetomidine as adjuvants to ropivacaine in lower limb orthopaedic surgery.
Materials and Methods: This double-blinded, randomised controlled study was carried out at the Department of Anaesthesiology, Jawaharlal Nehru Medical College, Acharya Vinoba Bhave Rural Hospital, Datta Meghe Institute of Higher Education and Research (DMIHER), Sawangi (Meghe), Wardha, Maharashtra, India. It was performed in 60 American Society of Anaesthesiologists (ASA) I-II patients aged 18-50 years undergoing elective lower limb operations. The patients were divided into two groups: Group-RD was administered 15 mg 0.5% hyperbaric ropivacaine with 10 μg dexmedetomidine and Group-RF was administered 15 mg 0.5% hyperbaric ropivacaine with 20 μg fentanyl. Haemodynamic parameters, sensory and motor block characteristics, sedation {as measured by the Ramsay Sedation Score (RSS)}. Duration of analgesia and sideeffects were recorded. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) v22.0 and GraphPad Prism v6.0 and p<0.05 was considered statistically significant.
Results: The mean age was 38.43±8.31 years in GroupRF and 37.27±8.75 years in Group-RD. Group-RD showed a significantly earlier onset of sensory block (4.33±0.64 min vs 5.58±0.59 min). Motor block onset was also earlier in Group-RD (5.04±0.75 min) than in Group-RF (7.57±0.60 min), with a longer motor block duration (207.26±6.58 min vs 148.9±8.22 min). Postoperative analgesia lasted significantly longer in Group-RD (391.86±9.89 min) compared with Group-RF (213.3±3.79 min). Haemodynamic parameters remained clinically stable in both groups, with only slight transient decreases in PR and blood pressure and no significant bradycardia or hypotension.
Conclusion: Dexmedetomidine is a better adjuvant to ropivacaine compared to fentanyl in SA. It provides better onset, longer sensory and motor block duration and increased analgesia without inducing further haemodynamic instability or respiratory depression.
Akansha Singhal, Karuna Taksande· Journal of Clinical and Diag...· 0 citations
Background: Epidural adjuvants improve the quality and duration of analgesia while reducing the dose requirement of local anaesthetics. Clonidine and fentanyl are commonly used epidural adjuvants, but their comparative efficacy remains a subject of interest. This study aims to compare the effects of clonidine and fentanyl as adjuvants to epidural bupivacaine in patients undergoingelective lower limb surgeries.Materials and Methods: This prospective, randomized comparative study was conducted over 18 months and included 60 ASA physical status I and II patients aged 18–60 years undergoing elective lower limb surgeries. Patients were randomly allocated into two groups (n = 30 each). Group BC received 16 mL of 0.5% isobaric bupivacaine with clonidine (1 μg/kg), while Group BF received 16 mL of 0.5% isobaric bupivacaine with fentanyl (0.5 μg/kg). The primary outcomes included onset and duration of sensory and motor block, and secondary outcomes included time to two-segment regression, duration of postoperative analgesia, haemodynamic parameters, sedation score, and adverse effects.Results: Group BF demonstrated a significantly faster onset of sensory block (6.3 ± 0.79 vs. 11.5 ± 0.82 minutes) and motor block (16.9 ± 1.32 vs. 24.2 ± 1.10 minutes) compared with Group BC (p < 0.001). However, Group BC showed significantly prolonged two-segment regression time (268.2 ± 0.38 vs. 109.2 ± 0.27 minutes), duration of sensory block (307.8 ± 0.47 vs. 147.0 ± 0.34 minutes), duration of motor block (292.8 ± 0.42 vs. 133.8 ± 0.35 minutes), and time to first rescue analgesia (307.8 ± 0.47 vs. 207.6 ± 0.34 minutes) (p < 0.001 for all comparisons). The incidence of adverse effects, including hypotension, bradycardia, and nausea/vomiting, was comparable between the two groups (p = 1.000).Conclusion: Epidural clonidine (1 μg/kg) as an adjuvant to bupivacaine provided significantly prolonged sensory and motor blockade and longer postoperative analgesia than epidural fentanyl (0.5 μg/kg), without increasing adverse effects. Therefore, clonidine may be considered an effective and safe alternative to fentanyl for epidural anaesthesia in elective lower limb surgeries.
Lavanya M. P, Harini Priyadarshini M. S, Amarnath C et al.· Asian Journal of Medical Res...· 0 citations
Background: Spinal anaesthesia is a well-established anaesthetic technique due to its quick onset and reliable sensory-motor inhibition. However, limited postoperative analgesia remains a major drawback of bupivacaine-based subarachnoid block. The addition of intrathecal adjuvants has been explored to improve block quality and extend analgesic duration. Among these, α₂-adrenergic agonists such as dexmedetomidine and clonidine have demonstrated favourable effects on anaesthetic performance. Owing to its greater α₂-receptor selectivity, dexmedetomidine may offer advantages over clonidine in enhancing spinal anaesthesia outcomes. Objective: To compare the efficacy and safety of dexmedetomidine and clonidine as intrathecal adjuvants to hyperbaric bupivacaine in spinal anaesthesia. Methods: This study was designed as a prospective randomized comparative trial at Combined Military Hospital, Dhaka, between December 2019 and December 2020. Study population consisted of adult patients (n = 120) undergoing elective infraumbilical surgery with spinal anaesthesia. were registered and randomly split into two groups equally. Group A received 10 mg of 0.5% hyperbaric bupivacaine combined with dexmedetomidine 5 µg, whereas Group B received the same dose of bupivacaine with clonidine 30 µg. Outcomes assessed included onset and duration of sensory and motor blockade, duration of postoperative analgesia, haemodynamic variables, and treatment-related adverse events. Results: Patients receiving dexmedetomidine exhibited a significantly shorter time to peak sensory blockade compared with those receiving clonidine (2.13±0.54 vs 3.52±0.34 minutes; p<0.001). Similarly, complete motor blockade was achieved earlier in the dexmedetomidine group (2.93±0.43 vs 4.42±0.34 minutes; p<0.001). Dexmedetomidine was also associated with significantly prolonged sensory regression time, delayed motor recovery, and extended postoperative analgesia (all p<0.001). The mean duration before rescue analgesia was required was 544.5±17.6 minutes in Group A and 423.5±16.6 minutes in Group B. Haemodynamic measurements remained stable in both groups, and the incidence of adverse effects was comparable, with no episodes of clinically significant respiratory depression or excessive sedation. Conclusion: Low-dose intrathecal dexmedetomidine provided superior block characteristics and longer postoperative analgesia than clonidine while maintaining stable hemodynamic and safety profiles. It appears to be an effective adjuvant to hyperbaric bupivacaine with a comparable safety profile in subarachnoid anesthesia.
Mohammad Abedur Reza, Tahmina Bhuiyan, Meryem Kamal et al.· Islami Bank Medical College...· 0 citations
Background: Regional anesthesia, particularly ‘
the supraclavicular brachial plexus block, is widely used for upper
limb surgeries due to its rapid onset, dense blockade, and superior postoperative analgesia. The addition of α2-
adrenergic agonists as adjuvants to local anesthetics can enhance block characteristics.
Aim: To compare the efficacy of dexmedetomidine and clonidine as adjuvants to ropivacaine in PNS-guided
supraclavicular brachial plexus block.
Methodology: This prospective comparative observational study was conducted on 80 ASA I–II patients
undergoing elective upper limb surgeries. Patients were randomly assigned to two groups: RC (ropivacaine with
clonidine 1 μg/kg) and RD (ropivacaine with dexmedetomidine 1 μg/kg). Onset and duration of sensory and motor
blocks, duration of analgesia, and hemodynamic parameters were assessed and analyzed using SPSS v24, with p
≤ 0.05 considered significant.
Results: The RD group showed a significantly faster onset of sensory (5.1 ± 0.9 vs. 10.65 ± 1.14 min) and motor
block (10.23 ± 1.12 vs. 14.8 ± 1.29 min) and prolonged sensory (752.5 ± 5.9 vs. 470.25 ± 29.39 min), motor
(513.75 ± 20.34 vs. 274.75 ± 28.19 min), and analgesia duration (765.82 ± 104.48 vs. 464.27 ± 66.2 min) than
RC (p < 0.001). Hemodynamics remained stable in both groups.
Conclusion: Dexmedetomidine is a superior adjuvant to ropivacaine compared to clonidine, providing faster
onset, longer block duration, and extended analgesia without significant adverse effects.
R. Singh, Sushmita Das, Chandrani Dutta Biswas et al.· International Journal of Pha...· 0 citations