title: Addition of epidural Clonidine enhances postoperative analgesia: A double-blind study in total knee- replacement surgeries.
abstract: BACKGROUND
  This study was undertaken to evaluate the analgesic effect of the combination of epidural Clonidine with Bupivacaine versus epidural Bupivacaine alone in patients undergone knee replacement surgery.
  
  
  METHODS
  A randomized double-blind design was used, and 60 adult patients (40-60 years) of ASA grade I and II scheduled for post-operative pain relief in total knee replacement surgeries by epidural Clonidine were studied. Patients received either an epidural Clonidine (1μg/kg) with Bupivacaine (1.5mg/kg) group CL (n=30) or Bupivacaine alone group CT (n=30) for Knee replacement surgeries. The pain score, blood pressure, heart rate, respiratory rate were measured at fixed times during the first 24 h after operation. Onset and duration of sensory and motor blockade, duration of analgesia, and analgesic requirement were compared.
  
  
  RESULTS
  The onset of sensory anesthesia was faster (493.8±31.66 in sec.) and the duration was significantly longer in Clonidine group (334.2 min). Requirement of supplementary analgesia (Inj. diclofenac) was markedly decreased in Clonidine group as evident from the findings that in control group 18 patients required 3 supplemental analgesic doses in first 24 hours as compared to only 3 patients in Clonidine group. Epidural Clonidine produced a significant decrease (P less than 0.05) in heart rate and blood pressure, whereas the respiratory rate was not affected. We also observed for side effects in both the groups. Incidence of significant hypotension was higher, 8 patients (26%) in Clonidine group compared to 2 patient (6%) in control group. Incidence of dryness of mouth was higher, 12 patients (48%) in Clonidine group compared to 5 (18%) in control group.
  
  
  CONCLUSIONS
  The addition of Clonidine to Bupivacaine epiduraly prolongs motor and sensory block and analgesia, without an increased incidence of side effects.
authors.affiliation: Department of Anesthesiology, M. P. Shah Medical College, Guru Gobind Singh hospital, Jamnagar - 361 008, Gujarat, India.
authors.forename: Shobhana
authors.initials: S
authors.lastname: Gupta
authors.affiliation: Department of Anesthesiology, M. P. Shah Medical College, Guru Gobind Singh hospital, Jamnagar - 361 008, Gujarat, India.
authors.forename: Dipak
authors.initials: D
authors.lastname: Raval
authors.affiliation: Department of Anesthesiology, M. P. Shah Medical College, Guru Gobind Singh hospital, Jamnagar - 361 008, Gujarat, India.
authors.forename: Mita
authors.initials: M
authors.lastname: Patel
authors.affiliation: Department of Anesthesiology, M. P. Shah Medical College, Guru Gobind Singh hospital, Jamnagar - 361 008, Gujarat, India.
authors.forename: Nirav
authors.initials: N
authors.lastname: Patel
authors.affiliation: Department of Anesthesiology, M. P. Shah Medical College, Guru Gobind Singh hospital, Jamnagar - 361 008, Gujarat, India.
authors.forename: Nehal
authors.initials: N
authors.lastname: Shah
keywords: Bupivacaive; clonidine; epidural analgesia; knee-replacement surgery