title: Thoracic epidural anesthesia for laparoscopic cholecystectomy using either bupivacaine or a mixture of bupivacaine and clonidine: A comparative clinical study.
abstract: BACKGROUND
  Traditionally laparoscopic cholecystectomy is done under general anesthesia. But recently there is a growing interest to get it conducted under central neuraxial blockade. We conducted a clinical study comprising bupivacaine alone or a combination of bupivacaine and clonidine (2 μg/kg) in thoracic epidural anesthesia for laparoscopic cholecystectomy (LC). The aim was to attenuate the undesirable hemodynamic changes due to pneumoperitoneum (PNO) and achieve a better qualitative blockade.
  
  
  METHODS
  After taking approval from Institutional Ethical Committee, 50 adult patients of ASA grade I and II were divided into two groups; group A where bupivacaine was given with 2 μg/kg of clonidine (Cloneon, Neon) and in group B bupivacaine (Anawin, Neon) was given with 1 ml of saline as placebo. Thoracic epidural was given at the T9-T10 or T10-T11 interspace to obtain a block of T4-L2 dermatome. Hemodynamic parameters like heart rate (HR), noninvasive blood pressure (NIBP), respiratory rate (RR), electrocardiogram (ECG), oxygen saturation (SpO2) and arterial pressure of carbon dioxide (PaCO2) were monitored and readings were recorded before and 10 minutes (min.) after the blockade and then at 5 min, 15 min and 30 min after PNO and 15 min after exsufflation.
  
  
  RESULTS
  All the parameters of the patients in group A remained stable but the patients of group B showed an increase in mean arterial pressure (MAP) and HR at 5, 15 and 30 min after PNO and 15 min after exsufflation as compared to Group A. PaCO2, SpO2 and RR values in both the groups were comparable. In group A, two patients complained of shoulder pain while in group B12 patients complained of shoulder pain.
  
  
  CONCLUSIONS
  Thoracic epidural anesthesia for LC is a satisfactory alternative technique in selected cases. Addition of clonidine (2 μg/kg) to bupivacaine produces better qualitative anesthetic conditions. It prevents hemodynamic perturbations produced by pneumoperitoneum and also decreases the incidence of shoulder pain. Thus we strongly advocate the incorporation of clonidine as an adjuvant in thoracic epidural anesthesia for LC.
authors.affiliation: Deparment of Anesthesiology and Critical Care, Rohilkhand Medical College and Hospital, Bareilly, Uttar Pradesh, India.
authors.forename: Malti
authors.initials: M
authors.lastname: Agrawal
authors.affiliation: Deparment of Anesthesiology and Critical Care, Rohilkhand Medical College and Hospital, Bareilly, Uttar Pradesh, India.
authors.forename: A P
authors.initials: AP
authors.lastname: Verma
authors.affiliation: Deparment of Anesthesiology and Critical Care, Rohilkhand Medical College and Hospital, Bareilly, Uttar Pradesh, India.
authors.forename: L S
authors.initials: LS
authors.lastname: Kang
keywords: cholecystectomy; clonidine; epidural anesthesia; α2-adrenergic receptor agonists