title: Efficacy of premixed versus sequential administration of clonidine as an adjuvant to hyperbaric bupivacaine intrathecally in cesarean section.
abstract: BACKGROUND
  Density of the drugs injected intrathecally is an important factor that influences spread in the cerebrospinal fluid. Mixing adjuvants with local anesthetics (LA) alters their density and hence their spread compared to when given sequentially in seperate syringes.
  
  
  OBJECTIVE
  To evaluate the efficacy of intrathecal administration of hyperbaric bupivacaine (HB) and clonidine as a mixture and sequentially in terms of block characteristics, hemodynamics, neonatal outcome, and postoperative pain.
  
  
  METHODS
  Prospective randomized single blind study at a tertiary center from 2010 to 2012.
  
  
  METHODS
  Ninety full-term parturient scheduled for elective cesarean sections were divided into three groups on the basis of technique of intrathecal drug administration. Group M received mixture of 75 μg clonidine and 10 mg HB 0.5%. Group A received 75 μg clonidine after administration of 10 mg HB 0.5% through separate syringe. Group B received 75 μg clonidine before HB 0.5% (10 mg) through separate syringe.
  
  
  METHODS
  Observational descriptive statistics, analysis of variance with Bonferroni multiple comparison post hoc test, and Chi-square test.
  
  
  RESULTS
  Time to achieve complete sensory and motor block was less in group A and B in which drugs were given sequentially. Duration of analgesia lasted longer in group B (474.3 ± 20.79 min) and group A (472.50 ± 22.11 min) than in group M (337 ± 18.22 min) with clinically insignificant influence on hemodynamic parameters and sedation.
  
  
  CONCLUSIONS
  Sequential technique reduces time to achieve complete sensory and motor block, delays block regression, and significantly prolongs the duration of analgesia. However, it did not matter much whether clonidine was administered before or after HB.
authors.affiliation: Department of Aneasthesia, Himalayan Institute of Medical Sciences, Jolly Grant, Doiwala, Dehradun, Uttarakhand, India.
authors.forename: Prachee
authors.initials: P
authors.lastname: Sachan
authors.affiliation: Department of Aneasthesia, Himalayan Institute of Medical Sciences, Jolly Grant, Doiwala, Dehradun, Uttarakhand, India.
authors.forename: Nidhi
authors.initials: N
authors.lastname: Kumar
authors.affiliation: Department of Aneasthesia, Himalayan Institute of Medical Sciences, Jolly Grant, Doiwala, Dehradun, Uttarakhand, India.
authors.forename: Jagdish Prasad
authors.initials: JP
authors.lastname: Sharma
keywords: Adjuvants; cesarean section; clonidine; hyperbaric bupivacaine; spinal anesthesia