title: Comparison of different routes of administration of clonidine for analgesia following anterior cruciate ligament repair.
abstract: OBJECTIVE
  A high percentage of patients undergoing arthroscopic repairs on day care basis complain of inadequate postoperative pain relief. Clonidine was evaluated for the best route as an adjuvant in regional anesthesia in anterior cruciate ligament (ACL) repair to prolong analgesia.
  
  
  METHODS
  A prospective randomized double-blinded study was planned in a tertiary care hospital in North India in which 85 American Society of Anesthesiologists I and II patients undergoing ACL repair were enrolled. All groups received 0.5% hyperbaric bupivacaine intrathecally as in control group C. Group IT received intrathecal 1 μg/kg of clonidine along with hyperbaric bupivacaine, group IA received 0.25% bupivacaine and 1 μg/kg clonidine intra-articularly, and group NB received 0.25% bupivacaine and 1 μg/kg clonidine in femoro-sciatic nerve block (FSNB). Postoperative pain free interval and block characteristics were the primary outcomes studied.
  
  
  RESULTS
  Pain-free duration was 546.90 (±93.66) min in group NB (P < 0.001) in comparison to 234.90 (±20.99), 367.80 (±47.40) and 172.20 (±54.82) min in groups IA, IT and C, respectively. Sensory block and motor blockade in NB were 474.90 (±43.80) and 267.40 (±34.59) min, respectively, and were significantly prolonged (P > 0.001) in comparison to other groups. The mean rescue analgesic requirement and cumulative frequency of rescue analgesia were least in group NB, followed by groups IT, IA and C.
  
  
  CONCLUSIONS
  Clonidine is safe and effective adjuvant with bupivacaine in prolonging analgesia through various routes employed for post knee surgery pain. The maximum prolongation of analgesia is achieved through FSNB with a risk of prolonging postanesthesia care unit stay.
authors.affiliation: Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Neeru
authors.initials: N
authors.lastname: Sahni
authors.affiliation: Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Nidhi B
authors.initials: NB
authors.lastname: Panda
authors.affiliation: Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Kajal
authors.initials: K
authors.lastname: Jain
authors.affiliation: Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Yatinder Kumar
authors.initials: YK
authors.lastname: Batra
authors.affiliation: Department of Orthopedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Mandeep Singh
authors.initials: MS
authors.lastname: Dhillon
authors.affiliation: Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Pushpa
authors.initials: P
authors.lastname: Jagannath
keywords: Anterior cruciate ligament; clonidine; postoperative pain