Issn Print: 1098-7339
Publication Date: 2004/09/01
Intrathecal clonidine prolongs discharge times when added to levobupivacaine for day-case arthroscopy in male subjects: 168.
A Nelis; V Hoffmann; M Vercauteren
Excerpt
Method: Levobupivacaine 10mg provides reliable spinal anaesthesia comparable to 15mg ropivacaine but slower regression of sensory block than lidocaine 60mg (1). Clonidine allows to reduce the local anaesthetic dose while offering better postoperative analgesia. The aim of the present study was to evaluate if the addition of clonidine may accelerate micturition and home discharge after spinal anaesthesia for day-case arthroscopy. Methods. Following approval by the Ethics committee and after their written informed consent, 40 male subjects (18-55 yrs) undergoing day case arthroscopy were randomized to receive in a double blind fashion for spinal anaesthesia either levobupivacaine 10mg or levobupivacaine 7.5mg to which was added clonidine 30mcg. Measured were vital parameters, onset of sensory block i.e. when T12 was reached, the maximal motor block, intraoperative side-effects, time needed for discharge to the day-case ward (when Bromage 1 was obtained), time to first micturition and discharge. To evaluate the quality of micturition a DxU-bladder scanner was used and micturition problems were classified by using a 5-point scale. Results. The onset of sensory block was significantly slower in patients receiving clonidine. This delayed the time to incision. The spread of the block was similar in both groups. Regression of sensory block was not different either. The degree of motor block was more pronounced in the clonidine group but recovery was faster. Nevertheless the time to arrival in the daycase department was prolonged in the combination group due the delayed incision and the higher incidence of hypotension requiring a prolonged recovery room stay. Micturition problems were comparable in both groups. Two patients in the plain group required in-and-out catheterisation while two patients in the clonidine group never had residual volumes less than 100ml, which they were able to obtain during an ambulatory visit one week after surgery. Time to micturition was not different but time to home discharge was significantly prolonged in the clonidine group which has to be explained by the occurrence of side-effects (hypotension and sedation) and multiple trials to reach a residual bladder volume less than 100ml. Conclusion and discussion. The addition of clonidine to levobupivacaine allows a dose sparing of 25%. However, the combination prolongs the onset and duration of sensory block while there were more side-effects which significantly delayed discharge times to both the ward and home.
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