International Journal of Research in Medical Sciences | November 2015 | Vol 3 | Issue 11 Page 3254 International Journal of Research in Medical Sciences Agarwal S et al. Int J Res Med Sci. 2015 Nov;3(11):3254-3261 www.msjonline.org pISSN 2320-6071 | eISSN 2320-6012 Research Article Epidural bupivacaine combined with dexmedetomidine or clonidine in infraumbilical surgeries: a comparative evaluation Shilpi Agarwal 1 , Rakesh Bahadur Singh 2 *, Dheer Singh 2 , Manoj Kumar 2 , Prashant Kumar Mishra 2 , Bharat Bhushan Bhardwaj 2 INTRODUCTION For thoracic, abdominal and major orthopaedic surgery epidural anaesthesia and analgesia can provide pain relief for a longer duration and the facility of further top-ups and continuous infusion of the analgesic drugs through epidural catheter thus provides an uneventful and smooth recovery. Almost without exception epidural analgesia regardless of analgesic agent, epidural regimen, and type and time of pain assessment, provided superior postoperative analgesia compared to intravenous patient- controlled analgesia. 1 Bupivacaine is a local anaesthetic drug belonging to the amino amide group and is indicated for nerve block, epidural and intrathecal anaesthesia. It is markedly cardiotoxic but adverse reactions are rare when it is administered correctly. 2 Epidural bupivacaine is equally safe and significantly more potent and more economical than epidural ropivacaine. ABSTRACT Background: Alpha-2 agonist are being extensively evaluated as an alternative to neuraxial opoids, as an adjuvants in regional anaesthesia The faster onset of action of local anaesthetics, rapid establishment of both sensory and motor blockade, prolonged duration of analgesia into postoperative period, dose sparing action of local anaesthetics and stable cardiovascular parameters make these agents a very effective adjuvant in regional anaesthesia. Methods: Our study had 45 patients, all patients belonged to ASA Grade-I or II, between 20 and 55 years of age with an average height of 150 and 170 cm and have ideal body weight requiring neuraxial blockade for lower abdominal surgeries. All the patients were randomly allocated into two groups Group-I: Epidural bupivacaine 0.5% (16 ml) + clonidine 75 μgm (1 ml) Group-II: Epidural bupivacaine 0.5 % (16 ml) + Dexmedetomidine 50 μgm (1 ml) Patients were monitored for sensory and motor blockade, hemodynamic parameters, rescue analgesia, sedation and adverse effects in perioperative period. Results: The time of onset of sensory block at T 10 and time to reach maximum sensory block (T6) in group-I was significantly longer as compared to group-II. The complete motor blockade (grade-3) was achieved much later and time taken for recovery to grade-0 was significantly shorter in group-I. The time for rescue analgesia in group-I was significantly shorter as compared to group-II. Hypotension was the most common side effect in both the groups. Dry mouth is a known side effect of alpha-2 agonists. Epidural dexmedetomidine produced profound sedation. Conclusions: We conclude from this study that dexmedetomidine is a better adjuvant than clonidine for providing early onset of sensory analgesia, superior sedative properties and prolonged post-operative analgesia. Keywords: Epidural, Bupivacaine, Clonidine, Dexmedetomidine 1 Department of Anaesthesiology, Bheem Rao Ambedkar Institute Rotatory Cancer Hospital, AIIMS, New Delhi, India 2 Department of Anaesthesiology, Rural Institute of Medical Sciences and Research, Saifai, Etawah, UP, India Received: 14 September 2015 Accepted: 07 October 2015 *Correspondence: Dr. Rakesh Bahadur Singh, E-mail: drrakeshsingh27@gmail.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20151172