COMPARATIVE EVALUATION OF DEXMEDETOMIDINE AND CLONIDINE AS EPIDURAL ADJUVANTS TO BUPIVACAINE IN LOWER LIMB SURGERIES

Abstract

Background: Epidural anaesthesia is commonly used for lower limb surgeries because it provides effective intraoperative anaesthesia, prolonged postoperative analgesia, and stable haemodynamics. Alpha-2 adrenergic agonists such as dexmedetomidine and clonidine are frequently used as adjuvants to local anaesthetics to improve the quality and duration of epidural blockade. Methodology: This prospective randomized comparative study was conducted in the Department of Anaesthesiology, Sree Mookambika Institute of Medical Sciences, Kulasekharam, from March 2025 to April 2026. Patients aged 20–60 years belonging to ASA physical status I and II undergoing elective lower limb surgeries under epidural anaesthesia were included in the study. Patients were randomly allocated into two groups. Group D received dexmedetomidine with 0.5% bupivacaine, while Group C received clonidine with 0.5% bupivacaine. Haemodynamic parameters, sedation scores, postoperative pain scores, duration of analgesia, and adverse effects were assessed and compared. Results: Both groups showed stable haemodynamic profiles throughout the study period. However, dexmedetomidine produced a greater reduction in heart rate and mean arterial pressure compared to clonidine while remaining within safe clinical limits. Ramsay Sedation Scores were significantly higher in the dexmedetomidine group at all observed intervals (p<0.05). Visual Analog Scale scores for postoperative pain were significantly lower in Group D at 120, 240, and 360 minutes, indicating prolonged analgesia. Bradycardia and hypotension were slightly more common in the dexmedetomidine group but were effectively managed. Conclusion: Dexmedetomidine was found to be a superior adjuvant to epidural bupivacaine compared to clonidine due to better sedation, prolonged postoperative analgesia, and effective haemodynamic stability with manageable adverse effects.