Comparative study between intravenous dexmedetomidine and clonidine as premedication in pediatric patients undergoing spinal anesthesia

Title
Comparative study between intravenous dexmedetomidine and clonidine as premedication in pediatric patients undergoing spinal anesthesia.
Background
Many techniques and drug regimens, with partial or greater success, have been tried from time to time to eliminate the anxiety component and to prolong the postoperative analgesia during regional anesthesia. In pediatric patients, anxiety and lack of cooperativeness for the regional procedure is the major problem in providing spinal anaesthesia. Alpha2-adrenergic agonists have both analgesic and sedative properties, when used as an adjuvant to regional anesthesia. They eliminate the anxiety, provide conscious sedation, lower the level of agitation and improve patient satisfaction. We designed a prospective, randomized, double-blind study, to evaluate and compare the efficacy of intravenous dexmedetomidine with clonidine as a premedication drug during spinal anaesthesia using intrathecal bupivacaine.
Materials and methods
In this prospective, randomized, double-blind study, 60 pediatric patients 4–10 years of age of the American Society of Anesthesiologists status I, scheduled for uro-genital surgery under spinal anesthesia, were randomly allocated into two groups of 30 each. Group DE received dexmedetomidine 1 μg kg and group CL received clonidine 1 μg kg diluted in 20 ml of normal saline intravenously over 10 min, 40 min before subarachnoid anaesthesia with 0.5% hyperbaric bupivacaine. The patients were monitored every 5 min for 1st 20 min and then every 10 min interval vitals were noted. Acceptable sedation score, parental separation anxiety level and degree of mask acceptance were assessed. Highest level of sensory blockade, time of two segment regression and time of first request of analgesic were also noted. Data was analyzed using Fisher’s exact test or Chi-square test and the value of P < 0.05 was considered statistically significant.
Results
Group DE and CL had comparable sedation score (p > 0.05). However, parental separation anxiety score and mask acceptance score, were better in DE than CL group (p < 0.05). There was no significant haemodynamic differences between the groups (p > 0.05). Duration of analgesia was also prolonged in DE group.
Conclusion
Dexmedetomidine is superior to clonidine as a premedication drug in pediatric patients undergoing spinal anesthesia.