BACKGROUND The spinal administration of combination of alpha 2 agonist, Clonidine and cholinesterase inhibitor Neostigmine along with bupivacaine is under clinical investigation for potential use in the perioperative period. Combination of both drugs in lower doses along with bupivacaine can produce adequate analgesia with less adverse effects. Aims and Objectives- The purpose of the study is to evaluate the efficacy and safety of combining a lower dose of clonidine and neostigmine added with bupivacaine for providing better analgesia with less adverse effects in patients undergoing lower limb orthopaedic surgery. MATERIALS AND METHODS 200 healthy patients of American Society of Anaesthesiologist's physical status I and II, aged between 50 to 55 years, weighing about 50- 60 kg, height 150 to 160 cm, scheduled for lower limb Orthopaedic surgery under spinal anaesthesia were divided in four groups (n= 50). The Group B received 0.5% Bupivacaine 12.5 mg (2.5 mL) with 0.5 mL normal saline; Group BN received 0.5% Bupivacaine 12.5 mg (2.5 mL) with 25 mcg Neostigmine; Group BC received 0.5% Bupivacaine 12.5 mg (2.5 mL) with 50 mcg Clonidine; and Group BCN received 0.5% Bupivacaine 12.5 mg (2.5 mL) with 12.5 mcg Neostigmine and 25 mcg Clonidine respectively. Heart rate, non-invasive mean arterial blood pressure, respiratory rate, SPO2, onset of sensory and motor block, duration of sensory and motor block, analgesia, sedation level and any adverse effects were recorded at regular interval and the parameters were compared among different groups with appropriate statistical methods. RESULTS There was no significant statistical difference between the age, weight, height, ASA status of the patients included in study group (p <= 0.05) and groups are comparable to each other in term of duration of surgery (p > 0.05). Onset of sensory block was highly significant in Gr BCN, as p value < 0.001. Onset of motor block was also significant in Gr BCN, as p value < 0.05. When Gr BC, BN and BCN were compared to Gr B, the duration of motor block was found significantly longer in all the three groups, as p value < 0.001. When Gr BC, BN and BCN were compared to Gr B, the duration of analgesia was found to be significantly prolonged in all three groups, as p value < 0.001. When Gr BC, BN and BCN were compared to Gr B, the sedation score was found to be significantly prolonged in Gr BC and Gr BCN, as p value < 0.001. Mean arterial pressure of the patients of Gr BC, Gr BN and Gr BCN were compared to Gr B, it was found to be significantly lower at some particular point of time in Gr BCN, as p value < 0.001. When pulse rate of the patients of Gr BC, Gr BN and Gr BCN were compared to Gr B, it was found to be significantly lower at some particular point of time in Gr BCN as p value < 0.001. The requirement of rescue analgesic drug was more in Group B patients than any other groups. CONCLUSION With neostigmine and clonidine added with bupivacaine as an adjuvant in lower dose provides good haemodynamic stability, lesser adverse effects and good postoperative analgesia.
