Efficacy Of 0.5% Hyperbaric Levobupivacaine With Clonidine And 0.5% Hyperbaric Levobupivacaine With Buprenorphine As Adjuvants For Total Abdominal Hysterectomy Under Subarachnoid Block - A Comparative Study

Abstract

Introduction: Total abdominal hysterectomy (TAH) is a common gynaecological surgery where subarachnoid block (SAB) with hyperbaric bupivacaine provides effective anesthesia but limited duration. Levobupivacaine, the S (-) isomer, offers similar efficacy with less cardio- and neurotoxicity and faster motor recovery. Adjuvants such as clonidine (α2-agonist) and buprenorphine (partial µ-agonist) are used to enhance and prolong block and analgesia.

Materials and Methods: Sixty ASA I–II patients aged 40–75 years undergoing TAH at Adichunchanagiri Hospital were randomised into two groups: LC (levobupivacaine + clonidine) and LB (levobupivacaine + buprenorphine). Onset, duration of sensory and motor block, analgesia, hemodynamics, and adverse effects were recorded. Data were analysed using SPSS v19; p <0.05 was significant.

Results: Demographics (age, height, weight, BMI, ASA) were comparable between groups. LC showed faster onset of sensory (2.37 vs 2.87 min) and motor block (5.66 vs 6.40 min), longer sensory regression (150.4 vs 120.5 min), motor block (186.7 vs 145.3 min), analgesia (219.2 vs 171.7 min), and delayed rescue analgesic need (192.7 vs 159.7 min), all p <0.001. Hemodynamic changes were minor and largely insignificant, though LC showed lower SBP and HR at some points. SpO₂ remained stable in both groups. Adverse effects were more frequent in LB, especially nausea (40% vs 6.7%).

Conclusion: Hyperbaric levobupivacaine 0.5% with clonidine provides faster onset, longer block, prolonged analgesia, and reduced rescue analgesic use compared to buprenorphine, with stable hemodynamics and fewer side effects.