Efficacy and safety of intrathecal clonidine vs fentanyl added to bupivacaine for lower abdominal procedures
DOI:
https://doi.org/10.11603/ijmmr.2413-6077.2026.1.16461Keywords:
spinal anaesthesia, postoperative analgesia, lower abdominal surgery, haemodynamic, sedationAbstract
Abstract. Intrathecal adjuvants such as fentanyl and clonidine may enhance the quality and duration of spinal anaesthesia and postoperative analgesia with bupivacaine, but their comparative efficacy and side-effect profiles remain important. The present study aimed to compare the effects of intrathecal fentanyl and clonidine as adjuvants to 0.5% bupivacaine on block characteristics, postoperative analgesia, haemodynamic, sedation, and adverse effects in patients undergoing lower abdominal surgery. This randomised double-blind comparative study was conducted in the Department of Anaesthesiology, Balrampur Hospital, Lucknow, among 96 patients aged 18-60 years, ASA physical status I-II, scheduled for lower abdominal surgeries. Patients were randomly allocated into three groups (n= 32 each): Group B received 2.5 mL of 0.5% bupivacaine with 0.5 mL normal saline, Group F received 2.5 mL of 0.5% bupivacaine with fentanyl 25 ug, and Group C received 2.5 mL of 0.5% bupivacaine with clonidine 30 ug. Outcomes included block onset and duration, rescue analgesia time, VAS score, haemodynamic, sedation, and adverse events. Baseline characteristics were comparable among groups. Group C showed the fastest onset of sensory block (1.45 ± 0.30 min) and the longest duration of sensory block (150.23 ± 28.47 min), followed by Group F and Group B (p< 0.0001). A similar pattern was observed for motor block onset and duration (p < 0.0001). Time to first rescue analgesia was significantly prolonged in Group C (6.00 ± 1.50 h) compared with Group F (4.50 ± 1.22 h) and Group B (2.80 ± 0.76 h) (p < 0.0001). Postoperative VAS scores were significantly lower in Group C. Haemodynamic variables remained largely comparable. Sedation was higher with clonidine, with marked sedation observed only in Group C. Intrathecal clonidine 30 ug with bupivacaine provided better block characteristics and longer postoperative analgesia than fentanyl 25 ug or bupivacaine alone, but with higher sedation
Received: 25.12.2025 | Revised: 23.04.2026 | Accepted: 26.05.2026
References
Fonseca NM, Guimarães GMN, Pontes JPJ, Azi LMTA, Oliveira RA. Safety and effectiveness of adding fentanyl or sufentanil to spinal anesthesia: Systematic review and meta-analysis of randomized controlled trials. Braz J Anesthesiol. 2023;73(2):198–216. DOI: 10.1016/j.bjane.2021.10.010 DOI: https://doi.org/10.1016/j.bjane.2021.10.010
Jouybar R, Saravi ZF, Dehghani N, Sadeghi S, Chehelgerdi Samani S, Esmaeilinezhad Z, et al. Comparative efficacy of 3 adjuvantmedicationsusedincombinationwithintrathecalbupivacaineforcaesariansectionanesthesia: Arandomized, double-blind clinical trial. Curr Ther Res Clin Exp. 2022;97:100688. DOI: 10.1016/j.curtheres.2022.100688 DOI: https://doi.org/10.1016/j.curtheres.2022.100688
Bhatia J, Suryawanshi C. Comparative analysis of intrathecal bupivacaine with fentanyl versus intrathecal bupivacaine with midazolam in lower abdominal and lower limb surgeries. Cureus. 2024;16(9):e68908. DOI: 10.7759/cureus.68908 DOI: https://doi.org/10.7759/cureus.68908
Manoharan MM, Paneer M, Elavarasan K, Punniyakoti KK. Dexmedetomidine versus clonidine as additives for spinal anesthesia: A comparative study. Anesth Pain Med. 2023;13(4):e138274. DOI: 10.5812/aapm-138274 DOI: https://doi.org/10.5812/aapm-138274
Dattatri S, Hareesh SB, Ashokanand DV. Comparison of intrathecal bupivacaine with different doses of clonidine as adjuvant. Med J Hematol Infect Dis. 2023;11(2):113–20. DOI: 10.4103/mjhs.mjhs_177_22 DOI: https://doi.org/10.4103/mjhs.mjhs_177_22
Shchegolkov EE, Loskutov OA. Comparative characteristics of the effectiveness of spinal anesthesia based on bupivacaine in combination with different intrathecal doses of dexmedetomidine. Emerg Med. 2024;20(2):112–8.
DOI: 10.22141/2224-0586.20.2.2024.1672 DOI: https://doi.org/10.22141/2224-0586.20.2.2024.1672
Ovsiienko T, Bondar M, Loskutov O. Assessment of the antinociceptive efficacy of varieties of multimodal low-opioid general anesthesia during laparoscopic renal surgery. Ukr J Nephrol Dialysis. 2022;4(76):51–61. DOI: 10.31450/ ukrjnd.4(76).2022.07 DOI: https://doi.org/10.31450/ukrjnd.4(76).2022.07
Sun LH, Jiao CC, Wu H, Dai AG, Chen Q, Jin L, et al. Intrathecal bupivacaine versus bupivacaine plus fentanyl for anaesthesia for Caesarean delivery: A randomised double-blind noninferiority trial. British J of Anaesth. 2026;136(2):584–90. DOI: 10.1016/j.bja.2025.09.059 DOI: https://doi.org/10.1016/j.bja.2025.09.059
Nayak A, Ninave S, Chandak A, Bhagat Q, Ambad R. Intrathecal adjuvant midazolam versus fentanyl with hyperbaric bupivacaine for post-operative analgesia in women undergoing total abdominal hysterectomy. Cureus. 2023;15(6):e40565. DOI: 10.7759/cureus.40565 DOI: https://doi.org/10.7759/cureus.40565
Sabertanha A, Makhmalbaf GR, Bayati M, Meshkini A. The effect of intrathecal bupivacaine plus dextrose 5% and fentanyl compared with bupivacaine alone on the onset and duration of analgesia in patients undergoing lower-limb orthopedic surgery. Adv Orthop. 2023;2023:2496557. DOI: 10.1155/2023/2496557 DOI: https://doi.org/10.1155/2023/2496557
Gu Y, Li Y, Liu W, Liu X, Ye Q. The effects of intrathecal fentanyl on postoperative opioid utilization rates in elderly patients undergoing lower extremity orthopedic surgery: A randomized controlled trial. Perioper Med (Lond). 2025;14:58. DOI: 10.1186/s13741-025-00541-9 DOI: https://doi.org/10.1186/s13741-025-00541-9
Joseph RB, Sunny N, Prakash DB. A comparative study between clonidine, fentanyl, and buprenorphine as adjuvants to intrathecal 0.5% hyperbaric bupivacaine in lower abdominal and lower limb surgeries. Int J Med Anesthesiol. 2025;8(1):1–6. DOI: 10.33545/26643766.2025.v8.i1a.533 DOI: https://doi.org/10.33545/26643766.2025.v8.i1a.533
The World Medical Association. Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects [Internet]. [cited 2025 April 10]. Available from: https://www.wma.net
European Commission. Ethics and Data Protection Guidance. [Internet]. [cited 2025 April 10]. Available from: https://ec.europa.eu
American Society of Anesthesiologists. [Internet]. [cited 2025 April 10]. Available from: https://www.asahq.org
Bajwa BS, Singh AP, Rekhi AK. Comparison of intrathecal clonidine and fentanyl in hyperbaric bupivacaine for spinal anesthesia and postoperative analgesia in patients undergoing lower abdominal surgeries. Saudi J Anaesth. 2017;11(1):37–40. DOI: 10.4103/1658-354X.197337 DOI: https://doi.org/10.4103/1658-354X.197337
Mahendru V, Tewari A, Katyal S, Grewal A, Singh MR, Katyal R. A comparison of intrathecal dexmedetomidine, clonidine, and fentanyl as adjuvants to hyperbaric bupivacaine for lower limb surgery: A double blind controlled study. J Anaesthesiol Clin Pharmacol. 2013;29(4):496–502. DOI: 10.4103/0970-9185.119151 DOI: https://doi.org/10.4103/0970-9185.119151
Sethi B, Samuel M, Sreevastava D. Efficacy of analgesic effects of low dose intrathecal clonidine as adjuvant to bupivacaine. Indian J Anaesth. 2007;51:415–9.
Khezri MB, Rezaei M, Delkhosh Reihany M, Haji Seid Javadi E. Comparison of postoperative analgesic effect of intrathecal clonidine and fentanyl added to bupivacaine in patients undergoing cesarean section: A prospective randomized double-blind study. Pain Res Treat. 2014;2014:513628. DOI: 10.1155/2014/513628 DOI: https://doi.org/10.1155/2014/513628
Kaushik S. Comparative study of using intrathecal clonidine and fentanyl as an adjuvant to hyperbaric bupivacaine (0.5%) in lower abdomen surgeries. Int J Res Rev. 2019;6(8):16–20.
Chhabra AR, Jagtap SR, Dawoodi SF. Comparison of clonidine versus fentanyl as an adjuvant to intrathecal ropivacaine for major lower limb surgeries: A randomized double blind prospective study. Indian J Pain. 2013;27:170– 4. DOI: 10.4103/0970-5333.124603 DOI: https://doi.org/10.4103/0970-5333.124603
Kothari N, Bogra J, Chaudhary AK. Evaluation of analgesic effects of intrathecal clonidine along with bupivacaine in cesarean section. Saudi J Anaesth. 2011;5(1):31–5. DOI: 10.4103/1658-354X.76499 DOI: https://doi.org/10.4103/1658-354X.76499
Bhattacharjee A, Singh NR, Singh SS, Debbarma P, Debbarma P, Singh T. A comparative study of intrathecal clonidine and fentanyl along with bupivacaine in spinal anesthesia for caesarean section. J Med Soc. 2015;29:145–9.
DOI: 10.4103/0972-4958.170782 DOI: https://doi.org/10.4103/0972-4958.170782
Singh G, Aulakh GS, Aulakh NK, Singh RM, Bose A, Katayal S, et al. Effect of intrathecal clonidine versus fentanyl on bupivacaine spinal block in transurethral resection of prostate surgeries. Anesth Essays Res. 2016;10:65–70. DOI: 10.4103/0259-1162.165513 DOI: https://doi.org/10.4103/0259-1162.165513
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Джухі Пал
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
