A COMPARATIVE STUDY OF INTRATHECAL DEXMEDETOMIDINE VERSUS CLONIDINE AS ADJUVANT TO 0.75% HYPERBARIC ROPIVACAINE IN INFRA UMBILICAL SURGERIES :A RANDOMISED CLINICAL TRIAL

70 patients will be randomly grouped by computer generated numbers and assigned to one of the two groups:

Group RD (n=35) will receive 0 .75% hyperbaric Ropivacaine 3 ml + Dexmedetomidine 5 mcg

Group RC (n=35) will receive 0 .75% hyperbaric Ropivacaine 3 ml + Clonidine 50 mcg intrathecally.

Data will be collected in the case record proforma meeting the objectives of the study. Pre anaesthetic evaluation will be done for each patient and written informed consent will be taken. All patients will be fasted 8 hours for solid food and 4 hours for clear fluids. Intravenous line will be obtained with 18-gauge cannula and will be preloaded with Ringer lactate at 15 ml/kg body weight about 20 minutes before anaesthesia. Patients will be monitored with pulse oximetry( spO2), electrocardiography (ECG), non- invasive blood pressure (NIBP).Under aseptic precautions lumbar puncture will be performed at the level of L3- L4 intervertebral space through a midline approach using 25 G Quincke’s spinal needle and study drug will be injected after confirmation of needle tip in the subarachnoid space by clear and free flow of cerebrospinal fluid.

Patients will be randomly divided into 2 groups by computer generated random sequence table (www.randomization.com)namely Group RD and Group RC in a sealed envelope with labelled syringe. Drug will be given by anaesthetist not involved in study.Intrathecal injection will be given over approximately 10-15seconds. Patients wil be made to lie in supine position immediately. All the things will be kept ready for general anesthesia if needed. Table will be kept in neutral position. All the patients wil be given oxygen by Hudson mask at 6 Litres/minute. The time of intrathecal injection will be noted and taken as 0 minute.

Patients will be monitored with ECG ,NIBP ,SPO2 and respiratory rate at regular intervals of every 5 minutes and continued in the post-operative period.When Visual Analogue Scale(VAS)of >4 or when patient desires rescue analgesic (Paracetamol)will be given

Sensory blockade will be tested using pin prick method with a blunt 27 Gauge hypodermic needle along midclavicular line bilaterally every 30 seconds till the loss of sensation at T10 dermatomal level and thereafter at 2 mins intervals till the maximum level of sensory blockade is achieved and subsequently at 30 mins interval until complete recovery.

Motor block will be assessed by using a Modified Bromage Scale every 1 minute for the first 5 min, then at 5-min intervals for next 30 minutes and at every 30 minutes intervals until complete resolution of motor  block.Parameters assessed will be BP, HR, SpO2, RR , onset ,duration and maximum level of sensory and motor block , duration of analgesia and sedation, rescue analgesic requirement. All these parameters will beonitered both intra  and postoperative period