Total knee replacement: a randomized study of clonidine and dexmedetomidine used for epidural postoperative analgesia


  • Satya Prasanna Nayak Department of Orthopaedics, MKCG Medical College, Berhampur, Odisha, India
  • Rabinarayan Dhar Department of Orthopaedics, VIMSAR, Burla, Odisha, India
  • Debaprasad Mohanty Department of Orthopaedics, MKCG Medical College, Berhampur, Odisha, India



Clonidine, Dexmedetomidine, Levobupivacaine, Total knee replacement


Background: Epidural anaesthesia with adjuvant is the preferred method for intra and postoperative pain relief after total knee replacement surgeries   but search for ideal adjuvant for prolonging the duration of postoperative analgesia without any side effect goes on. This study was conducted to evaluate the onset, extent and duration of sensory and motor block and side effects of clonidine or dexmedetomidine when used as an adjuvant in epidural anaesthesia in total knee replacement.

Methods: 60 patients of ASA status I and II, posted for total knee replacement were randomly allocated into two groups of 30 each. Group I group patients received 18 ml of 0.5% levobupivacaine and clonidine 2 mcg/kg in epidural route and Group II group patients received 18 ml of 0.5% levobupivacaine and dexmedetomidine 1.5 mcg/kg in epidural route. Intraoperative and postoperative block characteristics as well as hemodynamic parameters were observed and recorded.

Results: Dexmedetomidine had an earlier onset and longer duration of sensory and motor block in comparison to clonidine. Sedation scores were statistically significant with dexmedetomidine group in comparison to clonidine group.

Conclusions: Dexmedetomidine was a better than clonidine as an adjuvant to levobupivacaine in epidural anaesthesia in total knee replacement.


Tziavrangos E, Schug SA. Regional anaesthesia and perioperative outcome. Curr Opinion Anaesthesiol. 2006;19:521-5.

Becker DE, Reed KL. Local anesthetics: review of pharmacological considerations. Anesth Prog. 2012;59:90-101.

Ulke ZS, Senturk M. Non-analgesic effects of thoracic epidural anesthesia. Agriculture. 2007;19:6-12.

Huang Y, Pryor M. Mather L, Veering B. Cardiovascular and central nervous system effects of intravenous levobupivacaine and bupivacine in sheep. Anesth Analg. 1998;86:797-804.

Bardsley H, Gristwood R. Baker H, Watson N, Nimmo W. A comparision of the cardiovascular effects of levobupivacaine and rac-bupivacaine following intravenous administration to healthy volunteers. Brint J Clin Pharmacol. 1998;46:245-9.

Kamibayashi T, Maze M. Clinical uses of alpha-2 adrenergic agonists. Anaesthesiology. 2000;93:1345-9.

Scafati A. Analgesia and alpha agonists 2. Medens Rev. 2004;4:7.

Mauro VA, Brandao ST. Clonidine and dexmedetomidine through epidural route for postoperative analgesia and sedation in a cholecystectomy. Rev bras Anesthesiol. 2004;4:1-10.

Kanazi GE, Aouad MT, Jabbour Khoury SL, Al Jazzar MD, Alameddine MM, Al-Yaman R, et al. Effect of low dose dexmedetomidine or clonidine on the characteristics of bupivacaine spinal block. Acta Anesthesiol scand. 2006;50:222-7.

Disma N, Frawley G, Mameli L. Effect of epidural clonidine on minimum local anesthetic concentration (ED50) of levobupivacaine for caudal block in children. Paediat Anaesth. 2011;21(2):128-35.

Wallet F, Clement JH, Bouret C. Effectts of a continuous low-dose clonidine epidural regimen on pain, satisfaction and adverse events during labour: a randomized, double-blind, placebo-controlled trial. Eur J Anaesthesiol. 2010;27(5):441-7.

Milligan KR, Convery PN, Weir P. The efficacy and safety of epidural infusions of levobupivacaine with and without clonidine for postoperative pain relief in patients undergoing total hip replacement. Anesth Analg. 2000;91(2):393-7.

Akin A, Ocalan S, Esmaglu A. The effects of caudal or intravenous clonidine on postoperative analgesia produced by caudal levobupivacaine in children. Pediatric anesthesia. 2010;20:350-5.

Mahran E, Ibrahim W. Is the combination of epidural clonidine- levobupivacaine has same analgesic efficacy and safety as the combination Fentanyl – levobupivacaine after radical cystectomy. Egyptian J Anaesth. 2014;30(2):143-7.

Kamal MM, Talaat SM. Comparative study of epidural morphine and epidural dexmedetomidine used as adjuvant to levobupivacaine in major abdominal surgery. Egyptian J Anaesth. 2014;30(2):137-41.

Zeng XZ, Xu YM, CuiXG. Low-dose epidural dexmedetomidine improves thoracic epidural anaesthesia for nephrectomy. Anaesth Int Care. 2014;42(2):185-90.

Basuni AS, Ezz HAA. Dexmedetomidine as supplement to low-dose levobupivacaine in spinal anaesthesia for knee arthroscopy. Egyptian J Anaesth. 2014;30(2):149-53.

Esmaoglul A, Turk S, Bayram A, Akin A. The effects of Dexmedetomidine Added to Spinal Levobupivacaine for Transurethral Endoscopic Surgery. Balkan Med J. 2013;30:186-90.

E-Hennawy M, Abd-Elwahab AM, Abd-Elmaksoud AM. Addition of clonidine or dexmedetomidine to bupivacaine prolongs caudal analgesia in children. Br J Anaesth. 2009;103(2):268-74.

Al-Mustafa MM, Abu-Halaweh SA, Aloweida AS, Murshidi MM, Ammari BA, Awwad ZM, et al. Effect of dexmedetomidine added to spinal bupivacaine for urological procedures. Saudi Med J. 2009;30:365-70.

Bajwa SJS. Bajwa SK, Kaur J, Singh G, Arora V, Gupta S, et al. Dexmedetomidine and clonidine in epidural anaesthesia: a comparative evaluation. Indian J Anaesth. 2011:55(2):116-21.

Wu HH, Wang HT, Jin JJ, Cui GB, Zhou KC, Chen Y, et al. Does Dexmedetomidine as a Neuraxial Adjuvant Facilitate Better Anesthesia and Analgesia? A Systematic Review and Meta-Analysis. PLoS ONE. 2014;9(3):93114.

Crews JC, Hord AH, Denson DD, Schatzman C. Comparison of the analgesic efficacy of 0.25% levobupivacaine combined with 0.005% morphine, 0.25% levobupivacaine alone, or 0.005% morphine, alone for the management of postoperative pain in patients undergoing major abdominal surgery. Anesth Analg. 1999;89:150-9.






Original Research Articles