iarjaccIARJACCIARJACC2709-1880https://doi.org/10.47310/iarjacc.2021.v02i02.015The Analgesic Efficacy of Clonidine as an Adjuvant to Ropivacaine in Bilateral Transversus Abdominis Plane Block in Patients Undergoing Caesarean Section under Spinal Anesthesia: A Randomized, Double Blind, Control TrialRenuWakhlooHeenaGuptaDaminiWakhlooBackground: Transversus Abdominis Plane block (TAPB) is becoming a popular regional analgesic technique for postoperative pain relief in lower abdominal surgeries. Various adjuvants can be added to local anesthetics to prolong and improve their block characteristics. Material and Methods: The present randomized, double blind trial was carried out in 60 parturients of American Society of Anesthesiologists’ physical status (ASA) class Ⅰ and Ⅱ scheduled to undergo elective lower segment cesarean section (LSCS) under spinal anesthesia. After randomization, the subjects were allocated into two groups. Group R (n = 30) underwent TAPB with 39 ml of 0.375% ropivacaine and 1 ml normal saline (20 ml each side). Group C received TAPB with 39 ml of 0.375% ropivacaine and 1 ml of clonidine (50 µg) to receive 20 ml of drug solution each side. At the end of the surgery (skin closure), bilateral TAPB was performed in the lumbar triangle of Petit (ultrasound guided) using 18 G Tuohy needle (80 mm Smiths Medical Portex) at the level of anterior axillary line between 12th rib and iliac crest. All the subjects were assessed at 0, 2, 4, 8, 12, 16, 20, and 24 hours postoperatively for duration of postoperative analgesia (time to request for first analgesia), severity of pain using Visual Analog Scale score (VAS), number of doses of tramadol consumed in the first 24 hours after the block; pain, nausea, patient satisfaction scores, and possible clonidine side effects (dryness of the mouth, sedation, hypotension, and bradycardia). Results: Both the groups were similar in age, Body Mass Index (BMI) and duration of surgery. The time to request for first rescue analgesia was significantly longer in Group C (18.89±0.64 hours) as compared to Group R (6.16±0.51 hours) (p<0.001). In comparison to Group C, the total amount of rescue analgesia used was significantly more in Group R. Mean VAS score was significantly lower and patient satisfaction score higher in Group C (p<0.001). Nausea, bradycardia was not seen in any of the patients. Sedation and dry mouth was seen in a few patients in both the groups but it was statistically insignificant. No TAPB related complications were seen in either of the two groups. Conclusion: The addition of clonidine 25 μg to 20 ml ropivacaine 0.375% in TAPB bilaterally for cesarean section provides 17–18 hours of postoperative analgesia, decreases postoperative analgesic requirement, and increases maternal satisfaction compared to TAPB administration with 20 ml of ropivacaine 0.375% alone.