The Effect of Clonidine on Hemodynamics, Recovery and Post-Operative Pain in Laparoscopic Gynaecological Surgeries: A Comparative Study Involving Two Routes of Administration

Background: Laparoscopy requires creation of a pneumoperitoneum which produces a significant rise in heart rate, mean arterial pressure, reduction in venous return and systemic vascular resistance. Various pharmacologic agents are used to control hemodynamic changes associated with pneumoperitoneum. Aim: To compare the effects of Clonidine administered intravenously (group IV) and intraperitoneally (group IP) on hemodynamics,recovery and post-operative pain in patients undergoing elective laparoscopic gynaecological surgeries. Study design: Randomized controlled trial. Methodology: Sixty patients undergoing elective laparoscopic gynaecological surgeries were selected. General anaesthesia was administrered in all cases.After inserting ports Group IV: received Clonidine 1μg/kg i.v along with Ropivacaine 0.25% 20cc intraperitoneally using a ryles tube introduced and directed towards hepatophrenic recess Group IP: received Clonidine 1μg/kg along with Ropivacaine 0.25% 20cc.intraperitoneally Vitals weremonitored every 30min during the procedure. Postoperatively oxygen saturation,heart rate, and blood pressure weremonitored.Aldrete recovery scoring system was used to assessreadiness for discharge. When the score was>8, and pain was monitored using VAS scoring in lying and sitting posture next 12hours. Statistical Analysis: Continous data was analysed using student t-test while categorical data was analysed using fisher’s exact test and chi square test. Results:Intravenous Clonidine significantly reduced the MAP (group IP: 80.5±6.7,group IV: 67.44±5.6) during intraoperative period while intraperitoneal group showed reduced MAP in postoperative period (group IP: 75.98±7.35, group IV: 83.36±17.05). Heart rate both during intraoperativeperiod (group IP: 63.2±6.35, group IV: 77.6±9.35) and postoperative period (group IP: 75.6±7.35, group IV: 83.36±17.05) showed significant decrease in intraperitoeal group. Intraperitoneal Clonidine showed better hemodynamic control by maintaining heart rate and MAP postoperatively and better recovery profile in the form of VAS Scoring(2.0±0.618 p value <0.05) and time to request first rescue analgesia(6.567±0.9 p value <0.05). Conclusion: Clonidine when added to ropivacaine (0.25%) intraperitoneally provide better hemodynamic control and prolonged analgesia with less side effects than intravenous clonidine.