1Consultant Anaesthesiologist, DRM Hospital, Mysore, India
2Consultant Anaesthesiologist, DRM Multi Speciality Hospitals, Mysore, India
3Consultant Anaesthesiologist, DRM Multi Speciality Hospital, Mysore, India
4Consultant Anaesthesiologist, Karunakar Nagarajegowda Multi Speciality Hospital, Mysore, India
Background: Carbon dioxide pneumoperitoneum produces predictable sympathetic and neurohumoral activation; this combination with an increased systemic vascular resistance and increased arterial pressure complicates anesthetic management during laparoscopy. α2-agonists reduce central sympathetic outflow and may improve perioperative circulatory stability. There is good evidence for intravenous clonidine but few comparative data against intrathecal clonidine (as a sole neuraxial adjunct under general anesthesia).
Methods: In a prospective randomized comparative trial at Apollo BGS Hospital, Mysore (June 2017–May 2018), 60 ASA I–II adults (35–60 years) scheduled for elective laparoscopic assisted vaginal hysterectomy under general endotracheal anesthesia were randomized to the administration of intravenous clonidine 50 µg in 50 mL normal saline over 10 minutes, 10 minutes ahead of induction (Group IV; n=30), or intrathecal clonidine 50 µg at L3–L4 immediately before induction (Group IT; n=30). Heart rate (HR) and blood pressures were obtained under a blind observer at baseline (T0), post-intubation (T1), pre-pneumoperitoneum (T2), 5/15/30 minutes post pneumoperitoneum (T3/T4/T5), and 5 minutes post CO₂ release (T6). Ramsay Sedation Score (RSS) was administered in PACU for the evaluation of postoperative sedation.
Results: The baseline population and ASA distribution were similar. During pneumoperitoneum, Group IT had significantly reduced HR at T3–T6 (e.g., T4: 79.2±10.2 vs 87.5±10.9 bpm; p=0.004) and lower SBP/DBP/MAP from T2–T6 (all p≤0.011 at crucial intraoperative points). RSS distribution did not differ between groups (p=0.590). Hypertension episodes were fewer in Group IT (1 vs 6), while hypotension was more frequent (4 vs 1); no post-dural puncture headache occurred in Group IT.
Conclusion: In this LAVH cohort, intrathecal clonidine 50 µg resulted in enhanced attenuation of pneumoperitoneum-related tachycardia and pressor responses relative to intravenous clonidine 50 µg, without increasing early postoperative sedation. The trade-off was increased hypotension, demonstrating that a careful dose and readiness for vasopressors are warranted.
Keywords: clonidine; intrathecal; intravenous; pneumoperitoneum; laparoscopy; hemodynamics; hysterectomy; anesthesia.
How to cite this article: Rajath U, Nileena P, Kulkarni S, Yadhunandan S. Intrathecal Versus Intravenous Clonidine (50 µg) for Attenuation of Pneumoperitoneum-Related Hemodynamic Responses During Laparoscopic Assisted Vaginal Hysterectomy: A Prospective Randomized Comparative Study. Int J Drug Deliv Technol. 2026;16(9s): 15-21; DOI: 10.25258/ijddt.16.9s.2
Source of support: None
Conflict of interest: None