Abstract

Balanced Anesthesia Using Intravenous Clonidine Injection in Breast Conservation Surgery: A Prospective Randomized Control Trial

Author(s):Nayana Kulkarni, Ravindra Tandale, Shital Patil, Sirshendu Roy, Aditya Adhav, Raj Nagarkar, Roshankumar Patil, Nishtha Paleja and Yasam Venkata Ramesh

Background: Intra-operative strategies can significantly influence long-term cancer outcomes. Breast cancer surgeries are highly associated with unavoidable pain. Clonidine, an alpha agonist hypotensive agent was highly recommended as an adjuvant with general anesthesia for its analgesic, sedative, anxiolytic, and sympatholytic effects. This study evaluated all its outcomes as an adjuvant in patients undergoing breast conservation surgery.

Methods: A prospective, randomized, double blinded interventional trial. Eighty patients of the American Society of Anesthesiologists (ASA) I–III, with ECOG of <0-2 scheduled for breast conservation surgery were randomly divided into Clonidine arm (n=40, clonidine as an adjuvant followed by balanced general anaesthesia) and Placebo arm (n=40, balanced general anaesthesia alone).

Results: The HR and MAP of the patients from clonidine arm and placebo arm post-induction was observed to be 83 bpm, 8 1 mmHg and 91 bpm, 90 mmHg, respectively. The sedation score was well maintained in the clonidine arm. Consumption of additional analgesic (fentanyl, n=34) and β-blocker (labetalol, n=35) was evidently high in the placebo arm. Post-operative pain score was well maintained in clonidine arm even after 6 h. The common noticeable side effects in the placebo arm were found to be Post-Operative Nausea and Vomiting (PONV, n=11). Patients from the clonidine arm were found to have better QOR over the placebo arm.

Conclusion: Clonidine as an adjuvant provided better intra and postoperative analgesia. It was also found to be effective in achieving controlled hypotension while improving the surgical field in patients undergoing breast cancer surgery without any appreciable side effects.

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