The application of paravertebral block in high-risk patient with cardiorespiratory, liver and kidney problems: a case report

Background and Purpose: We present a case report of a patient of the American Society of Anesthesiologists’ (ASA) IV scheduled for a modified radical mastectomy (MRM) due to malignant disease. The patient was a high risk patient for general anesthesia and we opted for the application of unilateral paravertebral block on several levels. Case report. A 86-year-old female was scheduled for a surgery due to recurrent malignant process on her right breast. She was an ASA IV patient with chronic obstructive pulmonary disease (COPD GOLD A), respiratory failure, diabetes mellitus, diabetic nephropathy, cirrhosis and chronic laryngitis. Echocardiography showed diastolic dysfunction and pulmonary hypertension of moderate degree. During the preparation for the surgery, an invasive blood pressure measurement was set while the paravertebral space was identified with the neurostimulator using the linear ultrasound probe of 8 Hertz (Hz). The anesthetic [0.5% Levobupivacaine (Chirocaine®, Abbott Laboratories)] was applied in levels of Thoracic (Th) 2, Th3, Th4 and Th5 (5 milliliters(ml.) per level). We used 2% lidocaine [Lidocaine®, FC] for local infiltration at the site of the block. Results: Sensory blockade occurred after 32 minutes (min.) and lasted for about 8 hours (h) with normal perioperative period and hemodynamic parameters without accompanying complications. Discussion and Conclusion: This case report shows that the application of paravertebral block with lower doses of long-acting local anesthetic at several levels leads to a satisfactory anesthetic and analgesic effect while maintaining hemodynamic stability

The application of paravertebral block in high-risk patient with cardiorespiratory, liver and kidney problems: a case report

Background and Purpose: We present a case report of a patient of the American Society of Anesthesiologists’ (ASA) IV scheduled for a modified radical mastectomy (MRM) due to malignant disease. The patient was a high risk patient for general anesthesia and we opted for the application of unilateral paravertebral block on several levels. Case report. A 86-year-old female was scheduled for a surgery due to recurrent malignant process on her right breast. She was an ASA IV patient with chronic obstructive pulmonary disease (COPD GOLD A), respiratory failure, diabetes mellitus, diabetic nephropathy, cirrhosis and chronic laryngitis. Echocardiography showed diastolic dysfunction and pulmonary hypertension of moderate degree. During the preparation for the surgery, an invasive blood pressure measurement was set while the paravertebral space was identified with the neurostimulator using the linear ultrasound probe of 8 Hertz (Hz). The anesthetic [0.5% Levobupivacaine (Chirocaine®, Abbott Laboratories)] was applied in levels of Thoracic (Th) 2, Th3, Th4 and Th5 (5 milliliters(ml.) per level). We used 2% lidocaine [Lidocaine®, FC] for local infiltration at the site of the block. Results: Sensory blockade occurred after 32 minutes (min.) and lasted for about 8 hours (h) with normal perioperative period and hemodynamic parameters without accompanying complications. Discussion and Conclusion: This case report shows that the application of paravertebral block with lower doses of long-acting local anesthetic at several levels leads to a satisfactory anesthetic and analgesic effect while maintaining hemodynamic stability

Jednodnevna očna kirurgija i antikoagulantna terapija - noviji pristupi

One of the most common surgeries in elderly patients is eye surgery. An increasing number of patients undergoing ambulatory eye surgery are on antithrombotic therapy. These drugs may increase the risk of perioperative bleeding associated with ophthalmic needle blocks and/or eye surgery. Intraoperative bleeding and postoperative hemorrhagic complications may lead to the loss of vision or even eyes. On the other hand, stopping anticoagulants and antiplatelets before the surgery may increase the risk of thrombotic events with potentially life-threatening complications. The aim of this narrative review is to provide a systematic review of the published evidence for the perioperative antithrombotic management of patients undergoing different types of eye surgery in ambulatory settings. A comprehensive review of the English-language medical literature search utilizing PubMed, Ovid Medline® and Google Scholar from January 2015 to December 2018 was performed. The database searches included studies providing evidence relevant to ambulatory eye surgery and perioperative antiplatelet medications and anticoagulants. Updated recommendations will be given for continuation, discontinuation, and modification of antithrombotic agents in order to optimize the management of antithrombotic therapies in outpatients scheduled for eye surgery.U populaciji bolesnika starije dobi očni kirurški zahvati su jedni od najčešćih kirurških zahvata. Sve više bolesnika kojima je potreban kirurški zahvat na očima su starije dobi i većinom su na kroničnoj terapiji lijekovima uključujući antitrombocitne lijekove. Ti lijekovi mogu povećati rizik od perioperacijskog krvarenja prilikom izvođenja regionalnih očnih blokova ili kirurškog zahvata. Krvarenje tijekom operacije oka i hemoragijske komplikacije poslije zahvata mogu dovesti do gubitka vidne funkcije ili čak samog oka. S druge strane, prekidanje uzimanja antitrombocitnih i antikoagulacijskih lijekova prije kirurškog zahvata dovodi do povećanog rizika za nastanak ozbiljnih i za život opasnih tromboembolijskih komplikacija. Cilj ovoga narativnog preglednog članka je sustavni pregled objavljenih dokaza o perioperacijskom antitrombotskom liječenju očnih bolesnika planiranih za različite zahvate u dnevnoj očnoj kirurgiji. Pretražene su baze medicinskih podataka pomoću PubMed, Ovid Medline® i Google Scholar za razdoblje od siječnja 2015. godine do prosinca 2018. godine. Obuhvaćene su studije relevantne za planirane očne operacije u jednodnevnoj kirurgiji i perioperacijsko liječenje antitrombocitnim i antikoagulacijskim lijekovima s naglaskom na sadašnje stavove u pogledu nastavka, prekida ili modifikacije antitrombotske terapije kako bi se pospješila priprema bolesnika za očne zahvate

Lokalni anestetici i steroidi: kontraindikacije i komplikacije - trenutni klinički pregled

The objective of this clinical update, based on recently published literature, was to discuss incidence and characteristics of the most relevant clinical adverse effects associated with local anesthetic and steroid use in regional anesthesia and treatment of acute or chronic pain. A comprehensive review of the English-language medical literature search utilizing PubMed, Ovid Medline® and Google Scholar from 2015 to 2018 was performed. This narrative review provides anesthesia practitioners with updated evidences on complications and contraindications of local anesthetic and steroid use with emphasis on current points of view regarding prevention, early diagnosis and treatment of adverse events.Cilj rada je analizirati učestalost i karakteristike klinički važnijih nusučinaka lokalnih anestetika i kortikosteroida u regionalnoj anesteziji te liječenju akutne i kronične boli temeljem medicinske literature objavljene unatrag pet godina. Pretražene su baze medicinskih podataka na engleskom jeziku pomoću PubMed, Ovid Medline®i Google Scholara za razdoblje od početka 2015. do kraja 2018. godine. Ovaj narativni pregledni članak donosi pregled komplikacija i kontraindikacija za lokalne anestetike i kortikosteroide s naglaskom na sadašnje stavove u pogledu prevencije, rane dijagnoze i liječenja nuspojava

Uloga paravertebralnih blokova u ambulatornoj kirurgiji: pregled literature

Ambulatory surgery often involves surgical procedures on the thorax, abdomen and limbs, which can be associated with substantial postoperative pain. The aim of this narrative review is to provide an analysis of the effectiveness of paravertebral block (PVB) alone or in combination with general anaesthesia, in this setting, with an emphasis on satisfactory postoperative analgesia in comparison to other modalities. We have conducted a search of current medical literature written in English through PubMed, Google Scholar and Ovid Medline®. Peer-reviewed professional articles, review articles, retrospective and prospective studies, case reports and case series were systematically searched for during the time period between November 2003 and February 2019. The literature used for the purpose of creating this review showed that utilisation of paravertebral block either alone or in combination with general anaesthesia, has a positive effect on satisfactory analgesia in ambulatory surgery. With a multimodal analgesic approach of PVB and other techniques of anaesthesia and analgesia there is a reduction in postoperative opioid consumption, fewer side effects, lower pain scores, decreased mortality, earlier mobilisation of patients and reduced hospital stay.Ambulatorna kirurgija uključuje kirurške zahvate na udovima, u području prsnog koša i trbuha koji su često povezani s pojavom jake perioperacijske boli. Cilj ovoga narativnog preglednog članka je preispitati učinkovitost primjene paravertebralnoga bloka (PVB) samostalno ili u kombinaciji s općom anestezijom u postizanju zadovoljavajuće perioperacijske analgezije kod ambulatorne kirurgije naspram drugih analgetskih metoda. Proveli smo istraživanje aktualne medicinske literature napisane na engleskom jeziku kroz PubMed, Google Scholar i Ovid Medline®. Recenzirani stručni članci, pregledni članci, retrospektivne i prospektivne studije, prikazi slučajeva i serije slučajeva sustavno su pretraživani u razdoblju između studenog 2003. i veljače 2019. godine. Istraživanja uključena u naš narrative review prikazala su učinkovitost primjene PVB samostalno ili u kombinaciji s općom anestezijom u postizanju zadovoljavajuće perioperacijske analgezije kod ambulatorne kirurgije. Multimodalnim analgetskim pristupom primjene kombinacije PVB s drugim tehnikama anestezije i analgezije postiže se smanjenje potrošnje opioida, manje nuspojava, niže vrijednosti procjene boli na vizualno analognoj ljestvici, smanjenje mortaliteta, brža mobilizacija bolesnika te skraćenje vremena boravka u bolnici

Giant Spinal Schwannoma in a 76-year-old Woman - A Case Report

A schwannoma is a benign nerve sheath tumor composed of Schwann cells. Spinal schwannoma originates from dorsal roots of the spinal cord, causing symptoms due to the compression of neighboring structures. We present a patient with a low back pain and left L2 and L3 radiculopathy. Neuroimaging techniques (CT, MRI) showed a large expansive mass in the left lumbar paraspinal area. The tumor was removed totally by the posterior approach and was verified to originate from the left L2 spinal nerve root. The histopathological examination revealed typical findings of a schwannoma. The pain was resolved promptly after the surgery, however the patient’s neurological condition wasn\u27t improved. Surgical treatment was a final treatment, and no additonal therapy was necessary

A combination of levobupivacaine and lidocaine for paravertebral block in breast cancer patients undergoing quadrantectomy causes greater hemodynamic oscillations than levobupivacaine alone

Aim To test for differences in hemodynamic and analgesic properties in patients with breast cancer undergoing quadrantectomy with paravertebral block (PVB) induced with a solution of either one or two local anesthetics. Method A prospective, single-center, randomized, double- blinded, controlled trial was conducted from June 2014 until September 2015. A total of 85 women with breast cancer were assigned to receive PVB with either 0.5% levobupivacaine (n = 42) or 0.5% levobupivacaine with 2% lidocaine (n = 43). Hemodynamic variables of interest included intraoperative stroke volume variation (SVV), mean arterial pressure, heart rate, cardiac output, episodes of hypotension, use of crystalloids, and use of inotropes. Analgesic variables of interest were time to block onset, duration of analgesia, and postoperative serial pain assessment using a visual analogue scale. Results Although the use of 0.5% levobupivacaine with 2% lidocaine solution for PVB decreased the mean timeto- block onset (14 minutes; P < 0.001), it also caused significantly higher SVV values over the 60 minutes of monitoring (mean difference: 4.33; P < 0.001). Furthermore, the patients who received 0.5% levobupivacaine with 2% lidocaine experienced shorter mean duration of analgesia (105 minutes; P = 0.006) and more episodes of hypotension (17.5%; P = 0.048) and received more intraoperative crystalloids (mean volume: 550 mL; P < 0.001). Conclusion The use of 0.5% levobupivacaine in comparison with 0.5% levobupivacaine with 2% lidocaine solution for PVB had a longer time-to-block onset, but it also reduced hemodynamic disturbances and prolonged the analgesic effect

THE EFFECT OF LOCAL ANESTHETIC AND CLONIDINE ON THE CUTANEOUS SILENT PERIOD DURING AND AFTER SPINAL ANESTHESIA

Cilj istraživanja: Dosadašnja istraživanja pokazala su korelaciju između oštećenja A delta (Aδ) vlakana i spinotalamičkog puta s jedne strane te trajanja tihog kožnog perioda (TKP) i njegove latencije s druge strane. Klonidin dodan intratekalno levobupivakainu, produžuje osjetni, motorički blok i trajanje analgezije. Navedeni učinak ostvaruje putem A delta (Aδ), C vlakana i gelatinozne tvari u kralježničnoj moždini. S obzirom da klonidin najjači analgetski učinak ostvaruje kod intratekalne primjene, smatra se da je primarno mjesto djelovanja klonidina kralježnična moždina. Cilj ovog istraživanja bio je utvrditi postoji li utjecaj intratekalno dodanog klonidina levobupivakainu kod subarahnoidalnnog bloka (SAB) na trajanje TKP-a i latencije u odnosu na intratekalnu primjenu otopine samog levobupivakaina. Specifični ciljevi ovog istraživanja bili su pokazati postoji li utjecaj intratekalno dodanog klonidina levobupivakainu kod SAB-a na trajanje motoričkog i osjetnog bloka te na trajanje perioperacijske analgezije. Ispitanici i metode: Randomizirana prospektivna monocentrična, dvostruko slijepa studija provodila se od svibnja 2017. do listopada 2017. u Kliničkoj bolnici Dubrava, Zagreb, Hrvatska. U studiju je bilo uključeno 67 bolesnika oba spola, 18-60 godina bez simptoma i znakova poremećaja perifernog i centralnog živčanog sustava, a koji su bili predviđeni za operaciju ingvinalne kile. Bolesnici su randomizirani u dvije skupine s obzirom na primjenu otopine lokalnog anestetika levobupivakaina s dodatkom klonidina nasuprot primjeni otopine levobupivakaina bez klonidina [34 bolesnika u levobupivakain-klonidin skupini (LKS) i 33 bolesnika u levobupivakain skupini (LS)]. TKP i njegova latencija mjereni su četiri puta: prije primjene SAB-a, nakon regresije motoričkog bloka u Bromage 0 za vrijeme još prisutne osjetne blokade, šesti i 24. sat od primjene SAB-a. Rezultati: TKP je bio statistički značajno kraći u LKS nego u LS skupini tijekom 24 sata (P=0.004), a latencija je bila statistički značajno duža u LKS skupini nego u LS skupini tijekom 24 sata (P=0.001). LKS skupina u odnosu na LS skupinu imala je statistički značajno duže trajanje regresije motoričkog bloka (P<0.001), statistički značajno duže trajanje osjetnog bloka na operiranoj strani (P<0.001) te statistički značajno duže trajanje analgezije (P<0.001). U LKS skupini u odnosu na LS skupinu vrijeme primjene prve, odnosno druge analgetske terapije bilo je statistički značano duže (P<0.001). Nije postojala statistički značajna razlika u učestalosti hipotenzije i bradikardije niti je postojala statistički značajna razlika u učestalosti primjene efedrina i atropina između ispitivanih skupina. Zaključak: Intratekalna primijena klonidina kao dodatak levobupivakainu kod SAB-a rezultira značajno kraćim trajanjem TKP-a i značajno dužim trajanjem njegove latencije. Sukladno tome može se zaključiti da tijekom regresije SAB-a, male doze intratekalno primjenjenog klonidina, smanjuju inhibitorni tonus i ubrzavaju provođenje u oligosinaptičkom spinalnom krugu.Objective: Research to date, has revealed a correlation between damage to the A delta (Aδ), fibers, spinothalamic dysfunction and duration of the cutaneous silent period (CSP) and its latency. Clonidine added to levobupivacaine and administered intrathecally prolongs analgesia. It is considered that this effect is mediated via the Aδ, C-fibres and substantia gelatinosa in the spinal medulla. Considering that its analgesic effect is the strongest after intrathecal administration, it is deemed that the primary effect site of the action of clonidine is the spinal medulla. I aimed to establish whether the addition of clonidine to levobupivacaine for subarachnoid block (SAB), would influence the duration and latency of the CSP in comparison to levobupivacaine alone. A specific aims were to determine whether there were differences in duration of the motor, sensory block and duration of analgesia between the two studied groups. Patients and methods: This was a randomized, prospective, single-centre, double blind trial conducted from May 2017 to October 2017 in Clinical Hospital Dubrava, Zagreb, Croatia. A total of 67 male and female patients were included in this trial. They were 18-60 years of age, without neurological disorders and were scheduled for inguinal hernia repair surgery. The patients were randomized into two groups with regard to the intrathecally administered solution, either levobupivacaine with clonidine or levobupivacaine alone [34 patients in the levobupivacaine-clonidine (LC) group and 33 patients in the levobupivacaine (L) group]. CSP and its latency were measured four times: prior to the SAB, after motor block regression to Bromage 0 level of the Bromage scale with sensory blockade still present and 6 and 24 hours after SAB. Results: The CSP was statistically significantly shorter in the LC group during the 24-hour period (P=0.004), while the latency was statistically significantly longer in the LC group during the 24-hour period (P=0.001). The LC group had a significantly longer regression time of the motor block on the operated side, a longer time of sensory regression on the operated side, a longer duration of anagesia after SAB application and longer times of first and second use of nonstereoidal anti-inflammatory drugs (P<0.001). Between groups, there was no statistically significant difference in the incidence of hypotension and bradycardia nor in the administration of ephedrine and atropine. Conclusion: Intrathecal administration of clonidine to levobupivacaine for SAB results in a statistically shorter duration of CSP and a significant prolongation of its latency. Accordingly, I can conclude that during SAB regression, a small dose of intrathecally administered clonidine ameliorates the inhibitory tonus and accelerates the conduction in the oligosynaptic spinal circuit

THE EFFECT OF LOCAL ANESTHETIC AND CLONIDINE ON THE CUTANEOUS SILENT PERIOD DURING AND AFTER SPINAL ANESTHESIA

Cilj istraživanja: Dosadašnja istraživanja pokazala su korelaciju između oštećenja A delta (Aδ) vlakana i spinotalamičkog puta s jedne strane te trajanja tihog kožnog perioda (TKP) i njegove latencije s druge strane. Klonidin dodan intratekalno levobupivakainu, produžuje osjetni, motorički blok i trajanje analgezije. Navedeni učinak ostvaruje putem A delta (Aδ), C vlakana i gelatinozne tvari u kralježničnoj moždini. S obzirom da klonidin najjači analgetski učinak ostvaruje kod intratekalne primjene, smatra se da je primarno mjesto djelovanja klonidina kralježnična moždina. Cilj ovog istraživanja bio je utvrditi postoji li utjecaj intratekalno dodanog klonidina levobupivakainu kod subarahnoidalnnog bloka (SAB) na trajanje TKP-a i latencije u odnosu na intratekalnu primjenu otopine samog levobupivakaina. Specifični ciljevi ovog istraživanja bili su pokazati postoji li utjecaj intratekalno dodanog klonidina levobupivakainu kod SAB-a na trajanje motoričkog i osjetnog bloka te na trajanje perioperacijske analgezije. Ispitanici i metode: Randomizirana prospektivna monocentrična, dvostruko slijepa studija provodila se od svibnja 2017. do listopada 2017. u Kliničkoj bolnici Dubrava, Zagreb, Hrvatska. U studiju je bilo uključeno 67 bolesnika oba spola, 18-60 godina bez simptoma i znakova poremećaja perifernog i centralnog živčanog sustava, a koji su bili predviđeni za operaciju ingvinalne kile. Bolesnici su randomizirani u dvije skupine s obzirom na primjenu otopine lokalnog anestetika levobupivakaina s dodatkom klonidina nasuprot primjeni otopine levobupivakaina bez klonidina [34 bolesnika u levobupivakain-klonidin skupini (LKS) i 33 bolesnika u levobupivakain skupini (LS)]. TKP i njegova latencija mjereni su četiri puta: prije primjene SAB-a, nakon regresije motoričkog bloka u Bromage 0 za vrijeme još prisutne osjetne blokade, šesti i 24. sat od primjene SAB-a. Rezultati: TKP je bio statistički značajno kraći u LKS nego u LS skupini tijekom 24 sata (P=0.004), a latencija je bila statistički značajno duža u LKS skupini nego u LS skupini tijekom 24 sata (P=0.001). LKS skupina u odnosu na LS skupinu imala je statistički značajno duže trajanje regresije motoričkog bloka (P<0.001), statistički značajno duže trajanje osjetnog bloka na operiranoj strani (P<0.001) te statistički značajno duže trajanje analgezije (P<0.001). U LKS skupini u odnosu na LS skupinu vrijeme primjene prve, odnosno druge analgetske terapije bilo je statistički značano duže (P<0.001). Nije postojala statistički značajna razlika u učestalosti hipotenzije i bradikardije niti je postojala statistički značajna razlika u učestalosti primjene efedrina i atropina između ispitivanih skupina. Zaključak: Intratekalna primijena klonidina kao dodatak levobupivakainu kod SAB-a rezultira značajno kraćim trajanjem TKP-a i značajno dužim trajanjem njegove latencije. Sukladno tome može se zaključiti da tijekom regresije SAB-a, male doze intratekalno primjenjenog klonidina, smanjuju inhibitorni tonus i ubrzavaju provođenje u oligosinaptičkom spinalnom krugu.Objective: Research to date, has revealed a correlation between damage to the A delta (Aδ), fibers, spinothalamic dysfunction and duration of the cutaneous silent period (CSP) and its latency. Clonidine added to levobupivacaine and administered intrathecally prolongs analgesia. It is considered that this effect is mediated via the Aδ, C-fibres and substantia gelatinosa in the spinal medulla. Considering that its analgesic effect is the strongest after intrathecal administration, it is deemed that the primary effect site of the action of clonidine is the spinal medulla. I aimed to establish whether the addition of clonidine to levobupivacaine for subarachnoid block (SAB), would influence the duration and latency of the CSP in comparison to levobupivacaine alone. A specific aims were to determine whether there were differences in duration of the motor, sensory block and duration of analgesia between the two studied groups. Patients and methods: This was a randomized, prospective, single-centre, double blind trial conducted from May 2017 to October 2017 in Clinical Hospital Dubrava, Zagreb, Croatia. A total of 67 male and female patients were included in this trial. They were 18-60 years of age, without neurological disorders and were scheduled for inguinal hernia repair surgery. The patients were randomized into two groups with regard to the intrathecally administered solution, either levobupivacaine with clonidine or levobupivacaine alone [34 patients in the levobupivacaine-clonidine (LC) group and 33 patients in the levobupivacaine (L) group]. CSP and its latency were measured four times: prior to the SAB, after motor block regression to Bromage 0 level of the Bromage scale with sensory blockade still present and 6 and 24 hours after SAB. Results: The CSP was statistically significantly shorter in the LC group during the 24-hour period (P=0.004), while the latency was statistically significantly longer in the LC group during the 24-hour period (P=0.001). The LC group had a significantly longer regression time of the motor block on the operated side, a longer time of sensory regression on the operated side, a longer duration of anagesia after SAB application and longer times of first and second use of nonstereoidal anti-inflammatory drugs (P<0.001). Between groups, there was no statistically significant difference in the incidence of hypotension and bradycardia nor in the administration of ephedrine and atropine. Conclusion: Intrathecal administration of clonidine to levobupivacaine for SAB results in a statistically shorter duration of CSP and a significant prolongation of its latency. Accordingly, I can conclude that during SAB regression, a small dose of intrathecally administered clonidine ameliorates the inhibitory tonus and accelerates the conduction in the oligosynaptic spinal circuit

THE EFFECT OF LOCAL ANESTHETIC AND CLONIDINE ON THE CUTANEOUS SILENT PERIOD DURING AND AFTER SPINAL ANESTHESIA

Cilj istraživanja: Dosadašnja istraživanja pokazala su korelaciju između oštećenja A delta (Aδ) vlakana i spinotalamičkog puta s jedne strane te trajanja tihog kožnog perioda (TKP) i njegove latencije s druge strane. Klonidin dodan intratekalno levobupivakainu, produžuje osjetni, motorički blok i trajanje analgezije. Navedeni učinak ostvaruje putem A delta (Aδ), C vlakana i gelatinozne tvari u kralježničnoj moždini. S obzirom da klonidin najjači analgetski učinak ostvaruje kod intratekalne primjene, smatra se da je primarno mjesto djelovanja klonidina kralježnična moždina. Cilj ovog istraživanja bio je utvrditi postoji li utjecaj intratekalno dodanog klonidina levobupivakainu kod subarahnoidalnnog bloka (SAB) na trajanje TKP-a i latencije u odnosu na intratekalnu primjenu otopine samog levobupivakaina. Specifični ciljevi ovog istraživanja bili su pokazati postoji li utjecaj intratekalno dodanog klonidina levobupivakainu kod SAB-a na trajanje motoričkog i osjetnog bloka te na trajanje perioperacijske analgezije. Ispitanici i metode: Randomizirana prospektivna monocentrična, dvostruko slijepa studija provodila se od svibnja 2017. do listopada 2017. u Kliničkoj bolnici Dubrava, Zagreb, Hrvatska. U studiju je bilo uključeno 67 bolesnika oba spola, 18-60 godina bez simptoma i znakova poremećaja perifernog i centralnog živčanog sustava, a koji su bili predviđeni za operaciju ingvinalne kile. Bolesnici su randomizirani u dvije skupine s obzirom na primjenu otopine lokalnog anestetika levobupivakaina s dodatkom klonidina nasuprot primjeni otopine levobupivakaina bez klonidina [34 bolesnika u levobupivakain-klonidin skupini (LKS) i 33 bolesnika u levobupivakain skupini (LS)]. TKP i njegova latencija mjereni su četiri puta: prije primjene SAB-a, nakon regresije motoričkog bloka u Bromage 0 za vrijeme još prisutne osjetne blokade, šesti i 24. sat od primjene SAB-a. Rezultati: TKP je bio statistički značajno kraći u LKS nego u LS skupini tijekom 24 sata (P=0.004), a latencija je bila statistički značajno duža u LKS skupini nego u LS skupini tijekom 24 sata (P=0.001). LKS skupina u odnosu na LS skupinu imala je statistički značajno duže trajanje regresije motoričkog bloka (P<0.001), statistički značajno duže trajanje osjetnog bloka na operiranoj strani (P<0.001) te statistički značajno duže trajanje analgezije (P<0.001). U LKS skupini u odnosu na LS skupinu vrijeme primjene prve, odnosno druge analgetske terapije bilo je statistički značano duže (P<0.001). Nije postojala statistički značajna razlika u učestalosti hipotenzije i bradikardije niti je postojala statistički značajna razlika u učestalosti primjene efedrina i atropina između ispitivanih skupina. Zaključak: Intratekalna primijena klonidina kao dodatak levobupivakainu kod SAB-a rezultira značajno kraćim trajanjem TKP-a i značajno dužim trajanjem njegove latencije. Sukladno tome može se zaključiti da tijekom regresije SAB-a, male doze intratekalno primjenjenog klonidina, smanjuju inhibitorni tonus i ubrzavaju provođenje u oligosinaptičkom spinalnom krugu.Objective: Research to date, has revealed a correlation between damage to the A delta (Aδ), fibers, spinothalamic dysfunction and duration of the cutaneous silent period (CSP) and its latency. Clonidine added to levobupivacaine and administered intrathecally prolongs analgesia. It is considered that this effect is mediated via the Aδ, C-fibres and substantia gelatinosa in the spinal medulla. Considering that its analgesic effect is the strongest after intrathecal administration, it is deemed that the primary effect site of the action of clonidine is the spinal medulla. I aimed to establish whether the addition of clonidine to levobupivacaine for subarachnoid block (SAB), would influence the duration and latency of the CSP in comparison to levobupivacaine alone. A specific aims were to determine whether there were differences in duration of the motor, sensory block and duration of analgesia between the two studied groups. Patients and methods: This was a randomized, prospective, single-centre, double blind trial conducted from May 2017 to October 2017 in Clinical Hospital Dubrava, Zagreb, Croatia. A total of 67 male and female patients were included in this trial. They were 18-60 years of age, without neurological disorders and were scheduled for inguinal hernia repair surgery. The patients were randomized into two groups with regard to the intrathecally administered solution, either levobupivacaine with clonidine or levobupivacaine alone [34 patients in the levobupivacaine-clonidine (LC) group and 33 patients in the levobupivacaine (L) group]. CSP and its latency were measured four times: prior to the SAB, after motor block regression to Bromage 0 level of the Bromage scale with sensory blockade still present and 6 and 24 hours after SAB. Results: The CSP was statistically significantly shorter in the LC group during the 24-hour period (P=0.004), while the latency was statistically significantly longer in the LC group during the 24-hour period (P=0.001). The LC group had a significantly longer regression time of the motor block on the operated side, a longer time of sensory regression on the operated side, a longer duration of anagesia after SAB application and longer times of first and second use of nonstereoidal anti-inflammatory drugs (P<0.001). Between groups, there was no statistically significant difference in the incidence of hypotension and bradycardia nor in the administration of ephedrine and atropine. Conclusion: Intrathecal administration of clonidine to levobupivacaine for SAB results in a statistically shorter duration of CSP and a significant prolongation of its latency. Accordingly, I can conclude that during SAB regression, a small dose of intrathecally administered clonidine ameliorates the inhibitory tonus and accelerates the conduction in the oligosynaptic spinal circuit