Effective management of postoperative pain plays a critical role in patient recovery following lower limb surgeries. Bupivacaine is a widely used local anaesthetic for epidural anaesthesia, and the addition of adjuvants such as clonidine and fentanyl may enhance its analgesic profile. This study was conducted to compare the efficacy of clonidine and fentanyl as adjuvants to epidural bupivacaine in terms of onset, duration of analgesia, haemodynamic stability, sedation, and side effects. METHODS This randomized comparative clinical study was conducted on 60 ASA I and II patients aged 18–60 years scheduled for elective lower limb surgeries under epidural anaesthesia. Patients were randomly allocated into two groups (n=30 each): Group BC received 16 ml of 0.5% bupivacaine with clonidine (1 μg/kg). Group BF received 16 ml of 0.5% bupivacaine with fentanyl (0.5 μg/kg). Parameters observed included onset and duration of sensory and motor block, time to two-segment regression, sedation score, and time to first rescue analgesia. RESULTS Group BF showed significantly faster onset of sensory (6.3 ± 0.79 min) and motor block (16.9 ± 1.32 min) compared to Group BC (11.5 ± 0.82 min and 24.2 ± 1.1 min, respectively; p < 0.001). However, Group BC demonstrated significantly longer duration of sensory block (307.8 ± 0.47 min vs. 147 ± 0.34 min), motor block (292.8 ± 0.42 min vs. 133.8 ± 0.35 min), and time to rescue analgesia (307.8 ± 0.47 min vs. 207.6 ± 0.34 min) (p < 0.001 for all). Sedation scores were comparable between groups (p = 1.000). CONCLUSION While fentanyl as an adjuvant to epidural bupivacaine provides a faster onset of anaesthesia, clonidine offers a more prolonged sensory and motor block along with longer postoperative analgesia. Both drugs demonstrated favourable safety and sedation profiles, making them viable options for enhancing epidural anaesthesia in lower limb surgeries.

Clonidine, Fentanyl, Epidural Anaesthesia, Bupivacaine, Lower Limb Surgery, Postoperative Analgesia, Randomised Study.