A PROSPECTIVE, RANDOMIZED CONTROLLED STUDY OF INTRAVENOUS DEXMEDETOMIDINE ON 0.5% HYPERBARIC BUPIVACAINE USED IN SPINAL ANAESTHESIA
Abstract
Background and aims: Local anesthetics along with adjuvants like epinephrine, phenylephrine, adenosine, magnesium sulfate, sodium bicarbonate, neostigmine and alpha-2 agonists like clonidine, dexmedetomidine have been used intrathecally to prolong the duration of spinal anesthesia. Clonidine and dexmedetomidine, used intravenously are also known to prolong the duration of the spinal anesthesia.We proposed this study to evaluate the effect of intravenous dexmedetomidine on 0.5% bupivacaine spinal anesthesia.
Methods: In this prospective, double-blind, randomized controlled clinical trial, 60 patients aged 18 to 60 years, ASA grade 1 or 2 posted for planned elective surgery for more than two hours duration under spinal anesthesia.
study design: The patients were randomly allocated into 2 groups, after giving spinal anesthesia with 0.5% bupivacaine. Group D received a loading dose of 1 ug/kg Dexmedetomidine and Group C received an equivalent quantity of normal saline. The duration of sensory and motor blockade, hemodynamic parameters, postoperative analgesia, time of rescue analgesia, sedation scores and side effects were studied.
Results: The duration of sensory and motor block was significantly prolonged in dexmedetomidine group as compared to control group (p<0.001) Haemodynamic parameters like pulse rate, blood pressure was significantly lower in dexmedetomidine group. Mean time for first request of rescue analgesic in postoperative period was significantly longer in D group (5.43 hrs) as compared to C group (2.43 hrs) (p <0.001) Sedation scores were significantly higher in dexmedetomidine group [4.3+0.47] as compared to control group [2+0.0] (p<0.001) Side effects like shivering, nausea, and vomiting were less in D group
Conclusion: Intravenous dexmedetomidine significantly prolongs the duration of sensory and motor block of bupivacaine spinal anaesthesia, provides excellent sedation and good postoperative analgesia
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References
2. Al-Mustafa MM, Badran IZ, Abu-Ali HM, Al-Barazangi BA, Massad IM, AlGhanem SM. Intravenous dexmedetomidine prolongs bupivacaine spinal analgesia. Middle East J Anaesthesiol. 2009 Jun;20(2):225-31
3. Whizar-Lugo V,Gomez-Ramirez IA, Cisneros-Corral R, Martinez-Gallegos N. Intravenous dexmedetomidine vs. intravenous clonidine to prolong bupivacaine spinal anesthesia. A doubleblind study. Anestesia en Mexico 2007;19:143-146
4. Elcicek K, Tekin M, Kati I. The effects of intravenous dexmedetomidine on spinal hyperbaric ropivacaine anesthesia. J Anesth. 2010 Aug;24(4):544-8
5. Tekin M, Kati I, Tomak Y, Kisli E. Effect of Dexmedetomidine IV on the Duration of Spinal Anesthesia with Prilocaine: A Double-Blind, Prospective Study in Adult Surgical Patients.CurrTher Res Clin Exp. 2007 Sep;68(5):313-24. doi: 10.1016/j.curtheres.2007.10.006
6. Yazbek-Karam VG, Aouad MA. Perioperative uses of dexmedetomidine. M.E.J.Anesth 2006;18:1043-1058
7. Rhee K, Kang K, Kim J, Jeon Y: Intravenous clonidine prolongs bupivacaine spinal anesthesia. Acta Anaesthesiol Scand; 2003 Sep, 47(8):1001-5
8. Robert K. Stoelting, Simon C. Hillier. Pharmacology and Physiology in Anaesthetic Practice. Antihypertensive drugs; 4th edition USA, Lippincott Williams and wilkins; 2006:344-45
9. Kaya FN, Yavascaoglu B, Turker G, Yildirim A, Gurbet A, Mogol EB, Ozcan B. Intravenous dexmedetomidine, but not midazolam, prolongs bupivacaine spinal anesthesia. Can J Anaesth. 2010 Jan;57(1):39-45
10. Hong JY, Kim WO, Yoon Y, Choi Y, Kim SH, Kil HK. Effects of intravenous dexmedetomidine on low-dose bupivacaine spinal anesthesia in elderly patients. Acta Anaesthesiol Scand. 2012 Mar;56(3):382-7
11. Aantaa R, Jaakola ML, Kallio A, Kanto J, Scheinin M, Vuorinen J. A comparison of dexmedetomidine, and alpha 2-adrenoceptor agonist, and midazolam as i.m. premedication for minor gynecological surgery. Br J Anaesth. 1991 Oct;67(4):402-9
12. Virkkilä M, Ali-Melkkilä T, Kanto J, Turunen J, Scheinin H. Dexmedetomidine as intramuscular premedication for day case cataract surgery. A comparative study of dexmedetomidine, midazolam and placebo. Anaesthesia. 1994 Oct; 49(10):853-8
13. Venn RM, Hell J, Grounds RM. Respiratory effects of dexmedetomidine in the surgical patient requiring intensive care. Crit Care. 2000;4(5):302-8
14. Chilkunda N. Dinesh, N.A. Sai Tej, Bevinaguddaiah Yatish, Vinayak S. Pujari, R.M. Mohan Kumar, and Chadalawada V.R. Mohan Effects of intravenous dexmedetomidine on hyperbaric bupivacaine spinal anesthesia: A randomized study . Saudi J Anaesth. 2014 Apr- Jun; 8(2): 201-8
15. Arcangeli A, D'Alò C, Gaspari R. Dexmedetomidine use in general anaesthesia. Curr Drug Targets. 2009 Aug; 10(8):687-95
16. Anil Thomas, M. V. S. Satyaprakash, Lenin Babu Elakkumanan, Prasanna Udupi Bidkar, and Sandeep Kumar Mishra. Comparison of different regimens of intravenous dexmedetomidine on the duration of the subarachnoid block. J Anaesthesiol clin Pharmacol. 2016 Oct- Dec; 32(4): 497-500
17. SS Harsoor, D Devika Rani, Bhavana Yalamuru, K Sudheesh, and SS Nethra. Effect of supplementation of low dose intravenous dexmedetomidine on characteristics of spinal anesthesia with hyperbaric bupivacaine. Indian J Anaes. 2013 May; 57(3): 265-9
18. Talke P, Li J, Jain U, Leung J, Drasner K, Hollenberg M, Mangano DT. Effects of perioperative dexmedetomidine infusion in patients undergoing vascular surgery. The Study of Perioperative Ischemia Research Group. Anesthesiology. 1995 Mar;82(3):620-33
19. Talke P, Tayefeh F, Sessler DI, et al. Dexmedetomidine does not alter the sweating threshold, but comparably and linearly decreases the vasoconstriction and shivering thresholds. Anaesthesiology 1997; 87: 835-841
