Details
Category: Volume 06 Issue 02 February 2018
Hits: 1116

Title: Determination of Optimal Dose of Intrathecal Dexmedetomidine

Authors: Dr Rajesh Raman, Dr Rati Prabha, Prof. G P Singh, Prof. Dinesh Kaushal, Dr Shefali Gautam, Prof. Mohammad Parvez Khan

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i2.179

Abstract

Role of dexmedetomidine as adjuvant to intrathecal local anaesthetics is being increasingly described in the literature. This prospective, double blind, randomised study evaluated various doses of dexmedetomidine with an aim to find out the dose of dexmedetomidine. Patients undergoing elective vaginal hysterectomy were randomly divided into 5 groups of 16 patients each. Group 1 (control) received 3 ml of 0.75% isobaric ropivacaine. Group 2, 3, 4 and 5 received additional 3, 5, 10 and 15 µg dexmedetomidine respectively. Compared to control, onset of sensory block was quickened in all in groups except in group 2, while onset of motor block was quickened in all groups except groups 2 and 3. Sensory 2 segment regression, regression of sensory block to S2, time to regression of motor block to modified Bromage score 0 and time to 1st analgesic request was prolonged in all the test groups. Maximum Visual analogue score and total postoperative analgesic requirement was lower in all test groups when compared to control. No difference was observed between group 4 and 5 when they were compared in terms of onset or duration of sensory and motor block or post-operative analgesia. However, group 5 had higher incidence of hypotension and bradycardia and required higher dose of ephedrine and atropine than other groups. Dexmedetomidine in a dose of 10 µg is preferable to other doses in terms of balance between potentiation of subarachnoid block and development of undesirable effects.

Keywords: dexmedetomidine, spinal anesthesia, dose, anesthesia.

References

  1. Wiles MD, Nathanson MH. Local anaesthetics and adjuvants – future developments. Anaesthesia 2010;65:22–37.
  2. Christiansson L. Update on adjuvants in regional anaesthesia. Period boil 2009;111:161-70.
  3. Albrecht E, Kirkham KR, Liu SS, Brull R. The analgesic efficacy and safety of neuraxial magnesium sulphate: a quantitative review. Anaesthesia 2013;68:190–202.
  4. Shukla D, Verma A, Agarwal A, Pandey HD, Tyagi C. Comparative study of intrathecal dexmedetomidine with intrathecal magnesium sulphate used as adjuvants to bupivacaine. J Anaesthesiol Clin Pharmacol 2011;27:495–9.
  5. Kanazi GE, Aouad MT, Jabbour-Khoury SI, Al Jazzar MD, Alameddine MM, Al-Yaman R, et al. Effect of low-dose dexmedetomidine or clonidine on the characteristics of bupivacaine spinal block. ActaAnaesthesiolScand 2006;50:222-7.
  6. Grewal A. Dexmedetomidine: New avenues. J Anaesthesiol Clin Pharmacol 2011;27:297–302.
  7. Gupta R, Verma R, Bogra J, Kohli M, Raman R, Kushwaha JK. A Comparative study of intrathecal dexmedetomidine and fentanyl as adjuvants to Bupivacaine. J Anaesthesiol Clin Pharmacol 2011;27:339-43.
  8. Gupta R, Bogra J, Verma R, Kohli M, Kushwaha JK, Kumar S. Dexmedetomidine as an intrathecal adjuvant for postoperative analgesia. Indian J Anaesth 2011;55:347-51.
  9. Hala EA, Eid MD, Mohamed A, Shafie MD, Hend Youssef MD. Dose-related prolongation of hyperbaric bupivacaine spinal anesthesia by dexmedetomidine. Ain Shams J Anesthesiol 2011;4:83-95.
  10. Eisenach JC, Shafer SL, Bucklin BA, Jackson C, Kallio A. Pharmacokinetics and pharmacodynamics of intraspinal dexmedetomidine in sheep. Anesthesiology 1994; 80: 1349–59.
  11. Bajwa SJ, Bajwa SK, Kaur J, Singh G, Arora V, Gupta S, et al. Dexmedetomidine and clonidine in epidural anaesthesia: A comparative evaluation. Indian J Anaesth 2011;55:116-21.
  12. Yaksh TL. Pharmacology of spinal adrenergic systems which modulate spinal nociceptive processing. Pharmacol Biochem Behav1985 ;22:845-58
  13. Lo WC, Harris J, Clarke RW. Endogenous opioids support the spinal inhibitory action of an alpha 2-adrenoceptor agonist in the decerebrated spinalised rabbit. Neurosci Lett 2003;340:95-8
  14. Xu M, Kontinen VK, Kalso E. Effects of radolmidine, a novel alpha2-adrenergic agonist compared with dexmedetomidine in different pain models in the rat. Anesthesiology 2000;93:473-81.
  15. Talke P, Xu M, Paloheimo M, Kalso E. Effects of intrathecally administered dexmedetomidine, MPV-2426 and tizanidine on EMG in rats. Acta Anaesthesiol Scand 2003;47:347-54.
  16. Shimode N, Fukuoka T, Tanimoto M, Tashiro C, Tokunaga A, Noguchi K. The effects of dexmedetomidine and halothane on the Fos expression in the spinal dorsal horn using a rat postoperative pain model. NeurosciLett 2003;343:45-8.
  17. Horvath G, Joo G, Dobos I, Klimscha W, Toth G, Benedek G. The synergistic antinociceptive interactions of endomorphin-1 with dexmedetomidine and/or S (+)-ketamine in rats.AnesthAnalg 2001;93:1018-24.
  18. Onttonen T, Pertovaara A. The mechanical antihyperalgesic effect of intrathecally administered MPV-2426, a novel alpha2-adrenoceptor agonist, in a rat model of postoperative pain. Anesthesiology 2000;92:1740-5.
  19. Takano Y, Yaksh TL. Characterization of the pharmacology of intrathecally administered alpha 2-agonists and antagonists in rats. J PharmacolExpTher 1992;261:764-72
  20. Al-Mustafa MM, Abu-Halaweh SA, Aloweidi AS, Murshidi MM, Ammari BA, Awwad ZM, et al. Effect of Dexmedetomidine added to spinal bupivacaine for urological procedure. Saudi Med J 2009;30:365-70.

Corresponding Author

Dr Rati Prabha

Department of Cardiac Anesthesia

LPS institute of Cardiology, Kanpur India

Mobile No. 9452781293, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.