Abstract
Aim: So many adjuvants have been used with bupivacaine in epidural anaesthesia but none has been found ideal. We have conducted this study to evaluate the effect of epidural dexmedetomidine and ketamine when added to bupivacaine.
Methods: Fifty female patients who underwent hysterectomies under epidural anesthesia were included in this study. They were randomly allocated in to two groups of 25 each. Group BK received epidural bupivacaine 0.5%(15ml)+0.5mg/kg of ketamine (1ml) and group BD received epidural bupivacaine 0.5% (15ml)+ 0.5 μg/kg of dexmedetomidine (1ml). Following epidural administration, onset and duration of sensory and motor blockade, maximum dermatomal level achieved, duration of analgesia and incidence of side effects were recorded.
Results: Onset of sensory and motor block was earlier in group BD compared to group BK which was statistically significant. Block regression was significantly delayed with the addition of epidural dexmedetomidine (Group BD) as compared to group BK. The duration of analgesia was also significantly prolonged in group BD as compared to group BK. There were no significant difference either in haemodynamic parameters or in the incidence of side effects in both the groups.
Conclusion: Dexmedetomidine when added to epidural bupivacaine produces significantly longer sensory and motor blockade along with prolonged postoperative analgesia when compared to epidural ketamine. Dexmedetomidine provided haemodynamic stability without any significant side effects.
Keywords: Dexmedetomidine, bupivacaine, epidural, gynaecological, ketamine.
References
- 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.
- Esmaoglu A, Mizrak A, Akin A, Turk Y and Boyaci A. Addition of dexmedetomidine to lidocaine for intravenous regional anaesthesia. Eur J Anaesthesiol. 2005; 22:447-51.
- Herd DW, Anderson BJ,Holford NH: Modeling the norketamine metabolite in children and the implications for analgesia. Paediatr Anaesth 2007;17:831-840
- Clements JA,Nimmo WS: Pharmaco-kinetics and analgesic effect of ketamine in man.Br J Anaesth 1981:53:27-30
- Grant IS,Nimmo WS,Clements JA: Pharmacokinetics and analgesic effect if i.m and oral ketamine .Br J Anaesth 1981;53:805-810
- GeisslingerG,Hering W,Thomann P et al: Pharmacokinetics and pharmacodynamics of ketamine enantiomers in surgical patients using a stereoselective analytical method.Br J Anaesth 1993:;70:666-671
- Ohtani M,Kikuchi H,Kitahata LM,et al: Effects of ketamine on nociceptive cells in the medial medullary reticular formation of the cat.Anesthesiology 1979;51:414-417
- EI-Hennawy, A. M., Abd-Elwahab, A. M., Abd-Elmaksoud, A. M., EI-Ozairy, H. S., & Boulis, S. R. (2009). Addition of Clonidine or Dexmedetomidine to Bupivacaine prolongs caudal analgesia in children. British journal of anaesthesia, 103(2),268-274.
- Elhakim, M., Abdelhamid, D., Abdelfattach, H., Magdy, H., Elsayed, A., & Eishafei, M. (2010). Effect of epidural Dexmedetomidine on intraoperative awareness and post-operative pain after one-long ventilation.Acta anaesthe-siologica Scandinavica, 54(6), 703-709.
- Anand VG, Kannan M, Thavamani A, Bridgit MJ. Effects of dexmedetomidine added to caudal ropivacaine in paediatric lower abdominal surgeries. Indian J Anaesth 2011;55:340-6
- Slobodan Mihaljevic, Ljiljana Mihaljevic, Marko Cacic et al ; Sympathetic activity of S-(+)-ketamine low doses in the epidural space; Bras. Anestesiol. vol.64 no.4 Campinas July/Aug. 2014;p 227-335
- Shaikh SI, Mahesh SB. The efficacy and safety of epidural dexmedetomidine and clonidine with bupivacaine in patients undergoing lower limb orthopedic surgeries. J Anaesthesiol Clin Pharmacol 2016;32:203-9
- Gupta K, Bhawna Rastogi, Prashant K. Gupta, Manish Jain, Suneeta Gupta, Deepti Mangla; Epidural 0.5% levobupivacaine with dexmedetomidine versus fentanyl for vaginal hysterectomy: A prospective study; Indian Journal of Pain ; September-December 2014 ; Vol 28 ;Issue 3 14;p 149-54
- Walleed S, Ibrahim AS, Mostafa MG, Kurkar A, Elderwy AA. Ketamine versus magnesium sulfate with caudal bupivacaine block in pediatric inguinoscrotal surgery: A prospective randomized observer-blinded study. Urol Ann. 2015;7(3):325-9.
- Alireza Kamali, Abbas Zareei, Esmaeil Moshiri, Fariba Farokhi; Comparing the Effect of Adding Ketamine and Neostigmine to Bupivacaine 0.25 % for Epidural Analgesia among Patients Candidated for Elective Femoral Fracture Surgery; International Journal of Medical Research & Health Sciences, 2016, 5, 11:63-67.
- Sonawane NB, Balavenkatasubramanian J, Gurumoorthi P, Jadhav PA. Quality of post-operative analgesia after epidural dexmedetomidine and ketamine: A comparative pilot study. Indian J Anaesth. 2016;60(10):766-768.
Corresponding Author
Dr Aratiprava Sahu
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DOI: https://dx.doi.org/10.18535/jmscr/v6i12.126
