Abstract
Background and Aim: Our aim was to compare the analgesic efficacy following intrathecal administration of dexmedetomidine or clonidine as adjuvant with isobaric ropivacaine in lower limb orthopaedic surgery.
Methods: Ninety patients of ASA grade I or II, ages between 20-60 years, were randomly allocated to three equal groups, Group R received 2.5ml of isobaric ropivacaine (0.75%) with normal saline as a placebo, group D received 2.5ml of isobaric ropivacaine (0.75%) with 5 μg of dexmedetomidine and Group C received 2.5ml of isobaric ropivacaine (0.75%) with 30 μg of clonidine. All solutions were made up to 3 ml with addition of normal saline. The onset and duration of sensory and motor blockade, time to reach peak sensory and motor level and the sensory and motor regression times were recorded. Time to use first rescue analgesia, hemodynamic changes and side effects were recorded.
Results: Time to onset of sensory block and motor block was early in Group D and Group C as compared to Group R. Duration of sensory and motor blockade was prolonged in Groups C and D compared with Group R. The mean regression time to S1 segment was prolonged in Group D, and in Group C compared to Group B. The time to 1st rescue analgesia was significantly prolonged in Group D compared with Group C and group R.
Conclusion: The addition of dexmedetomidine to intrathecal ropivacaine prolongs the sensory block and provides prolonged postoperative analgesia when compared to ropivacaine with or without clonidine in lower limb orthopaedic surgeries.
Keywords: Clonidine, dexmedetomidine, intrathecal,ropivacaine.
References
- Elia N, Culebras X, Mazza C, Schiffer E, Tramèr MR. Clonidine as an adjuvant to intrathecal local anesthetics for surgery: Systematic review of randomized trials. Reg Anesth Pain Med. 2008; 33:159–67.
- Chung CJ, Choi SR, Yeo KH, Park HS, Lee SI, Chin YJ. Hyperbaric spinal ropivacaine for cesarean delivery: A comparison to hyperbaric bupivacaine. Anesth Analg. 2001;93:157–61
- Kakunje R, Sethuramachandran A, Parida S, Bidkar PU, Talawar P. Effects of adding low-dose clonidine to intrathecal hyperbaric ropivacaine: A randomized double-blind clinical trial. Anesth Essays Res. 2016;10:38–44
- Gautier P, De Kock M, Huberty L, Demir T, Izydorczic M, Vanderick B. Comparison of the effects of intrathecal ropivacaine, levobupivacaine, and bupivacaine for Caesarean section. Br J Anaesth. 2003;91:684–9.
- Wahedi W, Nolte H, Klein P. Ropivacaine for spinal anesthesia. A dose-finding study. Anaesthesist. 1996;45:737–44.
- Sagiroglu G, Sagiroglu T, Meydan B. The effects of adding various doses of clonidine to ropivacaine in spinal anesthesia. Eurasian J Med. 2009;41:149–53.
- Gupta R, Bogra J, Verma R, Kohli M, Kushwaha JK, Kumar S. Dexmedeto-midine as an intrathecal adjuvant for postoperative analgesia. Indian J Anaesth. 2011;55:347–51.
- Martin E, Ramsay G, Mantz J, Sum-Ping ST. The role of the alpha2-adrenoceptor agonist dexmedetomidine in postsurgical sedation in the intensive care unit. J Intensive Care Med. 2003;18:29–41
- Kalso EA, Pöyhiä R, Rosenberg PH. Spinal antinociception by dexmedetomidine, a highly selective alpha 2-adrenergic agonist. Pharmacol Toxicol. 1991;68:140–3.
- Mahendru V, Tewari A, Katyal S, Grewal A, Singh MR, Katyal R. A comparison of intrathecal dexmedetomidine, clonidine, and fentanyl as adjuvants to hyperbaric bupivacaine for lower limb surgery: A double blind controlled study. J Anaesthesiol Clin Pharmacol. 2013; 29:496–502.
- 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.
- El-Attar A, Aleem MA, Beltagy R, Ahmed W. A comparative study of intrathecal dexmedetomidine and fentanyl as additives to bupivacaine. Res Opin Anesth Intensive Care. 2015;1:43–9.
- Safari F, Aminnejad R, Mohajerani SA, Farivar F, Mottaghi K, Safdari H. Intrathecal dexmedetomidine and fentanyl as adjuvant to bupivacaine on duration of spinal block in addicted patients. Anesth Pain Med. 2016;6:e26714.
- 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 procedures. Saudi Med J 2009; 30:365–70.
- Hala E A Eid MD, Mohamed A Shafie MD, Hend Youssef MD. Dose-related prolongation of hyperbaric bupivacaine spinal anesthesia by dexmedetomidine. Ain Shams Journal of Anesthesiology 2011; 4:83–95.
- Kanazi GE, Aouad MT, Jabbour-Khoury SI, Al Jazzar MD, Alameddine MM, Al-Y aman, et al. Effect of low-dose dexmedetomidine or clonidine on the characteristics of bupivacaine spinal block. Acta Anaesthesiol Scand 2006;50:222–7.
- Al Ghanem SM, Massad IM, Al-Mustafa MM, Al-Zaben KR, Qudaisat IY, Qatawneh AM, et al. Effect of adding dexmedetomidine versus fentanyl to intrathecal bupivacaine on spinal block characteristics in gynecological procedures: A double blind controlled study. American Journal of Applied Sciences 2009; 6:882–7.
Corresponding Author
Dr Debasish Swain
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
DOI: https://dx.doi.org/10.18535/jmscr/v7i3.157
