Abstract
Background and Aims: The addition of adjuvants to local anesthetic (LA) agents through epidural route helps in lower limb surgeries by providing postoperative analgesia. We attempted to establish whether addition of Dexmeditomidine to Bupivacaine infusion provides better analgesia and hemodynamic stability than Ketamine as an adjuvant.
Methods: The study involved sixty patients undergoing lower limb surgeries, using either Dexmeditomedine (Group D [n=30]) or Ketamine (Group K [n=30]) as adjuvant along with primary LA (0.5% hyperbaric Bupivacaine) through epidural route with CSE (combined spinal epidural). Primary outcome measure was the VAS (visual analogue scale). Receding time for motor blockade, level of sedation, duration of analgesia, effects on hemodynamic parameters were among the secondary outcome parameters.
Results: VAS became significantly lower at 6 hours (p=0.002) and 12 hours (p=0.007) in Group D than Group K. The receding time for motor blockade was significantly (p=0.0001) higher in Group D (6.19±0.87 hrs.) than Group K (4.71±0.91 hrs.). The total LA drug used was significantly (p=0.0001) higher in Group K (209.40±20.58 ml) than Group D (168.13±10.34 ml). The level of sedation was level I in 86.7% patients in Group D and in all the patients of Group K. The duration of analgesia was significantly higher in Group D (8.78±0.41 hrs.) than Group K (6.37±0.64 hrs.) (p=0.04). Mean Systolic Blood Pressure (SBP) (p=0.001) and Mean Heart Rate (HR) (p=0.001) in Group D were significantly lower than Group K at all the time periods.
Conclusion: We conclude that using Dexmedetomidine as an adjuvant to LA through epidural route provides better postoperative pain relief and also reduces the requirement of LA.
Keywords: Dexmeditomidine, Ketamine,Epidural Analgesia.
References
- Bajwa SJS, Bajwa SK, Kaur J, Singh G, Arora V, Gupta S et al. Dexmedetomidine and clonidine in epidural anaesthesia: A comparative evaluation. Indian J Anaesth. 2011Mar;55(2):116-21.
- Nimmo SM. Benefit and outcome after epidural analgesia. BJA Contin Educ AnaesthCrit Care Pain.2004;4(2):44-47.
- Elhakim M, Abdelhamid D, Abdelfattach H, Magdy H, Elsayed A, Elshafei M. Effect of epidural dexmedetomidine on intraoperative awareness and post-operative pain after one-lung ventilation. Acta AnaesthesiolScand 2010;54:703–9.
- Bucklin B, Eisenach JC, Tucker B. Pharmacokinetics and dynamic studies of intrathecal, epidural and intravenous dexmedetomidine. Anesthesiology 1991;75:662.
- Bischoff P, Kochs E. Alpha 2-agonists in anesthesia and intensive medicine. AnasthesiolIntensivmedNotfallmedSchmerzther 1993;28:2–12.
- Villela NR, Nascimento Pd., Junior. Dexmedetomidine in anesthesiology Rev Bras Anestesiol. 2003;53:97–113.
- Linde He MO. The clinical use of dexmedetomidine. Rev Bras Anestesiol 2004;54:1–4.
- Schnaider TB, Vieira AM, Brandão AC, Lobo MV. Intraoperative analgesic effect of cetamine, clonidine and dexmedetomidine, administered through epidural route in surgery of the upper abdomen. Rev Bras Anestesiol 2005;55:525–31.
- Ebert TJ, Hall JE, Barney JA, Uhrich TD, Colinco MD. The effects of increasing plasma concentrations of dexmedetomidine in humans. Anesthesiology 2000;93:382–94.
- Sethi M, Sethi N, Jain P, Sood J. Role of epidural ketamine for postoperative analgesia after upper abdominal surgery. Indian J Anaesth 2011;55:141–5.
- Hussain AM, Buhary BM, Tamanna Z. Comparative Study of Intrathecal Midazolam and Ketamine with Bupivacaine for Post-Operative Analgesia in lower limb and perianal surgery. Biomedical Research 2012; 23 (2): 259-67.
- Memis D, Turan A, Karamanlıoglu B, Pamukc Z, Kurt I. Adding dexmedetomidine to lidocaine for intravenous regional anesthesia. AnesthAnalg 2004;98:835–40.
- Li R, Qi F, Zhang J, Ji Y, Zhang D, Shen Z, Lei W. Antinociceptive effects of dexmedetomidine via spinal substance P and CGRP. TranslNeurosci. 2015 Dec 16;6(1):259-264.
- Abdallah FW, Abrishami A, Brull R. The facilitatory effects of intravenous dexmedetomidine on the duration of spinal anesthesia: a systematic review and meta-analysis. 2013;117(1):271–278.
- 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 Oct;60(10):766–68.
- Saadawy I, Boker A, Elshahawy MA, Almazrooa A, Melibary S, Abdellatif AA, et al.Effect of dexmedetomidine on the characteristics of bupivacaine in a caudal block in pediatrics. Acta AnaesthesiolScand 2009;53:251-6.
- 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.
- Salgado PF, Sabbag AT, Silva PC, Brienze SL, Dalto HP, Módolo NS, et al. Synergistic effect between dexmedetomidine and 0.75% ropivacaine in epidural anesthesia. Rev Assoc Med Bras 2008;54:110-5.
Corresponding Author
Dr Kriti Singh
Batra Hospital and Medical Research Centre, New Delhi
DOI: https://dx.doi.org/10.18535/jmscr/v8i3.39
