Abstract
Introduction: The efficacy of local anesthetics in spinal anesthesia can be enhanced by using adjuvants like fentanyl, morphine, tramadol and α2-agonists like clonidine, dexmeditomidine so as to improve the postoperative patient comfort and satisfaction.
Aim: The present study was designed to study the analgesic efficacy and side effects of adding dexmedetomidine to bupivacaine in spinal anesthesia for gynaecological surgeries i.e hysterectomies.
Patients and Methods: In a prospective, randomized, double-blind study, after taking their informed consent, 60 patients were randomly divided into two groups of 30 each. Sub arachnoid block was given with 12.5 mg of 0.5% hyperbaric bupivacaine in group I (n = 30) and with 12.5 mg of 0.5% hyperbaric bupivacaine plus 5 μg of dexmedetomidine in group II (n = 30). The two groups were compared with respect to hemodynamic parameters, onset of sensory block to T10 and regression to S1, time to achieve Bromage 3 and regression to Bromage 0, duration of analgesia, number of doses and type of rescue analgesia required, and complications occurring in 24 h.
Results: Significant difference was observed in relation to onset of sensory block [12.7 ± 1.015 min in group I and 6.84 ± 0.792 min in group II (P < 0.001)], total duration of sensory block [177.74 ± 28.573 min in group I and 353.36 ± 12.138 min in group II (P < 0.001)], total duration of motor block [146.94 ± 9.173 min in group I and 318.36 ± 9.374 min in group II (P < 0.001)], duration of analgesia [283.96 ± 11.165 min in group II and 126.34 ± 7.684 min in group I (P < 0.001)], and total number of doses of rescue analgesia required in 24 h [1.44 ± 0.501 in group II and 2.56 ± 0.675 in group I (P < 0.001)].
Conclusion: Addition of dexmedetomidine to bupivacaine in sub arachnoid block leads to early onset of sensory and motor block with prolonged duration, and patients remained pain free for a longer period with decreased demand for rescue analgesia in the postoperative period as compared with hyperbaric bupivacaine alone without addition of dexmeditomidine.
Keywords: bupivacaine, dexmedetomidine, intrathecal, subarachnoid block.
References
- Koller C. On the use of cocaine for producing anaesthesia on the eye . Lancet 1 884; 2:990.
- Casati A , Fanelli G, B eccaria P, Aldegheri G, Berti M, Senatore R, Torri G. Block distribution and cardiovascular effects of unilateral spinal anaesthesia by 0.5% hyperbaric bupivacaine. A clinical comparison with bilateral spinal block. Minerva Anestesiol 1998; 64:307–312.
- Albright GA Cardiac arrest following regional anesthesia with etidocaine or bupivacaine. Anesthesiolo gy 1979; 51:285–287.
- Buvanendran A, Kroin JS Useful adjuvants for postoperative pain management. Best Pract Res Clin Anaesthe siol 2007; 21:31–49.
- Bouaziz H, Hewitt C, Eisenach JC. Subarachnoid neostigmine potentiation of alpha-2-adrenergic agonist analgesia, dexmedetomidine vs clonidine. Reg Anesth 1995; 20:121–127.
- Glynn C, Dawson D, Sanders R. A double-blind comparison between epidural morphine and epidural clonidine in patients with chronic noncancer pain. Pa in 1988; 34:123–128 .
- Kalso EA, Poyhia R, Rosenberg PH. Spinal antinociception by dexmedet-omidine, a highly selective alpha 2-adrenergic agonist. Pharmacol Toxic ol 1991; 68:140–143.
- Sommer M, de Rijke JM, Van Kleef M, Kessels AG, Peters ML, Geurts JW, et al. The prevalence of postoperative pain in a sample of 1490 surgical patients. Eur J Anesth esiol. 2008; 25:267–274.
- Bromage PR. Epidural Analgesia. Philadelphia: WB Saunders; 1978:144. Available at: http://www.soap.org/media/newsletters/spring2003 / research_column.htm
- American Society of Anesthesiologists Continuum of depth of sedation: definition of general anesthesia and levels of sedation/analgesia. Available at: http://en.wikipedia.org/wiki/Sedation. [Last accessed on 2010 Nov 29].
- Kalso E. Effect of intrathecal morphine, injected with bupivacaine, on pain after orthopedic surgery. Br J A naes th 1983; 55:415 –422.
- Al-Mustafa MM, Abu-H alaweh SA, A loweidi AS, Murshidi MM, Ammari BA, Awwad ZM, et al. Effect of dexmedetomidine added to spinal bupivacaine for urological procedures. Saudi Med J 2009; 30:365–370.
- Hala EA, Shafie MA, Youssef H. Dose-related prolongation of hyperbaric bupivacaine spinal anaesthesia by dexmedetomidine. Ain Shams J Anae sthesiol. 2011; 4:83–95.
- Ibrahim FA. A comparative study of adding intrathecal dexmedetomidine versus sufentanil to heavy bupivacaine for postoperative analgesia in patients undergoing inguinal hernia repair. Benha Med J 2009; 26 :207–217.
- Kanazi GE, Aoua d MT, Jabbour- Khoury SI, Al Ja zzar MD, Alameddine MM, Al-Yaman R, et al. Effect of low-dose dexmedetomidine or clonidine on the characteristics of bupivacaine spinal block. Acta Anaesthesiol Scan d. 2 006; 50: 222–227.
- Mahendr u V, Tewar i A, Katya l S, Grewal A, Singh MR, Katyal R. A comparison of intrathecal dexmedeto-midine, clonidine, and fentanyl as adjuvants to hyperbaric bupivacaine for lower limb surgery: a double blind controlled study. J Anaesthesiol Clin Pharmac ol.2013; 29:496–502.
- Solanki SL, Bharti N, Batra YK, Jain A, Kumar P, Nikhar SA. The analgesic effect of intrathecal dexmedetomidine or clonidine, with bupivacaine, in trauma patients undergoing lower limb surgery: a randomised, doubleblind study. Anaesth Intensive Care 2013; 41:51–56.
- Kim JE, Kim NY, Lee HS, Kil HK. Effects of intrathecal dexmedetomidine on low dose bupivacaine spinal anaesthesia in elderly patients undergoing transuretheral prostatectomy. Biol Phar m Bull 2013; 36:959–965.
- Kaur M, Katyal S, Kathuria S, Singh P. A comparative evaluation of intrathecal bupivacaine alone, sufentanil or butorp-hanol in combination with bupivacaine for endoscopic urological surgery. Saudi J Anae sth 2011; 5:202–207.
- Dahlgren G, Hulstrand C, Jakobsson J, Norman M, Eriksson EW, Martin H. Intrathecal sufentanil, fentanyl or placebo added to bupivacaine for caesarean section. Anaesth A nalg 1997; 85:1288–1293.
- Niu XY, Ding XB, Guo T, Chen MH, Fu SK, Li Q. Effects of intravenous and intrathecal dexmedetomidine in spinal anesthesia: a meta-analysis. CNS Neurosci Ther 2013; 19:897–904.
Corresponding Author
Lt Col (Dr) Ritu Grewal
Classified Specialist (Anaesthesiology), Military Hospital Jaipur Rajasthan
DOI: https://dx.doi.org/10.18535/jmscr/v5i12.91
