Comparison of Single Bolus Dose of Dexmedetomidine with Bolus Plus Continuous Infusion of Dexmedetomidine on Characteristic of Spinal Anaesthesia with Hyperbaric Bupivacaine (original) (raw)
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Pain Research and Management, 2014
OBJECTIVE: To compare the postoperative analgesic characteristics and side effects of two different doses of intrathecal dexmedetomidine in combination with hyperbaric bupivacaine, and to evaluate the effects of these combinations on spinal anesthesia.METHODS: After obtaining approval from the local ethics committee, 60 male patients who were undergoing inguinal surgery and were classified as American Society of Anesthesiologists physical status class I were included in the study. The present study was conducted in 2003 in a military hospital with a capacity of 100 beds. The patients were randomly assigned to three groups of 20 patients: group 1, 0.5 mL saline added to 3 mL (15 mg) hyperbaric bupivacaine; and groups 2 and 3, 2 μg dexme-detomidine and 4 μg dexmedetomidine added to 3 mL (15 mg) hyperbaric bupivacaine, respectively. Medications were administered by intrathecal injection in a total volume of 3.5 mL. The postoperative analgesic characteristics, effects on spinal anesthes...
IP Innovative Publication Pvt. Ltd., 2019
Introduction and Objectives: Sub Arachnoid Block is one of the commonly used anaesthetic technique for lower limb surgeries, the duration and quality of block can be prolonged using several adjuvants. The objective of this study was to assess the quality, duration of block and time required for supplemental analgesia in patients undergoing lower limb surgeries. Materials and Methods: Fifty ASA class I and II patients scheduled for lower limb surgeries, received Subarachnoid block with 15 mg hyperbaric bupivacaine or 15 mg hyperbaric bupivacaine plus intravenous dexmedetomidine 0.5microgm/kg body weight in 10ml saline as bolus dose prior to Sub Arachnoid Block. Outcome measures included onset and duration of sensory and motor block and duration of analgesia. Results: Duration of sensory block (p=0.0001), duration of motor block (p=0.0001) and duration of analgesia (p=0.0001) was significantly longer in dexmedetomidine group than the patients who received Subarachnoid block with 15 mg Bupivacaine alone. A significant decrease in heart rate, systolic blood pressure and mean arterial pressure was noted in dexmedetomidine group. Conclusion: Intravenous dexmedetomidine in a single dose of 0.5?g/kg, administered over a period of 10 minutes prior to sub arachnoid block, prolongs the duration of sensory and motor blockade with arousable sedation, without any respiratory depression. Keywords: Intravenous, Dexmedetomidine, Postoperative, Pain, Spinal anaesthesia, Analgesia, Sensory, Motor, Blockade.
Background and aims: Local anesthetics along with adjuvants like epinephrine, phenylephrine, adenosine, magnesium sulfate, sodium bicarbonate, neostigmine and alpha-2 agonists like clonidine, dexmedetomidine have been used intrathecally to prolong the duration of spinal anesthesia. Clonidine and dexmedetomidine, used intravenously are also known to prolong the duration of the spinal anesthesia.We proposed this study to evaluate the effect of intravenous dexmedetomidine on 0.5% bupivacaine spinal anesthesia. Methods: In this prospective, double-blind, randomized controlled clinical trial, 60 patients aged 18 to 60 years, ASA grade 1 or 2 posted for planned elective surgery for more than two hours duration under spinal anesthesia.study design: The patients were randomly allocated into 2 groups, after giving spinal anesthesia with 0.5% bupivacaine. Group D received a loading dose of 1 ug/kg Dexmedetomidine and Group C received an equivalent quantity of normal saline. The duration of sensory and motor blockade, hemodynamic parameters, postoperative analgesia, time of rescue analgesia, sedation scores and side effects were studied. Results: The duration of sensory and motor block was significantly prolonged in dexmedetomidine group as compared to control group (p<0.001) Haemodynamic parameters like pulse rate, blood pressure was significantly lower in dexmedetomidine group. Mean time for first request of rescue analgesic in postoperative period was significantly longer in D group (5.43 hrs) as compared to C group (2.43 hrs) (p <0.001) Sedation scores were significantly higher in dexmedetomidine group [4.3+0.47] as compared to control group [2+0.0] (p<0.001) Side effects like shivering, nausea, and vomiting were less in D group Conclusion: Intravenous dexmedetomidine significantly prolongs the duration of sensory and motor block of bupivacaine spinal anaesthesia, provides excellent sedation and good postoperative analgesia
IP Innovative Publication Pvt. Ltd., 2018
Introduction and Aim: Dexmedetomidine, a neuraxial adjuvant, when given intrathecally with hyperbaric bupivacaine provides stable hemodynamic conditions, good quality of intraoperative and prolonged postoperative analgesia with minimal side effects. When intravenous dexmedetomidine is used in conjunction with neuraxial anesthesia, few studies have shown that it prolongs the sensory-motor blockade and provides better intraoperative and postoperative analgesia. We formulated this hypothesis that intravenous (IV) dexmedetomidine bolus followed by infusion would prolong the duration of subarachnoid block (SAB) with 0.5% heavy bupivacaine. Our aim was to assess the onset and duration of sensory and motor blockade following IV dexmedetomidine supplementation after SAB. Materials and Methods: Sixty American Society of Anesthesiologists Grade I and II patients undergoing elective surgeries under spinal anesthesia were randomized into two groups of 30 each. Immediately after subarachnoid block with 3 ml of 0.5% hyperbaric bupivacaine, patients in group II received a loading dose of 1 µg/kg of dexmedetomidine intravenously by infusion pump over 10 min followed by a maintenance dose of 0.5 µg/kg/hr till the end of surgery, whereas patients in group I received an equivalent quantity of normal saline. The time to reach peak sensory block level, time taken for two segment regression and maximum motor block, total duration of sensory and motor blockade, Ramsay sedation score and modified Bromage score were statistically analyzed using Statistical Package for Social Sciences (SPSS Inc. Chicago, IL, USA) Windows-based version 16.0. Results: Two segment regression time of sensory blockade was more in the dexmedetomidine group (130.33±14.49 mins) as compared to the normal saline group (94.67±15.02 mins) which was statistically significant (P< 0.0001). The duration of both sensory (277.67±24.73 mins vs. 173.67±12.45 mins) and motor blockade (206±23.72 mins vs. 135±13.83 mins) was more in the dexmedetomidine group than the normal saline group (P <0.0001). Conclusion: The results of the present study shows that, intravenous dexmedetomidine given as a loading dose followed by maintenance dose prolonged the duration of sensory and motor blockade of bupivacaine-induced spinal anesthesia. It also provided conscious sedation without respiratory depression while maintaining good hemodynamic stability. Keywords: Intravenous dexmedetomidine, Spinal anesthesia, 0.5% bupivacaine.
Asian Journal of Pharmaceutical and Clinical Research, 2018
Objectives: Dexmedetomidine was shown to prolong the duration of spinal anesthesia and enhance post-operative analgesia. The aim of the study was to compare the effect of intravenous (IV) versus intrathecal (IT) administration of dexmedetomidine on bupivacaine spinal anesthesia in patients undergoing lower limb surgery. Methods: A prospective randomized controlled study was conducted during the year 2014-15. 60 American Society of Anesthesiologists physical status I-II aged 18-60 years scheduled for lower limb surgery under spinal anesthesia were assigned randomly to two groups: (1) IT group (IT group) (n=30) patients received 3 ml of 0.5% hyperbaric bupivacaine and 5 µg of dexmedetomidine intrathecally (100 µg/1 ml ampoule drawn in 40 IU/ml insulin syringe making 5 µg=2 IU=0.05 ml) and (2) IV group (IV group) (n=30) received 3 ml of 0.5% hyperbaric bupivacaine and 0.05 ml of normal saline intrathecally followed 5 min later by IV dexmedetomidine 0.5 µg/kg by infusion pump over 10 min as a single dose. Results: The IT group had a statistically significantly earlier sensory onset to T10 and shorter time from injection to highest sensory level (p<0.001). The regression times of two dermatomes, regression time to S1 dermatome and time to reach Bromage 3 motor block were significantly less in the IT group, whereas regression time to Bromage 0 was prolonged (p<0.001). The IT group showed a significantly longer time to the use of rescue analgesia and less analgesic consumption in first 24 h than the IV group (p<0.001). Furthermore, the intensity of pain was significantly less in the IT group as compared to IV group (p<0.001). Compared with IV group, the IT group had low sedation score, fewer overall side effects, which was statistically not significant (p>0.05). Conclusion: In bupivacaine spinal anesthesia for limb surgeries, dexmedetomidine, when administered intrathecally, has greater augmentation to sensory and motor block, more hemodynamic stability, better analgesic properties, and fewer overall side effects compared to the IV route of administration.
Introduction: Spinal anaesthesia is commonly used regional anaesthetic technique all over the world. This study investigates the effect of intrathecal administration of dexmedetomidine added to spinal hyperbaric bupivacaine on the duration of sensory and motor block and postoperative analgesic requirements in lower abdominal surgeries. Material and Methods: Hundred adult patients posted for lower abdominal surgeries were randomized in two groups. Each patient was given 3.5 ml of drug solution intrathecally that consisted of 3 ml 0.5% hyperbaric bupivacaine and 0.5 ml containing 7.5 μg dexmedetomidine in Group D patients or normal saline in Group B patients. Intraoperative Heart rate, arterial blood pressure, sensory level, motor block, pain and level of sedation were assessed and continued up to 24 hours post spinal anesthesia for any complication during the procedure. Results: Time to two segment regression, sensory regression to S1, regression of motor block to modified Bromage 0 and time to first rescue analgesic were significantly prolonged in dexmedetomidine group along with significantly decreased postoperative pain scores. Conclusion: Intrathecal dexmedetomidine in doses of 7.5μg significantly prolong the anesthetic and analgesic effects of spinal hyperbaric bupivacaine.
JNMA; journal of the Nepal Medical Association
Various adjuvants to local anaesthetic are used to improve quality and duration of spinal anaesthesia. Dexmedetomidine, a novel alpha-2 adrenergic agonist, has been proposed to augment local anaesthetic effects. This study aims to investigate effects of intrathecal Dexmedetomidine on duration of analgesia and duration of sensory block during spinal anaesthesia. In this randomized double-blind study 38 patients were allocated into each of two groups. Otherwise healthy patients (18 to 75 years) scheduled for inguinal hernia repair or vaginal hysterectomy were included. For spinal anaesthesia, Group A received 2.5 ml hyperbaric Bupivacaine 0.5%, whereas Group B received five micrograms intrathecal Dexmedetomidine in addition. Characteristics of sensory and motor blocks, duration of analgesia, analgesic requirements, and side effects were studied for 24 hours. Student's t-test for quantitative variables and Chi- squared test for qualitative variables were used for statistical analys...
International Journal of Research in Medical Sciences, 2016
Despite advances in knowledge of pathophysiology, pharmacology and the development of more effective techniques for the management of peri-operative analgesia, many patients continue to experience distressing pain in post-operative period. 1 Uncontrolled post-operative pain may activate the sympathetic nervous system which may increase myocardial oxygen consumption leading to development of various morbidity and mortality like myocardial ischemia and infarction. 2,3 Intrathecal use of hyperbaric bupivacaine 0.5% is an appropriate for surgeries of short duration and may lead to early analgesic intervention in post-operative period. There are many studies done to improve the effect and duration of spinal anesthesia by using various drugs as an ABSTRACT Background: Efficacy of sub-arachnoid block can be improved by addition of various adjuvants to local anesthetics. Intrathecal administration of clonidine or dexmedetomidine has improved the quality of spinal anesthesia in terms of longer duration of post-operative analgesia with comparatively lesser side effects. In present study we compared the onset and duration of motor and sensory block, hemodynamic effects, post-operative analgesia and adverse effects of clonidine and dexmedetomidine used intrathecally with bupivacaine. Methods: Present study was conducted in 150 patients (ASA class I and II) undergoing lower abdominal surgeries. Patients were randomly divided into three group's viz. B, C and D. Group B received bupivacaine (12.5 mg), group C received clonidine (30 µg) with bupivacaine and group D received dexmedetomidine (5 µg) with bupivacaine. Volume of administered drug was set at 3ml in all the groups. The onset time to reach peak sensory and motor block level, regression time to sensory and motor block, hemodynamic changes and side effects if any were assessed and recorded. Results: In our study we observed that there was no significant difference in patient demography and duration of surgical procedure. The time to onset of sensory blockage was similar in all the three groups but time to onset of motor block was shorter in group C and D compared to group B. Total duration of sensory and motor block was significantly higher in group D compared to group C and B. The duration of sensory block in group D was 139.58+14.49, in group C it was 122.46+18.55 and in group B it was 100+13.43 minutes. The duration of motor block in group D was 250.40+27.33, in group C it was 229.28+23.68 and in group B it was 175.64+17.41 minutes. Conclusions: It was concluded that though both clonidine and dexmedetomidine prolonged duration of sensory and motor block of Bupivacaine, Dexmedetomidine is better in terms of longer duration of action.
Caspian Journal of Internal Medicine, 2019
Background: Spinal anesthesia is the common choice for anesthesia in lower abdomen surgery and intrathecal adjutants have gained popularity with the aim of prolonging the duration of block, quality of block and post operation pain control. The purpose of this study was to evaluate the effects of adding dexmedetomidine to hyperbaric bupivacaine in lower abdominal surgery under spinal anesthesia. The main outcomes were considered pain score, duration of analgesia, hemodynamic changes and adverse side effects like nausea and vomiting. Methods: This double-blind randomized clinical trial was conducted on one hundred patients between 18 to 65 years old scheduled for lower abdominal surgery. Fifty patients were randomly allocated to receive either 12.5mg hyperbaric bupivacaine (2.5cc) plus 5µgr dexmedetomidine (0.5cc) intrathecally while fifty patients received either 12.5mg hyperbaric bupivacaine (2.5cc) and 0.5cc Saline 0.9% intrathecally. Results: Vital sign parameters like heart rate, blood pressure and oxygen saturation levels were registered in the normal range in both groups. The average duration of the onset of pain (230±86 min) in bupivacaine group was significantly (p≤0.000) less than dexmedetomidine group (495±138 minutes). The severity of pain at all times in dexmedetomidine group was significantly (p<0.05) less than bupivacaine group. The severity of shivering and the number of patients who needed treatment for nausea and vomiting in dexmedetomedine group has been less in comparison to bupivacaine. Conclusion: We concluded that intrathecal dexmedetomidine increases the duration of analgesia and reduces postoperative pain without changes in the hemodynamic parameters and adverse side effects. It can be considered as an appropriate adjuvant to intrathecal local anesthetics for lower limb surgeries.
Aims & Objectives: Various adjuncts have been used with local anesthetics in spinal anesthesia to provide good quality of intra-operative and better post-operative analgesia. Dexmedetomidine is a new α-2 adrenergic agonist, now being used as a neuraxial adjuvant. The aim of our study was to investigate the effect of intrathecal administration of dexmedetomidine 5 µg and 10 µg, as an adjuvant to bupivacaine 0.5%, on the onset and duration of sensory and motor block, the hemodynamic effects, the duration of analgesia and the occurrence of side effects. Methodology: This prospective randomized double blind study included 90 patients. Patients were randomly allocated into three groups of 30 patients each. Group B received 15 mg of 0.5% hyperbaric bupivacaine with normal saline, group D1 received 15 mg of hyperbaric bupivacaine with 5 µg and group D2 received 15 mg of hyperbaric bupivacaine with 10 µg of dexmedetomidine with normal saline to a total volume of 3.5 ml. The onset and duration of sensory and motor block, the hemodynamic effects, the duration of analgesia and the occurrence of side effects were noted. Results: The mean time taken for the sensory block to reach T10 dermatome and motor block to reach Bromage 3 grade was significantly rapid in D1 and D2 groups as compared to bupivacaine group. The time taken for regression of sensory block to S1 dermatome and Bromage 0 motor block and the time to first rescue analgesic were increased significantly by addition of dexmedetomidine in a dose dependent manner. Conclusion: Dexmedetomidine added to hyperbaric bupivacaine intrathecally has a dose dependent favorable effect on the onset and regression of sensory and motor block. Citation: Shaikh SI, Dattatri R. Dexmedetomidine as an adjuvant to hyperbaric spinal bupivacaine for infra-umbilical procedures: A dose related study. Anaesth Pain & Intensive Care 2014;18(2):180-185