The effect of dexmedetomidine on spinal anesthesia quality and hemodynamic changes in patients undergoing inguinal hernia repair surgery: intravenous versus intrathecal (original) (raw)
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Indian Journal of Pain, 2020
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.
Birat Journal of Health Sciences, 2020
Introduction: The use of intrathecal adjuvants in spinal anaesthesia in enhancing and prolonging it’s action has been well established and is widely used for surgery below the umbilicus. Dexmedetomidine, a selective α2A receptor agonist is a suitable adjuvant due to its selective activity. Objectives: To evaluate the effect of a single bolus dose of intravenous dexmedetomidine as an adjuvant in cases undergoing lower limb surgeries under spinal anaesthesia. Methodology: One hundred patients posted for lower limb surgery under spinal anaesthesia with hyperbaric bupivacaine, were equally divided into two groups. In group D, in addition to spinal, intravenous dexmedetomidine 0.5mcg/kg over 10 min was given whereas group C patients received spinal and intravenous normal saline . Results: The onset of sensory and motor block was faster in group D (2.09 ± 0.71 min, 3.18 ± 1min)compared to group C (3.5 ± 0.82 min, 6.19 ± 1.87 min) which was statistically significant . The duration of senso...
IOSR Journals , 2019
Spinal anaesthesia is a popular technic adopted but there are some drawbacks linked with spinal anaesthesia, pain at the puncture site, fear of needles,stress factors in operation room, block level mismatch, monitor sounds and recall of the procedure. The importance of sedation is that it offers analgesia, anxiolysis, and amnesia. Dexmeditomidine and propofol for moderate sedation are best during spinal anaesthesia. AIM: The objectives are to compare Intraoperative sedation, Intraoperative hemodynamic parameters , Intraoperative respiratory stability and side effects. METHODOLOGY: Study was approved by institutional medical ethics committee and written informed consent obtained from all patients participating in the study. 150 patients of ASA grade I ,II between 18-60 years age of both sexes undergoing various surgeries under spinal anesthesia.Patients divided into 3 groups containing 50 each according to computer generated random allocation method. Group D recieved Dexmeditomidine.(1mic/kg loading dose over 10 min followed by maintenance of 0.5 mic/kg/hr) ,Group P recieved Propofol 6mg/kg/hr infused over 10 minutes (1mg/kg bolus) followed by 1.5mg/kg/hr and Group C received normal saline. RESULTS: Throughout the infusion process, hemodynamic data, respiratory rate, oxygen saturation, sedation, pain, and side effects were recorded. Postoperative hemodynamic measurements, oxygen saturation, sedation, pain scores were obtained : CONCLUSION: Dexmeditomidine is a safe and attractive drug for sedation in patients undergoing surgeries under spinal anaesthesia
2016
Introduction: Dexmedetomidine has been reported to potentiate the effects of intrathecal local anaesthetics. This study was conducted to evaluate the effects of intravenous dexmedetomidine on spinal bupivacaine anesthesia. Material and Methods: 80 female patients with ASA grade I/ II aged 35-55 yrs. undergoing abdominal hysterectomy under spinal anaesthesia were randomized into two groups of 40 each. Before spinal anesthesia patients in group D received a loading dose of 0.5 μg /kg IV Dexmedetomidine over 10 min. by infusion pump followed by a maintainance dose of 0.5 μg/ kg/hr till completion of the surgery, while patients in group C received the same calculated volume of normal saline. Time for onset of sensory and motor blockade, time to reach peak sensory level, time taken for two segment regression and maximum sensory level, Ramsay sedation score, duration of analgesia and haemodynamic parameters were recorded and statistically analyzed. Results: Onset of sensory block in group...
Anesthesia: Essays and Researches, 2019
Context: Various intravenous (i.v.) adjuvants have been used along with spinal anesthesia to delay the onset of postoperative pain. Aims: To compare effects of i.v. dexmedetomidine with midazolam on duration of spinal anesthesia. Settings and Design: This prospective randomized control trial was conducted in a tertiary care institution. Subjects and Methods: Forty-three patients presenting for elective infraumbilical surgery under spinal anesthesia were randomly allocated into two groups. Group A received a loading dose of 0.5 μg/kg followed by 0.5 μg/kg/h of i.v. dexmedetomidine. Group B received a loading dose of 0.03 mg/kg followed by 0.03 mg/kg/h of i.v. midazolam. Two dermatomal regressions, regression to S1level, and sedation score were noted. Statistical Analysis Used: To test the statistical significance of duration of sensory blockade, Mann–Whitney U-test was applied. The incidence of bradycardia and hypotension was analyzed using Pearson's correlation coefficient test. Results: The mean time for two dermatomal regressions was significantly prolonged in Group A (2.3 ± 0.4 h) than Group B (1.6 ± 0.5 h, P = 0.001). Mean time for sensory regression to S1dermatome was also prolonged in Group A (5.2 ± 0.83 h) than in Group B (4.4 ± 0.87 h, P = 0.01). Glycopyrrolate was administered in 45% of patients in Group A and 21% in Group B, which was statistically significant (P = 0.039). Conclusion: Conscious sedation with i.v. dexmedetomidine at a loading dose of 0.5 μg/kg followed by 0.5 μg/kg/h prolongs duration of spinal anesthesia than i.v. midazolam at a loading dose of 0.03 mg/kg followed by 0.03 mg/kg/h in patients undergoing infraumbilical surgeries. However, dexmedetomidine is associated with higher incidence of hemodynamic instability.
ragijain5@gmail.com, 2017
Introduction: Spinal anaesthesia is the anesthesia of choice for patients undergoing lower abdominal and lower limb surgeries. However its use is restricted by the limited duration of its action. Aim: To study the comparative evaluation of clinical efficacy of dexmedetomidine when used either by intravenous or intrathecal route in patients undergoing surgeries under spinal anaesthesia. Materials and Methods: 60 American Society of Anaesthesiologists Grade I and II were randomized to receive dexmedetomidine by either intravenous (0.5µgm/kg) (Group I) or intrathecal (0.5µgm) (Group II) routes, in patients scheduled for surgeries under spinal anaesthesia. Primary outcomes studied were the duration of sensory and motor blocks. Secondary outcomes were the time for first request of analgesia, sedation levels and incidence of bradycardia and hypotension. Results: Group II patients showed significant prolongation of sensory and motor block as compared to Group I (p= 0.009, ˂0.000 respectively). Similarly the time of rescue analgesia is greater in Group II (p= 0.0001). However mean sedation levels were greater in Group I (p=0.02). There was no significant difference in the incidence of bradycardia and hypotension between two groups. Conclusion: Intrathecal dexmedetomidine as an adjuvant in spinal anaesthesia, showed significant prolongation of duration of sensory and motor blocks as compared to its intravenous counterpart, without significant increase in incidence of adverse effects.
Dexmedetomidine as an Intrathecal Adjuvant in Spinal Anaesthesia: A Study
International Journal of Health Sciences and Research, 2015
Background: This study was conducted to evaluate the effect of 10 μg dexmedetomidine as intrathecal adjuvant in bupivacaine spinal anesthesia in terms of the onset and duration of sensory and motor blockade. Methods: In this prospective, randomized, double-blinded study, 60 (sixty) patients undergoing elective lower abdominal and lower limb surgeries under spinal anaesthesia were randomly allocated into two groups to receive: Group D (n=30): 2.5ml (12.5mg) hyperbaric bupivacaine 0.5% plus 0.1ml (10μg) dexmedetomidine intrathecal and Group C (n= 30): 2.5ml (12.5 mg) hyperbaric bupivacaine 0.5% plus 0.1ml preservative free normal saline. Then, the onset and duration of sensory and motor blockade as well the side effects were studied and statistically analysed. Results: The mean sensory onset time to reach T10 in Group D vs. Group C was 2.53±0.57 vs. 4.10±0.55 min (p <0.001), and time to modified Bromage 3 was 3.60±0.62 vs. 5.37±0.56 respectively (p <0.001). The difference in the...
Dexmedetomidine as an Adjunct to Spinal Anesthesia in Urological Procedures
Introduction: Patients undergoing urological procedures under spinal anaesthesia are usually elderly having comorbid conditions. Dexmedetomidine, the new highly selective α-2 agonists is being used as an adjuvant in spinal anaesthesia with improved quality of anaesthesia and analgesia and minimal side effects. The present study was designed to evaluate the effect of intrathecal dexmedetomidine to bupivacaine in spinal anesthesia for urological procedures. Material and Methods: Sixty patients of ASA class I and II were randomly divided into two groups of thirty patients each. The control group received hyperbaric bupivacaine 15 mg + 0.5 ml normal saline (3.5 ml).The study group received hyperbaric bupivacaine 15 mg +10 mcg dexmedetomidine diluted in 0.5 ml normal saline (3.5ml). Results: The time taken to reach the highest sensory level was 8.5 ± 0.5 minutes in control group while 6.2 ± 0.4 minutes in study group. The mean time to reach the bromage 3 was 10.1 ± 2.9 minutes in control group while 7.8 ± 1.9 minutes in study group. Time taken to sensory regression to S1 and duration of motor blockade was significantly higher (311 ± 36.6 min and 286 ± 34.2 min) in study group when compared to control group (230 ± 19.3 min and 197.9 ± 17.5 min). The duration of analgesia was significantly higher (339.7 ± 47.4 min) in study group as compared to control group (272.1 ± 39 min) Conclusion: Addition of dexmeditomidine to hyperbaric bupivacaine in spinal anaesthesia results in early onset of sensory and motor block, prolongs duration of motor and sensory block, improves quality of intraoperative and post operative analgesia with good hemodynamic stability and minimal side effects.