Comparative study of clonidine and dexmedetomidine used as adjuvant to epidural ropivacaine in orthopaedic lower limb surgery (original) (raw)
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Journal of Evolution of Medical and Dental Sciences
BACKGROUND Epidural anaesthesia is now increasingly being used for lower limb surgeries for its certain advantages. Different adjuvants have been used with epidural ropivacaine to prolong the intraoperative and postoperative analgesia. Evidence is growing in favour of dexmedetomidine as an epidural adjuvant. Different doses of dexmedetomidine have been used with epidural ropivacaine with variable success in modifying the block characteristics and adverse event profile. The aim of the present study was to compare the block characteristics between epidural ropivacaine with dexmedetomidine (2 µg/kg) as adjuvant and epidural ropivacaine alone in patients undergoing lower limb surgeries. MATERIALS AND METHODS In this randomised, double-blinded study, 88 adult patients of either sex, aged between 40-65 years, scheduled for elective lower limb surgery under epidural anaesthesia, were randomly allocated into two groups to receive either 0.75% ropivacaine alone (Group A) or dexmedetomidine (2 µg/kg) as an adjuvant to ropivacaine 0.75% (Group B) in epidural space. Data from 40 patients of each group were finally analysed. The time to achieve T6 sensory block (Primary outcome), time to reach maximum sensory block, time to achieve complete motor block, time to two-segment regression of sensory block and duration of analgesia were noted in all cases. The incidences of adverse events such as nausea, vomiting, hypotension, dry mouth, bradycardia, desaturation, respiratory depression, etc. were also noted. Statistical analysis was performed using independent sample Student's 't' test for normally distributed variables and Pearson Chi-square test for categorical data. The level of significance was set as P < 0.05. RESULTS The time to achieve sensory block at T6 level in group B (9.45±1.04 minutes) was significantly shorter than group A (13.65±1.12 minutes), P<0.05. The time to achieve maximal sensory block and time to achieve complete motor block were also found shorter in dexmedetomidine group. Sensory block regressed later in dexmedetomidine group compared to control (157.03±7.87 versus 118.47±7.32 minutes, respectively, P <0.05). The time to first rescue epidural top-up was prolonged in dexmedetomidine group compared with ropivacaine alone group (346.12±17.29 versus 327.98±17.60 minutes, respectively). Incidences of adverse events were comparable. CONCLUSION Epidural dexmedetomidine is a reliable adjuvant with ropivacaine (0.75%) to provide early onset of sensory block and longer duration of analgesia in lower limb surgeries.
Innovative publication, 2016
Background: Ropivacaine, the pure S enantiomer of propivacaine, due to its less lipophilicity than bupivacaine does not produce cardiotoxicity or neurotoxicity and causes less motor blockade. Dexmedetomidine the newer selective alpha 2 adrenergic agonist has several advantages when given through epidural route as a neuraxial adjuvant. Aim: To compare 0.75% Inj.Ropivacaine with Inj.Fentanyl and 0.75% Inj.Ropivacaine with Inj.Dexmedetomidine epidurally for the duration of analgesia, hemodynamic changes, degree of motor blockade and occurrence of side effects. Materials and Methods: 60 patients undergoing lower limb orthopaedic surgeries were randomized to two groups. Group RF (n=30) received 0.75% Inj.Ropivacaine 20 cc with Inj.Fentanyl 50 mcg whereas Group RD (n=30) received 0.75% Inj.Ropivacaine 20 cc with Inj.Dexmedetomidine 50 mcg in normal saline diluted upto 1cc. Quality of sensory block, motor block, pulse rate, blood pressure, pain assessment and any adverse outcome were noted. Statistical analysis was done by student's paired t-test for intragroup comparison and unpaired t-test for intergroup comparison and p<0.05% was taken to be significant. Results: Dexmedetomidine fastens the onset of analgesia, prolongs the duration of analgesia thereby reducing the doses of rescue analgesics post operatively, improves the quality of motor blockade without aggravating changes in haemodynamic parameters and has less adverse effects. Conclusion: We conclude that dexmedetomidine serves as a good neuraxial adjuvant when added to 0.75% ropivacaine in epidural anaesthesia given for lower limb orthopaedic surgery.
IP innovative publication pvt ltd, 2020
Introduction: Spinal anaesthesia provides faster onset, effective sensory and motor block, adequate muscle relaxation and profound analgesia simply by injecting a small amount of local anaesthetic drug directly into CSF in subarachnoid space. This present study was conducted to assess the efficacy of Dexmedetomidine as an adjuvant to Ropivacaine in terms of duration of sensory and motor block, post-operative analgesia and side effects in lower limb orthopedic surgeries. Materials and Methods: This prospective study was done on 50 ASA I/II patients of age 18-60 years undergoing spinal anaesthesia for lower limb orthopaedic surgery. In this study patients received an intrathecal injection of 22.5 mg Ropivacaine (3ml Ropivacaine 0.75%) & 5mg dexmedetomidine i.e. 0.5 ml. Onset of sensory/motor block, duration of sensory/motor block, duration of analgesia and side effects were noted. Results: Post-hoc bonferroni test was used for intercomparison of mean HR and MAP and significant difference was observed between them. The mean onset of Sensory Block was 3.510.50, mean Time to achieve maximum height of block (Minutes)was 10.630.59, Time to onset of regression at the level of L1 (minutes) was 187.4522.61, mean Motor Block-Time to modified Bromage score 3 was 6.120.84 and Motor Block - Time to complete recovery (minutes) was 173.1434.26. The mean Time to complete analgesia (in minutes) was 401.0616.91 and mean Time to effective analgesia (in minutes) was 415.2516.70. Conclusion: The present study concludes that addition of dexmedetomidine with Ropivacaine provides faster onset of sensory/motor block.
Journal of Evolution of Medical and Dental Sciences, 2016
BACKGROUND Spinal anaesthesia was introduced in clinical practice by Karl August Bier in 1898. More than a century has passed and even today, it is one of the most popular techniques for both elective and emergency surgical procedures, particularly caesarean section, lower abdominal surgeries, orthopaedic and urological surgeries. The aim of this study was to compare the onset and height of sensory and motor block, haemodynamics, duration of analgesia in post-operative period, number of rescue analgesic epidural doses administered in 24 hours and record complications. Settings and Design-This was a prospective, randomised and single blind study conducted on 60 patients divided in 2 groups viz. Group RD and RN. MATERIALS AND METHODS Group RN received 15 mL of 0.75% ropivacaine with 5 microgram/kg Inj. Neostigmine while Group RD received 15 mL of 0.75% ropivacaine with 1 microgram/kg of Inj. Dexmedetomidine. Statistical Analysis Used-Unpaired Student's t test and Z test. RESULTS Dexmedetomidine emerged as superior drug when compared to neostigmine as an adjunct with epidural ropivacaine 0.75% for patients undergoing lower limb surgery because it provides faster onset of anaesthesia, better intraoperative and postoperative analgesia and prolonged duration of motor and sensory blockade without significant increase in adverse effects. CONCLUSION Onset of sensory anaesthesia was faster with RD group (Ropivacaine and dexmedetomidine) in comparison with RN group (Ropivacaine and neostigmine). Maximum level of blockade achieved remains same. Time to attain maximum sensory level of T6-T7 and maximum motor blockade was faster when dexmedetomidine was used as additive when compared with neostigmine. Haemodynamic parameters remain unchanged during the surgery in both groups. Sedation was associated with epidural administration of both neostigmine and dexmedetomidine but more with dexmedetomidine. Dexmedetomidine emerged as superior drug when compared to neostigmine as an adjunct with epidural ropivacaine 0.75% for patients undergoing lower limb surgery and lower limb orthopaedic surgery because it provides faster onset of anaesthesia, better intraoperative and postoperative analgesia and prolonged duration of motor and sensory blockade without significant increase in adverse effects.
Journal of Evolution of Medical and Dental Sciences, 2017
BACKGROUND Epidural anaesthesia is one of the most common regional anaesthetic techniques used for lower abdominal and lower limb surgeries. Epidural anaesthesia provides effective surgical anaesthesia and can also achieve the extended duration of surgical needs, provides prolonged postoperative analgesia, lowers the incidence of haemodynamic changes. The quality and duration of analgesia is improved when a local anaesthetic is combined with alpha-2 adrenergic agonist as neuraxial adjuvants. The aim of our study is to compare the effect of Clonidine and Dexmedetomidine when used as an adjuvant to epidural Ropivacaine in lower abdominal and lower limb surgeries. MATERIALS AND METHODS A prospective randomised double blinded study was conducted in 60 patients of either sex between the ages of 20 and 60 years of (American Society of Anaesthesiologists) ASA I/II grade who underwent lower abdominal and lower limb surgeries. The patients were randomly allocated into two groups; Ropivacaine + Clonidine (RC) and Ropivacaine + Dexmedetomidine (RD) comprising of 30 patients each. Group RC received 15 mL of Ropivacaine (0.75%) with 75 µg Clonidine and group RD received 15 mL of Ropivacaine (0.75%) with Dexmedetomidine 50 µg epidurally. Onset of sensory analgesia using bilateral pin-prick method, onset of motor blockade using Bromage scale, time to two dermatome regression of sensory level, time to first demand for analgesia, intraoperative haemodynamic parameters and complications were observed. Statistical analysis was done by chi-square test for qualitative data and unpaired student t-test for quantitative data using statistical package for social science (SPSS) version 19 for windows and value of p<0.05 was considered significant and p<0.001 as highly significant. RESULTS The demographic profile and cardiorespiratory parameters were comparable and statistically non-significant in both the groups. The side effect profile was also comparable with a little higher incidence of nausea and dry mouth in both the groups which was again a non-significant entity (P>0.05). Dexmedetomidine group (RD) had rapid onset of sensory and motor blockade (p<0.05), prolonged duration of sensory and motor block (p<0.05) and postoperative analgesia (p<0.05). CONCLUSION Dexmedetomidine is a better neuraxial adjuvant to epidural Ropivacaine compared to clonidine for providing early onset and long duration of sensory analgesia and motor blockade, longer post-operative analgesia.
Wolters Kluwer - Medknow, 2020
Dexmedetomidine (DEX) can prolong duration of anesthesia and shorten onset of sensory and motor block relative to clonidine. This study attempted to compare the efficacy of intravenous DEX and clonidine for hemodynamic changes and block after spinal anesthesia with ropivacaine in lower limb orthopedic surgery. In a double-blind randomized clinical trial, 120 patients undergoing spinal anesthesia in lower limb orthopedic surgery were recruited and divided into three groups using balanced block randomization: DEX group (n = 40; intravenous DEX 0.2 μg/kg), clonidine group (n = 40; intravenous clonidine 0.4 μg/kg), and placebo group (n = 40; intravenous normal saline 10 mL) in which pain scores were assessed using visual analogue scales (at recovery, and 2, 4, 6, and 12 hours after surgery) and time to achieve and onset of sensory and motor block. Statistically significant differences were found in mean arterial pressure among the groups at all times except baseline (P = 0.001), with a less mean arterial pressure and a prolonged duration of sensory and motor block (P = 0.001) in the DEX group where pain relieved in patients immediately after surgery and at above mentioned time points (P = 0.001). Simultaneous administration of intravenous DEX with ropivacaine for spinal anesthesia prolongs the duration of sensory and motor block and relieves postoperative pain, and however, can decrease blood pressure. Although intravenous DEX as an adjuvant can be helpful during spinal anesthesia with ropivacaine, it should be taken with caution owing to a lowering of mean arterial pressure in patients especially in the older adults. This study was approved by Ethical Committee of Arak University of Medical Sciences (No. IR.Arakmu.Rec.1395.450) in March, 2017, and the trial was registered and approved by the Iranian Registry of Clinical Trials (IRCT No. IRCT2017092020258N60) in 2017. Key words: dexmedetomidine; intravenous clonidine; ropivacaine; spinal anesthesia; pain; visual analog scale; mean arterial pressure; motor block; sensory block
Archives of Anesthesiology and Critical Care (Spring 2024); 10(2): 131-137., 2024
Background: Dexmedetomidine and Fentanyl both possess hypnotic, sedative, analgesic properties and have been utilised as an additive in epidural anaesthesia. The purpose of this study is to compare the sedative and analgesic effects of Dexmedetomidine and Fentanyl when added epidurally with Ropivacaine (0.75%)during lower limb orthopaedic surgery. Methods: The study comprised of 60 patients, both male and female, aged 18 to 60, who had ASA classification I or II for tibia fibula surgery. Two groups of patients were split up at random: Group RD contains– Ropivacaine (0.75%) 15ml + Dexmedetomidine (1microgm/kg) 0.5ml + 0.5ml sterile water (Total volume-16ml) and Group RF - Ropivacaine 15ml (0.75%) + 1ml Fentanyl (1microgm/kg) (Total volume-16 ml). The epidural space was maintained 4 cm within and situated between L3 and L4 space. Investigations were conducted on parameters such as sensory and motor block features, sedation score, hemodynamic factors and pain assessment. Using the student `t` test, statistical analysis was performed using STATAIC13 software. Results: Onset of sensory analgesia at L1 and Complete sensory and motor blockage occurred much earlier in the RD group. Higher sedation scores and significantly prolonged postoperative analgesia was observed in RD group. Conclusion: Dexmedetomidine is a safer and more effective epidural adjuvant than fentanyl because it provides stable hemodynamics, extended post-operative analgesia, early onset and development of sensory and motor effects and sedation
INTRODUCTION: Regional anaesthesia is safe, cost-effective approach wherever feasible and also it is the technique of choice for providing excellent postoperative analgesia. Spinal anaesthesia, regional anaesthetic technique, the early-onset and sure success of the method, ease in technique but duration of anaesthesia and analgesia is limited. Epidural anaesthesia, has many advantages for a prolonged duration with frequent top-ups for delivering excellent postoperative analgesia. It contributes to intraoperative hemodynamic stability reduce perioperative stress response, decrease in complications and improving patient outcome by relieving postoperative pain, decreases the incidence of thromboembolic events. AIMS AND OBJECTIVES OF THE STUDY: To evaluate the efficacy of dexmedetomidine and clonidine, adjuvant to ropivacaine in epidural anaesthesia for lower abdominal and lower limb surgeries. Compare Onset and duration of sensory blockade, motor blockade, duration of analgesia, haemodynamic changes and side effects. MATERIALS AND METHODS: 60 patients aged between 18 and 60 belonging to ASA I and II divided into two groups, each group consist of 30 patients. Group RC: Receives 15ml of 0.75 % ropivacaine with 1 µg/kg clonidine. Group RD: Receives 15ml of 0.75 % ropivacaine with 1 µg/kg dexmedetomidine. Injected epidurally undergoing lower abdominal and lower limb surgeries. All patients are managed similarly and the effect of onset, duration of sensory, motor blockade, haemodynamic and complications are evaluated. Results obtained were tabulated and analysed. RESULTS: The onset and duration of sensory blockade were faster in group RD than group RC which was statistically significant. The onset and duration of Motor blockade is more intense and Sedation score is greater in RD group than RC group which is highly significant. Side effects are more with RD group than RC which are treatable. CONCLUSION: The addition of Dexmedetomidine to Ropivacaine for epidurally to shorten the onset of block and prolong the duration of block. The dosage of 1µg/kg used in the study significantly increase the duration of the analgesia.
Saudi Journal of Anaesthesia, 2015
cardio toxicity and lesser motor blockade. A slightly larger dose of ropivacaine may be required, but the addition of an adjuvant helps in the reduction of total required dose of local anesthetic and enhances the efficacy thereby providing increased duration and intensity of blockade. [6-8] The quality and duration of analgesia is improved when a local anesthetic is combined with alpha 2 adrenergic agonist. Both clonidine and dexmedetomidine are alpha 2 adrenergic agonists, which have analgesic properties and potentiate local anesthetic effects. [9-11] Neuraxial clonidine, enhances the action of local anesthetics, increases the intensity and duration of analgesia. It is known to have sedative properties and the side effects are hypotension and bradycardia. [12-15] Dexmedetomidine is about 8 times more selective towards the alpha 2 adrenoreceptor than clonidine and hence allows the use of higher doses with less α 1 effect. It has been found to have hemodynamic stability, sedative, anxiolytic, analgesic, neuroprotective and anesthetic sparing effect. It causes more intense motor blockade and cooperative sedation without increasing the incidence of side effects.
International Journal of Advanced Research in Biological Sciences (IJARBS), 2016
Background and Aims: Alpha (α-2) adrenergic agonists have both analgesic and sedative properties when used as an adjuvant in regional anesthesia. A prospective randomized double-blind study was carried out to evaluate the efficacy of epidural route and to compare the efficacy and clinical profile of dexmedetomidine and clonidine as an adjuvant to bupivacaine with special emphasis on their quality of analgesia, sedation and the ability to provide the smooth intra-operative and postoperative course. Material and Methods: The study was conducted in prospective, randomized and double-blind manner. It included 60 American Society of Anesthesiologists Class I and II patients undergoing lower limb surgery under epidural anesthesia. Patients were randomly divided into Group A receiving 0.5% isobaric bupivacaine 15 ml with dexmedetomidine 1 μg/kg and Group B receiving 0.5% isobaric bupivacaine 15 ml with clonidine 2 μg/kg epidurally. Onset and duration of sensory and motor blocks, duration of analgesia, sedation, and adverse effects were assessed. Results: Demographic data, surgical characteristics cardio-respiratory parameters, side-effect profile were comparable and statistically not significant in both the groups. However, sedation scores with dexmedetomidine were better than clonidine and turned out to be statistically significant. The onset times for sensory and motor blocks were significantly shorter in Group A as compared to Group B. The duration of analgesia and motor block was significantly longer in A Group as compared to Group B. Conclusion: Dexmedetomidine is a superior neuraxial adjuvant to bupivacaine when compared to clonidine for early onset of analgesia, superior intra-operative analgesia, stable cardio-respiratory parameters, prolonged postoperative analgesia and providing patient comfort.