Effect of Dexmedetomidine on Post Operative Analgesia and Haemodynamics when added to Bupivacaine 0.5% in Epidural Block for Pelvic and Lower Limb Orthopedic Surgeries (original) (raw)
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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.
Background: The pain experienced after upper abdominal surgery leads to a reduction in 70-75% of vital capacity which leads to postoperative pulmonary complications. The ideal adjuvant for epidural analgesia in patients undergoing upper abdominal surgery seems to be every effective for better outcome and early immobilization in the immediate postoperative period. With this background we planned to conduct a study on epidural analgesia by comparing two alpha 2 agonists. Methods: 50 patients who have planned for elective upper abdominal surgery under general anaesthesia were enrolled in our study. Before induction of general anaesthesia, epidural catheterization was done. The surgical procedure was carried out under routine general anaesthesia with endotracheal controlled ventilation. The patients were given either Dexmedetomidine or Clonidine in the dosage of 2mcg/Kg with 0.125% Bupivacaine via epidural catheter after extubation. Patients were shifted to Post Anaesthesia Care Unit for observation. Sedation and pain were assessed with monitoring of vital parameters. The side effects were also noted. Results: Statistical analysis showed that the duration of analgesia was prolonged in the patients who received Dexmedetomidine as an adjuvant with local anaesthetic agent (417.32±67.36 minutes, p value < 0.05). The time to first rescue analgesia was comparatively delayed in Dexmedetomidine group while comparing with Clonidine group (425.6±64.27 minutes, p value < 0.05). The incidence of hypotension and bradycardia was greater in Clonidine group. There was no significant statistical difference with respect to side effects in both groups. Conclusion: From our study we concluded that Dexmedetomidine provides both analgesia and sedation with better hemodynamic status while compared to Clonidine used as adjuvants in epidural analgesia. But needs further study to optimize the dosage of these two adjuvants while giving via epidural route along with local anaesthetic agent.
Panacea Journal of Medical Sciences
Background: Requirement of anesthetic agents is reduced due to addition of adjuvants in epidural anaesthesia as they augment the local anesthetic action and have analgesic properties as well. Effective epidural analgesia ensures stable hemodynamics and satisfactory perioperative period. Objective: To evaluate efficacy of epidural clonidine compared to dexmedetomidine as adjuvants in postoperative analgesia Materials and Methods: Comparative, randomized clinical study was carried out among 100 subjects undergoing abdominal and vaginal hysterectomies of age 44-65 years with ASA grade I and II. They were divided randomly into two group of 50 each. Group A received 17ml of 0.5% of bupivacaine with 2mcg per kg clonidine. Group B received 17ml of 0.5% of bupivacaine with 1.5mcg per kg dexmedetomidine. Various parameters related to sensory and motor blockade, Ramsay sedation scale for sedation score, Hemodynamic parameters were monitored continuously and recordings were made at regular intervals. Results: Both groups were comparable in terms of age, weight, duration of surgery, ASA grades and type of surgery. Parameters pertaining to time for onset of sensory and motor block were significantly higher in clonidine group compared to the dexmedetomidine group (p<0.05). Postoperative block duration was significantly higher in dexmedetomidine group compared to clonidine group (p<0.05). The hemodynamic parameters and Ramsay sedation score at pre-operative and at 120min were comparable (p>0.05) between two groups except for heart rate which was significantly less in dexmedetomidine group at 120min compared to clonidine group (p<0.05). Conclusion: Dexmedetomidine added to bupivacaine epidurally prolonged postoperative analgesia longer than clonidine.
Southern African Journal of Anaesthesia and Analgesia, 2012
Background: The present study was a randomised controlled trial designed to evaluate the perioperative effect of epidural dexmedetomidine, in conjunction with intrathecal bupivacaine. Method: In this trial, 60 male patients of American Society of Anesthesiologists' grades I and II, between 20-50 years of age, and posted for elective lower limb orthopaedic surgery, were selected. After written informed consent was obtained and a thorough preanaesthetic checkup carried out, the patients were randomly divided into two groups using the manual envelope randomisation technique. Group I received 2.5 ml of 0.5% bupivacaine intrathecally, plus 10 ml normal saline (NS) epidurally (control). Group II received 2.5 ml of 0.5% bupivacaine intrathecally, plus 2.0 µg/kg dexmedetomidine epidurally, made up to 10 ml with NS (study). Results: We observed a significant prolongation in the duration of analgesia to 424.1 minutes (Group II) in patients receiving epidural dexmedetomidine, in comparison to 140.0 minutes in patients receiving saline (Group I). There was a significant fall in the pulse rate and mean arterial pressure five minutes following epidural dexmedetomidine in Group II patients, which lasted throughout the study period. The majority of the patients in Group II were sedated, yet arousable, by verbal commands or light tactile stimulus (sedation scale 3-4) 10 ± 5 minutes following administration of dexmedetomidine in the epidural space. This decrease in the level of consciousness lasted for 45 ± 5 minutes. Conclusion: The addition of 2 µg/kg dexmedetomidine epidurally to 2.5 ml of intrathecal bupivacaine prolongs the duration of analgesia, and decreases the requirement of rescue analgesics in patients undergoing lower-limb orthopaedic surgery, with a significant fall in pulse rate and mean arterial pressure.
Global Anesthesia and Perioperative Medicine, 2015
Background: Epidural block provides surgical anesthesia as well as post-operative analgesia in patients undergoing lower abdominal surgeries. Ropivacaine, is safe and effective for regional anesthetic techniques. Dexmedetomidine, alpha-2 agonist, as adjuvant to local anesthetic is reported to have synergistic effect for epidural anesthesia. The present study was designed with the aim to evaluate the efficacy and safety of dexmedetomidine as an adjuvant to epidural 0.75% ropivacaine in patients undergoing infraumbilical surgery. Method: Eighty adult consented patients 18-58 yr of age, of either sex, of ASA grade I/II undergoing infraumbilical surgeries were enrolled for the present study. Patients were randomised in two groups of 40 patients each: Group A received epidural ropivacaine only whereas Group B received epidural ropivacaine and dexmedetomidine. Patients of group A received 15 ml 0.75% ropivacaine + 1 ml Normal Saline and group B received 15 ml 0.75% ropivacaine + 0.6 µ kg-1 dexmedetomidine in 1 ml NS (group B) epidurally. Various block characterstics sensory onset time, time to complete motor block, time to two dermatome regression, duration of sensory analgesia and motor block, sedation scores, hemodynamic changes and any side effect were all recorded and statistically analysed by one way ANOVA and chi-square test. The p value<0.05 is considered significant and p<0.001 as highly significant. Results: The demographic profile of patients was comparable in both the groups. Onset of sensory block (2.50 ± 0.877 vs 7.00 ± 1.198 min) and establishment of complete motor blockade (17.20 ± 4.10 vs 23.90 ± 3.57 min) was significantly earlier in the ropivacaine with dexmedetomidine group. Postoperative analgesia was prolonged significantly in the ropivacaine with group (429.25 ± 58.34 min). Sedation scores were also higher in the dexmedetomidine group with statistically highly significant difference (p<0.001). Incidence of nausea, vomiting and shivering were were more in patients of ropivacaine alone group with statistically significant difference (p=0.003) Conclusion: Dexmedetomidine is effective adjuvant with ropivacaine for epidural block as it prolongs duration of motor block and analgesia with adequate sedation and minimal side effects.
Comparative Evaluation of Epidural Clonidine and Dexmedetomidine in Post Operative Analgesia
https://www.ijrrjournal.com/IJRR\_Vol.5\_Issue.10\_Oct2018/Abstract\_IJRR002.html, 2018
Background and Aims: Clonidine and dexmedetomidine are -2 adrenergic agonists with analgesic proprieties which potentiate local anesthetic effects when epidurally administered. The present study was undertaken with following aims: 1. To compare onset & duration of analgesia, incidence of side effects and complications of epidural clonidine and dexmedetomidine in post operative analgesia. 2. To study the potentiating effect of epidural clonidine /dexmedetomidine associated with ropivacaine (0.2%) 3. To know hemodynamics related to epidural clonidine and dexmedetomidine. Materials & Methods: After taking institutional approval and consent from patients, the study was carried out on 60 patients of A.S.A. grade I and grade II between 18-50 years. All patients were divided into two groups group 1 and 2 randomly. Group-1: received Ropivacaine 0.2% plus clonidine 1 mcg/kg Group-2: received Ropivacaine 0.2% plus dexmedetomidine 1 mcg/kg. Result: Statistically significant values were observed on comparison of post-operative block characteristics among the two groups (p < 0.001), both for time to two segment regression and time for first rescue top-up. Dexmedetomidine provided a smooth and prolonged post-operative analgesia as compared to clonidine. There was significant change in VAS score at 5 and 10 min post injection of drug in both groups as p value is <0.001 (very highly significant) at both time intervals, but mean VAS sore were higher in clonidine group in comparison to Dexmedetomidine group. There was decreasing trend of mean Pulse rate after 4 hours post injection & this decrease was very highly significant in the RC group (group 1) compared to RD group (group 2). The incidence of dry mouth was significantly higher in both the groups but it was statistically non-significant on comparison (P > 0.05). Conclusion: Dexmedetomidine is a better adjuvant than clonidine in epidural post operative analgesia as far as patient comfort, stable cardio-respiratory parameters, and post-operative analgesia is concerned.
2015
Epidural anaesthesia with adjuvants is the preferred method for intra and postoperative pain relief in lower abdominal and lower limb surgeries but search for ideal adjuvant without any side effect goes on. This study was conducted to evaluate the onset, extent and duration of sensory and motor block and side effects of clonidine or dexmedetomidine when used as an adjuvant in epidural anaesthesia in lower abdominal and lower limb surgery. 60 patients of ASA status I and II, posted for lower abdominal and lower limb orthopaedic surgery were randomly allocated into two groups of 30 each. Group I(LC group) patients received 18 ml of 0.5% levo bupivacaine and clonidine 2mcg/kg. Group II(LD group) patients received 18 ml of 0.5% levo bupivacaine and dexmedetomidine 1.5mcg/kg. Preoperative and postoperative block characteristics as well as hemodynamic parameters were observed and recorded. The results were Dexmedetomidine had an earlier onset and longer duration of sensory and motor block...
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.
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.