Evaluation and comparison of intravenous clonidine and intravenous dexmedetomidine on duration of bupivacaine spinal anesthesia (original) (raw)
Related papers
Academia Anesthesiologica International
Background: Spinal anesthesia with bupivacaine is administered routinely for lower abdominal and lower limb surgeries. The ensuing nerve block is sufficient to ensure patient’s well being, while motor block facilitates the surgeon’s work. In patients receiving spinal anaesthesia, with local anesthetic agents like bupivacaine, the addition of another drug as adjuvant prolongs the analgesia. The present study is designed to study the effect of dexmedetomidine (D) and Clonidine (C) on the duration of motor and sensory block as well as postoperative analgesia by intrathecal bupivacaine in patients undergoing lower limb orthopedic surgery. Subjects and Methods: This study was carried out on 90 patients in the age group of 18 to 50 years, belonging to the American Society of Anesthesiologists(ASA) physical status I and II presenting for lower limb orthopedic surgery were included in the study. Patients were divided randomly into 3 groups. Group D received 1μg kg-1of dexmedetomidine, group...
Intravenous Dexmedetomidine vs. Intravenous Clonidine to Prolong Bupivacaine Spinal anaesthesia
Journal of Medical Science And clinical Research, 2019
Intrathecal adjutants are being used to prolong the action of spinal anesthesia. Most of the studies have been conducted using intrathecal clonidine. This is a randomized clinical trial conducted to compare the effects of intravenous clonidine and dexmedetomidine on 0.5% bupivacaine in prolonging action of spinal anaesthesia. Method: A prospective study of 120 patients undergoing lower limb and intra abdominal surgeries were divided into 3 groups: Group A-Received 0.9% saline infusion 20 minutes after spinal block. All patients received intravenous fluids as needed till the end of surgery. Group B-Received injection clonidine 2mcg/kg given as 20 minutes infusion started 20 minutes after spinal block and followed by a 0.9% saline drip till the end of surgery. Group C-Received an infusion of injection 1mcg/kg dexmedetomidine started 20 minutes after the spinal block and infused in 20 minutes, followed by 0.5mcg/kg/h dexmedetomidine drip till the end of surgery. Study was analyzed by Anova test. P value <0.05 was considered statistically significant. Results: Patient demographics were comparable in all groups. Duration of sensory blockade was longer with group C (in minutes) (325.74± 10.59) than group B (270.41±11.98) and group A (222.54±15.03), p value 0.001. Duration of motor blockade was longer with group C (270.97± 6.15) than group B (243.67±9.22) & group A (208±12.83), p value (0.001). Duration of analgesia was longer with group C (366.13± 0.19) than group B (300±12.65) and group A (252.51±8.80), p value (0.001). Dexmedetomidine has more incidence of bradycardia and hypotension than other two groups but without any major clinical impact. Conclusion: Intravenous dexmedetomidine and clonidine both prolongs action of spinal anaesthesia and postoperative analgesia than 0.5% hyperbaric bupivacaine. Dexmedetomidine has longer duration of action than Clonidine due to its alpha 2 receptor selectivity.
Adjuvants enhance and prolong analgesia, lower the dose requirements and reduce the dose dependent side effects of local anaesthetics but there is limited data comparing different alpha 2 agonists as intrathecal additives. This study aims to compare clonidine and dexmedetomidine as an adjuvant to 0.5% bupivacaine for spinal anaesthesia. Method: A total of 60 patients undergoing infraumbilical surgery under spinal anaesthesia were included in study. Patients were randomly assigned into following two groups. Group A (n=30)-patients received 12.5 mg (2.5ml) of 0.5% bupivacaine along with 50mcg of clonidine. Group B (n=30)-patients received 12.5 mg (2.5 ml) of 0.5% bupivacaine along with 5mcg of dexmedetomidine. Time to reach T10 dermatome, onset and duration of motor block, intraoperative hemodynamic changes and time to first postoperative rescue analgesia was noted. Result: The two groups assessed were comparable in terms of demographic profile, baseline hemodynamics, time of onset of sensory and motor block, duration of motor block. There was fall in Heart rate (HR) more in Group B and blood pressure (both systolic SBP and diastolic DBP) more in group A after spinal anaesthesia was administered with results being statistically significant (p< 0.05). Also, significant difference was seen in time to first postoperative rescue analgesia that is 330 and 311 minutes in Group B and A respectively. (p value < 0.001). Conclusion: Intrathecal dexmedetomidine provides longer duration of pain free period postoperatively with better hemodynamic stability than clonidine.
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.
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.
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.
International Journal of Advanced Research, 2022
Background : To evaluate the effect of low dose intrathecal dexmedetomidine and clonidine as adjuvant to bupivacaine on motor , sensory blockade and post operative analgesia . A total of 60 patients , scheduled for lower abdominal , lower limb and gynaecological procedures were selected to participate in this prospective , randomised double blind study . After injecting the drug time were noted (T0) and the patient were turned to supine position . Following observation were recorded : Duration of sensory block(T5) , Duration of motor block (T6) , Time for rescue analgesia(T7) were noted , Pain was assessed using the Visual Analogue Score (VAS)(0:no pain, 10:maximum pain). Results : The results of outcome variables were suggestive of improved effect of addition of clonidine or dexmedetomidine as adjuvant to 0.5 % Bupivacaine (heavy) on duration of sensory block , duration of motor block , post operative analgesia . Conclusions : Increased duration of both motor , sensory block and po...
Is dexmedetomidine a better sedative agent than clonidine in spinal anesthesia
Background and Aims: Regional anesthesia offers benefits to patients and anesthetists by keeping the patients awake, preserving the airway reflexes, by providing cardiovascular stability during the procedure and fast postoperative recovery. Patients are often uncomfortable, because of pain at puncture site, recall of procedure and limited duration of blockade. Alpha-2 adrenoreceptor agonists were introduced in anesthesia for their sedative and analgesic effects. The aim of this study was to compare the effects of intravenous dexmedetomidine or clonidine as adjuvants during bupivacaine spinal anesthesia. Methodology: A prospective, randomized study was conducted involving 120 patients scheduled for elective infraumbilical surgery under spinal anesthesia. Patients were randomly divided into three groups (n = 40) and were given the following drugs intravenously as per group allocation: Group A received 1 μg/kg of dexmedetomidine, followed by an infusion at the rate of 0.5 µg/kg/h; Group B received 1 μg/ kg of clonidine, followed by an infusion at rate of 1 µg/kg/h and Group C received normal saline bolus and infusion. Loading dose was given over 10 min, prior to (SAB), followed by a maintenance infusion. Ramsay sedation score of 3-4 was considered as target sedation. Patients were assessed for time required to achieve target sedation, prolongation of analgesia and motor blockade. The hemodynamic parameters and side effects were also observed. Results: The target sedation was achieved significantly earlier in Group A (14.32 ± 5.25 min) as compared to Group B (30.01 ± 2.33 min) (P = 0.001). In Group A, the mean duration of analgesia was 208.25 ± 28.29 min as compared to 169.75 ± 20.15 min in Group B and 135.25 ± 22.60 min in Group C (P < 0.05). Duration of motor blockade was increased in Group A (217 ± 24.697 min) as compared to Group B and C. Conclusion: Intravenous dexmedetomidine infusion is better than intravenous clonidine as it provides earlier onset of adequate sedation along with prolongation of analgesia and motor blockade during bupivacaine spinal anesthesia.
International Journal of Health Sciences and Research, 2014
Background: Prolongation of spinal analgesia extends not only the duration of surgical anaesthesia but also provides postoperative analgesia. The effects of adjuvants like dexmedetomidine and magnesium sulphate to intrathecal bupivacaine are compared in this study. Materials and Methods: In a prospective randomized double-blinded placebo-controlled study, 90 adult patients of American Society of Anaesthesiologists (ASA) physical status I and II scheduled for lower abdominal and lower limb surgeries were randomly allocated to one of three groups: Group-D (n=30) received 12.5mg(2.5ml) hyperbaric bupivacaine 0.5% plus 10µg (0.1ml) dexmedetomidine, Group-M(n=30) received 12.5mg(2.5ml) hyperbaric bupivacaine plus 50mg (0.1ml) magnesium sulphate 50%, and Group-C (n=30) received 12.5mg (2.5ml) hyperbaric bupivacaine plus 0.1ml normal saline 0.9% without preservative intrathecally. The onset times to reach T 10 sensory and Bromage 3 motor block, peak sensory block level, time to reach peak block, time to two segment regression, the regression times to reach S 1 sensory level and modified Bromage 0 motor scale, side-effects, and time to first analgesic request after surgery were assessed. Results: The onset time of sensory and motor blockade were significantly shortened in group D (2.53±0.57 min.) and prolonged in group M (8.00±1.29 min.) compared to group C (4.10±0.55 min.).Dexmedetomidine group showed significantly prolonged time to two segment regression (group D vs group M-132.33 ±12.51 min. vs. 91.83 ±9.69 min.; p<0.001) and significantly delayed time to first analgesic request (group D vs. group M-356.50±30.82 min vs 193.00±18.78min. p<0.001). Conclusion: Dexmedetomidine had faster onset of anesthesia and provided prolonged postoperative analgesia compared to magnesium sulphate.
2016
Introduction: There are studies which infer that spinal anaesthesia can be prolonged after adding adjuvants to local anaesthetics or by oral premedication before the block is performed. Aim of our study: To prolong the duration of spinal anaesthesia after the block has been performed. The study was done to compare the effects of intrathecal and intravenous clonidine on duration of spinal anaesthesia and to evaluate any advantages or disadvantages of intravenous over intrathecal clonidine in terms of analgesia, sedation, post–operative shivering and hemodynamic stability. Methodology: A prospective randomized double blind controlled comparative clinical study, was conducted on 60 patients, aged 20-60 years belonging to ASA I and II scheduled for elective infraumbilical procedures. Patient were divided into three groups of 20 each randomly, Group A-intrathecal bupivacaine (0.5% heavy) 3ml (15mg) + 75mcg of intrathecal clonidine, Group Bin -trathecal bupivacaine (0.5% heavy) 3ml (15mg) + 3 mcg/Kg of intravenous clonidine over 10min, Group C – (control group)-intrathecal bupivacaine (0.5% heavy) 3ml (15mg) + 0.5ml of normal saline, intrathecally in L3-L4 interspace with a 25G Quinke's needle. Intraoperatively the parameters noted were; Sensory characteristics-Time of onset of analgesia (T10), Maximum level of analgesia achieved, Time taken for maximum level of analgesia, Time for sensory block to regress to T10, Total duration of anal-gesia(rescue analgesic on patient demand). Motor characteristics-Time of onset of motor blockade (grade 1 bromage), Maximum grade of motor blockage achieved, Total duration of motor blockade (regression to Bromage-I), Hemodynamic monitoring, Sedation levels (OAA/Sscale) and Shivering episodes. Statistical software: The Statistical software namely SAS 9.2, SPSS 15.0, Stata 10.1, MedCalc 9.0.1, Systat 12.0 and R environment ver.2.11.1 were used for the analysis of the data and Microsoft word and Excel have been used to generate graphs, tables. Results: Intravenous clonidine after bupivacaine spinal anaesthesia has characterstics similar to and comparable with intrathecal clonidine with bupivacaine with an added advantage of significant. Intraoperative and post-operative sedation, Protection against postoperative shivering and Beneficial in prolonged surgeries.