Anesthesia & Clinical (original) (raw)
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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.
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.
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.
The influence of preemptive spinal anesthesia on postoperative pain
Journal of Clinical Anesthesia, 2000
Israel-a government hospital. Measurements and Main Results: 30 ASA physical status I and II unpremedicated women undergoing elective total abdominal hysterectomy were randomly allocated into two groups of 15 patients each using a sealed envelope technique. Patients in Group 1 were given a subarachnoid injection of 12 mg hyperbaric bupivacaine and after 10 minutes general anesthesia was induced. Patients in Group 2 received only general anesthesia. Anesthesia was induced with midazolam and maintained with oxygen, N 2 O, isoflurane, and pancuronium. No opioids were given intraoperatively. Postoperatively patientcontrolled analgesia (PCA) with morphine was initiated in both groups (1 mg. mL Ϫ1 , bolus dose 1 mg, lockout interval 10 minutes, and background infusion 1 mg.mL Ϫ1) at patient first request for analgesic. Pain was assessed over 24 hours by cumulative morphine dose and visual analog score (VAS). Postoperative PCA morphine consumption at 2, 6, and 24 hours following patient first request for analgesic for Groups 1 and 2 were: 3.1 Ϯ 1 mg versus 7.2 Ϯ 3 mg (p ϭ 0.04), 13.4 Ϯ 2 mg versus 17.2 Ϯ 4 mg (p ϭ 0.03) and 35.9 Ϯ 8 mg versus 47.7 Ϯ 8 mg in Group 2 (p ϭ 0.04). VAS scores at 4, 6, 12, and 24 hours postoperatively were not significantly different between the two groups. Conclusions: Preoperative neural blockade may reduce postoperative analgesic requirements.
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.
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.
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.
Medical gas research, 2022
This trial-based paper strives to address the comparative efficacy of some ropivacaine adjuvant options, comprising dexmedetomidine, granisetron, and nitroglycerin, on pain and hemodynamic changes in intravenous anesthesia for forearm surgeries. This double-blind, placebo-controlled study enrolled four block-randomized eligible groups with patients (overall, n=128) undergoing orthopedic forearm surgeries in the dexmedetomidine, nitroglycerin, granisetron, and placebo groups. Intra- and post-operative vital signs (mean arterial pressure/heart rate/ oxygen saturation) were monitored at baseline and captured every 10 minutes until the end of the surgery, as well as the onset of sensory and motor block and length and duration of the block and mean opioid use within 24 hours. Lastly, pain was noted after tourniquet inflation (at 15, 30, and 45 minutes every 15 minutes until the end of surgery) and after deflation (every 30 minutes to 2 hours at 30, 60, 90, and 120 minutes), as well as 6, 12, and 24 hours after the tourniquet was deflated. The dexmedetomidine-sedated subjects appeared to demonstrate quicker onset and longer length and duration of sensory and motor block, plus less pain and opioid use at all scheduled times (both P = 0.0001). Dexmedetomidine is recommended as an adjuvant to regional anesthesia (Bier’s block), while being coupled with the rapid onset and prolonged length and duration of sensory and motor blocks, in addition to soothed pain and diminished opioid use within postoperative 24 hours. The study was approved by Ethics Committee of Arak University of Medical Sciences (approval No. IR.ARAKMU.REC.1398.112) on July 21, 2019, and registered at Iranian Registry of Clinical Trials (registration number IRCT20141209020258N123) on November 2, 2019.