Comparing intravenous dexmedetomidine and clonidine in hemodynamic changes and block following spinal anesthesia with ropivacaine in lower limb orthopedic surgery: a randomized clinical trial (original) (raw)
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Wolters Kluwer - Medknow, 2019
The study aims to compare the efficacy of different doses of intrathecal dexmedetomidine on hemodynamic parameters and block characteristics after ropivacaine spinal anesthesia in lower-limb orthopedic surgery. In a double-blind trial, 90 patients undergoing spinal anesthesia for lower-limb orthopedic surgery were included and then randomly assigned to three groups; dexmedetomidine 5 μg/kg, dexmedetomidine 10 μg/kg and placebo. Blood pressure, heart rate, and oxygen saturation were recorded in the three groups at the first 15 minutes and then every 15 to 180 minutes at recovery by a resident anesthesiologist, as well as sensory-motor block onset. The visual analog scale scores for the assessment of pain were recorded at recovery, and 2, 4, 6, and 12 hours postoperatively and the data were analyzed by Stata software. The onset and time to achieve sensory block to ≥ T8 were faster in the 10 μg/kg dexmedetomidine group than the other groups (P = 0.001). The Bromage score was higher in the 10 μg/kg dexmedetomidine group (P = 0.0001) with lower pain score as compared with the 5 μg/kg dexmedetomidine and placebo groups (P = 0.0001). Therefore, an increase in dexmedetomidine hastens the onset of sensory-motor block but not causes side effects. This study was approved by the Ethical Committee of Arak University of Medical Sciences in 2017 (Ethical Code: IR.ARAKMU.REC.1396.37), and the trail was registered and approved by the Iranian Registry of Clinical Trials in 2017 (IRCT No. IRCT2017070614056N12). Key words: dexmedetomidine; ropivacaine; hemodynamic changes; block characteristics; blood pressure; heart rate; oxygen saturation; sensory block; motor block; randomized clinical trial
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.
innovative publication, 2017
Context: Alpha-2 agonists improve the block characteristics in regional anesthesia, when added to local anesthetics. Aim: To evaluate and compare efficacy of dexmedetomidine and clonidine, as an intravenous adjuvant to intrathecal bupivacaine. Settings and Design: Prospective, randomized, double-blind placebo-controlled study. Methods and Material: 75 patients of American Society of Anaesthesiologists status I or II, scheduled for orthopaedic lower limb surgery under spinal anaesthesia, were randomly allocated into three groups of 25 each. Patients in group D received dexmedetomidine 1μg/kg; group C received clonidine 2μg/kg and group PL received physiological saline, each premixed to 20 ml intravenously over 20 min, starting 20 min after the subarachnoid block with 15 mg of 0.5% hyperbaric bupivacaine. Duration of sensory and motor blockade, postoperative analgesia, sedation scores and side effects were recorded. Statistical analysis used: Parametric testing done using one-way analysis of variance (ANOVA), intergroup comparison with post-hoc analysis Tukey's test. Categorical data analyzed using Chi-square test. P< 0.05 was statistically significant. Results: Duration of sensory block was significantly prolonged by dexmedetomidine (231.20+24.84 min) and clonidine (200+23.67 min) than placebo (171+12.25 min) (p<0.001). Duration of motor block was 135.20+12.87 min with placebo, 180.40+24.70 min with clonidine and 205.20+25.56 min with dexmedetomidine (p<0.001). Postoperative analgesia was significantly prolonged by dexmedetomidine (255+23.14 min) than by clonidine (221.40+ 24.30 min) and placebo (202.60+14.08 min) (p<0.001). The mean sedation score was significantly higher in dexmedetomidine group. Conclusion: Single-dose intravenous dexmedetomidine and clonidine given after spinal anaesthesia prolong duration of sensory and motor block and postoperative analgesia. Key Messages: Alpha-2 agonists prove to be useful intravenous adjuncts to spinal anesthesia. They effectively prolong the duration or both sensory and motor block as well as postoperative analgesia, without any clinically significant adverse effects.
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.
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.
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...
Background: A lot of researches have been done to find an ideal adjuvant to ropivacaine in regional anaesthesia that inhibits intra and post operative pain and prolong the duration of anaesthesia without any side effects. was conducted to evaluate th dexmedetomidine when used as an adjuvant to ropivacaine in epidural anaesthesia in lower limb orthopaedic surgery. Materials and Methods: A prospective randomized stu anaesthesiologists' status I and II, posted for lower limb orthopaedic surgery. All patients were randomly allocated into two groups of 30 each; group I was ropivacaine group (RD). Group I (RC) patients received 16 ml of 0.75% ropivacaine and clonidine 2mcg/kg. Group II (RD) patients received 16 ml of 0.75% ropivacaine and dexmedetomidine 1.5mcg/kg. The onset, extent, duration of sens blocks, and side effects were recorded. earlier onset and longer duration of sensory and motor block. Sedation scores were statistically significant with RD group in comparison to RC group. RD group showed visible superiority over RC group in various post characteristics like the weaning of sensory and motor block, prolonged post Dexmedetomidine was a better alternative orthopaedic lower limb surgeries.
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.
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...