Abstract
Background and objectives: Different adjuvants have been used to prolong intrathecal spinal anesthesia, with the possible advantages of delayed onset of post-operative pain, delayed and reduced analgesic requirements. The aim of this study was to evaluate the effect ofintravenous dexmedetomidine on prolongation of intrathecal spinal anesthesia, level of sedation, post-operative analgesic requirement. Methods: Ninety adult patients classified as American Society of Anaesthesiologists physical status (ASA) I or II scheduled for various elective surgical proceduresbelow umbilicus under intrathecal spinal anesthesia were doubleblind randomized to one of three groups. Each patient received 0.5% hyperbaric bupivacaine 2.5 ml intrathecal spinal anesthesia. Group C (control): Patient receiving intravenous normal saline 10 ml over 10 mins (as placebo) 10 minutes before intrathecal spinal anesthesia with 0.5% hyperbaric bupivacaine 2.5 ml and normal saline 10 ml over 10 mins (as placebo) after 30 minutes of spinal anesthesia. Group D1: Patient receiving intravenous dexmedetomidine 1 μg/kg over 10 mins, 10 minutes before intrathecal spinal anesthesia. Group D2: Patient receiving intravenous dexmedetomidine 1 μg/kg over 10 mins after 30 minutes of intrathecal spinal anesthesia. Results: Sensory block was higher in group D2 (T-4.1 ± 0.7) than D1 (T-4.5 ± 0.5) and C (T-6.3 ± 0.8). Time for sensory regression of two blocks was 145 ± 32, 142 ± 28 and 94 ± 26 min in group D2, D1 and C respectively. Duration of motor block was similar in all groups. GroupD2 and D1 increased the time to first request for postoperative analgesia by 190.3 ±13.3 and 174 ± 19.5 min whereas in group C 133.40 ±10.4 min. The maximum Ramsay sedation score was greater in the group D1 and D2 than in C. Conclusion: Intravenous dexmedetomidine prolonged spinal bupivacaine sensory blockade in both the groups. It also provided sedation and additional analgesia.
Highlights
Spinal anesthesia is a well-known technique used in surgical practice
GroupD2 and D1 increased the time to first request for postoperative analgesia by 190.3 ±13.3 and 174 ± 19.5 min whereas in group C 133.40 ±10.4 min
This was aprospective, randomized, and double-blind clinical studybased on assumption that intravenous dexmedetomidine, may prolong the duration of spinal anesthesia induced sedation and post-operative analgesia with minimal effect on cardiovascular and respiratory systems
Summary
Spinal anesthesia is a well-known technique used in surgical practice It may cause some discomfort either by the procedure itself or due to prolonged peri-operative period, requiring simultaneous administration of hypnotic, sedative or amnesic drugs. Dexmedetomidine highly selective alpha2-adrenergic agonists, better hypnotic, sedative, and analgesic It has been used safely for general anesthesia, postoperative analgesia and ISA without any respiratory depression [2]. A synergistic interaction between ISA dexmedetomidine and bupivacain has been observed in previous studies the literature on intravenous dexmedetomidine on the duration of sensory and motor block during ISA is scarce [5,6] This was aprospective, randomized, and double-blind clinical studybased on assumption that intravenous dexmedetomidine, may prolong the duration of spinal anesthesia induced sedation and post-operative analgesia with minimal effect on cardiovascular and respiratory systems. The aim of this study was to evaluate the effect ofintravenous dexmedetomidine on prolongation of intrathecal spinal anesthesia, level of sedation, post-operative analgesic requirement
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