Comparison of the Effect of Intrathecal Hyperbaric 0.5% Bupivacaine Alone and With Addition of Dexemedetomidine on First Analgesic Request in Post-Operative Care Unit Following Elective Cesarean Section

Muhammad Shahid,Raffat Shakil,Imtiaz Ahmed,Faizan Ahmad Ali,Asiya Sibtain,Bahauddin Khan,Mujahid Ul Islam

doi:10.54393/pbmj.v5i1.260

Abstract

Spinal anesthesia has been considered preferred method of anesthesia for patients undergoing elective cesarean sections. Dexmedetomidine (DXM) is relatively a newer drug in Pakistan as compared to conventional used drug i.e. Bupivacaine (BPV) and that’s why the local data regarding its efficacy in cesarean section is lacking. Objective: To compare the mean duration of spinal anasthesia between hyperbaric bupivacaine 0.5% alone versus hyperbaric bupivacaine 0.5% with dexmedetomidine on first analgesic request for women undergoing elective cesarean section under subarachnoid block Methods: Spinal anesthesia was performed in the sitting position under sterile conditions with 25G pencil point needle. After successful intra thecal injection, patient was placed in the supine position with left tilt. The cases in Group A received hyperbaric 0.5% BPV (2.25ml) with 5ug DXM (0.25ml) and those in Group B received only 0.5% BPV (2.25ml) with 0.25ml normal saline under full aseptic measures. These patients underwent cesarean section and were assessed in post-operative time after every 30 minutes to first request of analgesia which were given if there was pain of 4 or more on visual analogue scale. Results: In Group A, mean and SDs for duration of analgesia was 359.73+8.021 minutes. In Group B, mean and SDs for duration of analgesia was 182.30+7.720 minutes Conclusions: In this study, hyperbaric bupivacaine 0.5% with DXM in spinal anesthesia for patients undergoing caesarean section significantly prolonged the duration of analgesia

Highlights

Pain has been a scourge for humankind and much effort has been done to understand it and thereby control it
Data was strati ed for age, BMI, duration of surgery, American Society of Anesthesiologists (ASA) Class, parity, history of prior Csection to see its effect on outcome i.e. duration of analgesia with the help of independent sample t test and post strati cation p value ≤ 0.05 was considered as signi cant
In another study done by Kamat standard deviations (SDs) et al, mean duration of analgesia with BVP alone was seen as 187.32±16.45 as compared to 357.46±30.64 minutes with BVP with DXM which was in agreement to the ndings of this study, where in Group A, mean and SDs for duration of analgesia was 359.73+8.021

Summary

Introduction

Pain has been a scourge for humankind and much effort has been done to understand it and thereby control it. Due to increased dose requirement and less e cient pain control in post-operative care when used alone [4]. Intrathecal adjuvant such as ketamine, opioids, Alpha 2 agonists and neostigmine has been used to enhance the effect of spinal anesthesia [5,6]. DXM can effectively prolong the duration of spinal anesthesia and provide effective pain control in postop period. Opioids remain the mainstay among the various adjuvants to local anesthetics (LAs) in SAB primarily by virtue of its various properties such as reducing the dose of LA, minimizing side effects, and prolonging the duration of anesthesia [4]. It will be providing information to the other surgeons and anesthesiologists regarding the new drug, its e ciency and comparison with the conventional one

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Conclusion