Abstract
ObjectiveIn this study, we aim to investigate the effect of different doses of dexmedetomidine as an adjuvant to hyperbaric ropivacaine in spinal anesthesia for cesarean section.MethodsSeventy-five parturients with American Society of Anesthesiologists (ASA) I or II were anesthetized with intrathecal ropivacaine (12.5 mg) alone (R group) or in combination with dexmedetomidine 3 μg (RD3 group) and 5 μg (RD5 group) to undergo a cesarean section. The anesthetic parameters, postoperative analgesia, stress responses and neonates outcomes were monitored.ResultsThe onset time of sensory block to T10, T4, and peak level in the RD3 group and RD5 group were significantly shorter than those in the R group (p < 0.05). The time of the level of sensory block to descend two segments and to T10 in the RD3 group(57.28 ± 16.65 min, 3.87 ± 1.60 h) and RD5 group (71.92 ± 10.10 min, 3.99 ± 1.06 h) were longer than that in the R group (40.64 ± 12.06 min, 1.98 ± 1.01 h) (p < 0.05). The median time of motor blockade to both legs score 3 on the Bromage scale (B3B3) in the RD3 group and RD5 group was shorter than that in the R group (p < 0.001). The time of motor blockade recovery to both legs score 0 on the Bromage scale (B0B0) in the RD5 group (3.6 h) was longer than that in the R group (2 h) or RD3 group (2.2 h) (p < 0.001). Visceral traction response and abdominal muscle relaxation during the operation in the RD3 group and the RD5 group were better than that in the R group. The Visual Analogue Score (VAS) in the 12 h after the operation in the RD3 group (3.30 ± 1.17) and RD5 group (2.80 ± 0.87) was smaller than that in the R group (3.80 ± 1.47) (p < 0.05). The incidence of shivering in the RD3 group and RD5 group was significantly lower than that in the R group (p < 0.05). The postoperative concentrations of c-reactive protein (CRP), interleukin-6 (IL-6) and cortisol in the RD3 and RD5 groups were lower than that in the R group (p < 0.05).Conclusion3 µg intrathecal dexmedetomidine as an adjuvant to ropivacaine improved intraoperative somato-visceral sensory block characteristics and postoperative analgesia, alleviated shivering in parturients, and did not prolong the time of motor block or produce any side effects, which makes this dose appropriate for cesarean delivery.Cinical Trial RegistrationChiCTR, identifier ChiCTR1800014454. Registered 15 January 2018, http://www.chictr.org.cn/edit.aspx?pid=24613&htm=4
Highlights
Ropivacaine has a lower central nervous and cardiac toxic potential than bupivacaine
Several studies have been conducted to elucidate the efficacy of intrathecal ropivacaine with adjuvants such as fentanyl (Chung et al, 2002) and sufentanil (Sun et al, 2001; Chen et al, 2010) in cesarean delivery
Intrathecal dexmedetomidine, an a2-adrenergic receptor agonist used as an adjuvant to bupivacaine, has been found to provide better intraoperative nerve blockade than bupivacaine alone as well as prolong postoperative analgesia and alleviate shivering in patients undergoing cesarean section (Bi et al, 2017; He et al, 2017; Xia et al, 2018; Liu et al, 2019)
Summary
Ropivacaine has a lower central nervous and cardiac toxic potential than bupivacaine. Intrathecal dexmedetomidine, an a2-adrenergic receptor agonist used as an adjuvant to bupivacaine, has been found to provide better intraoperative nerve blockade than bupivacaine alone as well as prolong postoperative analgesia and alleviate shivering in patients undergoing cesarean section (Bi et al, 2017; He et al, 2017; Xia et al, 2018; Liu et al, 2019) This minimal dose of intrathecal dexmedetomidine after absorbed into blood and metabolized by the liver may not cause potential fetal toxicity based on the previous studies (Bi et al, 2017; He et al, 2017; Xia et al, 2018; Liu et al, 2019). Zhou et al found that dexmedetomidine can reduce the traumatic stress response and immune suppression caused by surgery and has a protective effect on the spinal cord in spinal surgery (Zhou et al, 2017)
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