Effects of intravenous dexmedetomidine infusion on local anaesthetic block: A spinal anaesthesia clinical model in dogs undergoing hind limb surgery

Abstract

The aim of this randomised, prospective clinical trial was to determine how the administration of a low dose of dexmedetomidine (DEX) by IV constant rate infusion, modified the duration of the nerve block in dogs undergoing spinal anaesthesia (SA) in a clinical setting. Forty-four dogs undergoing hind limb orthopaedic surgery in a day-surgery regime, maintained under anaesthesia with isoflurane plus SA, were randomly assigned to receive 1 μg/kg/h (IV) of DEX (group D) or not (group C). Spinal anaesthesia was performed with a hyperbaric solution of bupivacaine and morphine at the L5–6 interspace. Every mean arterial pressure (MAP) increase by 30% above the pre-skin incision value was considered an intraoperative analgesic failure and treated with a bolus of fentanyl as intraoperative rescue analgesia (iRA). Time free from iRA was analysed with a Kaplan-Maier survival curve. The ability to walk at 5 h from SA and the event of bradycardia (HR lower 60 beat per min) and hypotension (MAP value lower 60 mmHg) were recorded. The mean times at which iRA was required were 77.4 (3.2) in group C and 112.2 (8.6) in group D (Logrank test P = 0.038). In groups C and D hypotension incidence was 11/17 (65%) and 2/22 (9%), (P = 0.0004) and bradycardia 3/17 (18%) and 6/22 (27%) (P = 0.704), respectively. The ability to walk 5 h after SA was 14/14 (100%) and 13/14 (93%) in groups C and D, respectively. DEX infusion significantly prolonged the duration of the nociceptive nervous block without prolonging the motor block or increasing the bradycardia events.