Abstract
ObjectIn this study, we aimed to investigate the beneficial effects of dexmedetomidine on somato-visceral sensory block characteristcs, postoperative analgesia and stress response of intrathecal bupivacaine administration in women undergoing cesarean section, and to find out which dose is better.MethodsSixty parturients with the American Society of Anesthesiologists (ASA) physical status I or II were anesthetized with intrathecal bupivacaine(10mg) alone or in combination with dexmedetomidine (3 μg and 5 μg) to undergo cesarean section. The anesthetic parameters, postoperative analgesia and stress responses were monitored.ResultsCo-administration of dexmedetomidine(3 μg and 5 μg) prolonged the duration of motor and sensory block compared with bupivacaine(10mg) alone. Less supplemental dose of lidocaine and fentanyl were required in dexmedetomidine(3 μg and 5 μg) co-administration groups. Visceral traction response and abdominal muscle relaxation in operation were better in dexmedetomidine(3 μg and 5 μg) co-administration groups. No difference in haemodynamics was detected among groups. There was no significant difference in Apgar scores, neonatal umbilical pH, oxygen pressure, carbon dioxide pressure and lactate level among groups. Postoperative plasma IL-6 and cortisol levels were lower in dexmedetomidine(3 μg and 5 μg) co-administration groups. At 6 hour after operation the visual analogue scale (VAS) was smaller in dexmedetomidine(3 μg and 5 μg) co-administration groups. The uterine contraction pain at 6 and 12 hour after operation and supplemental analgesics had no difference across three groups. No difference of side effects(shivering, nausea and vomiting, itching), the first anal aerofluxus time and intraoperation tramadol dose were detected among the three groups.ConclusionThe use of dexmedetomidine especially at the dose of 3μg as an adjuvant to bupivacaine in cesarean surgery provides better intraoperative somato-visceral sensory block characteristcs and postoperative analgesia, which produced no influence on Apgar scores, side effects and stress response.
Highlights
Spinal anesthesia is commonly used in cesarean section surgery
Co-administration of dexmedetomidine(3 μg and 5 μg) prolonged the duration of motor and sensory block compared with bupivacaine(10mg) alone
Less supplemental dose of lidocaine and fentanyl were required in dexmedetomidine(3 μg and 5 μg) co-administration groups
Summary
Spinal anesthesia is commonly used in cesarean section surgery. Apart from being economical and easy to administer, spinal anesthesia provides both analgesia and muscular relaxation with rapid onset of action [1]. The administration of local anesthetics alone has a short duration of effect, and is insufficient for preventing visceral pain and nausea especially at an earlier stage [2,3,4]. Visceral pain is common during spinal anesthesia with mini dose local anesthetics. It is especially uncomfortable in cesarean surgery as the surgeons need to lift the uterus and suture the peritoneal during surgery. To overcome the defects of local anesthetics, joint administration of adjuvant drugs has become an widely accepted practice in clinical work
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