EFFECTIVENESS OF INTRATHECAL DEXMEDETOMIDINE IN COMBINATION WITH HYPERBARIC BUPIVACAINE FOR LOWER ABDOMINAL SURGERIES AND ITS POSTOPERATIVE ANALGESIC CHARACTERISTIC
AbstractBackground: Intra-thecal anaesthesia is the commonly preferred, block for surgeries of lower abdomen, perineal and lower limb. It is easy to administer and very economical but needs skills. Intrathecal use of local anaesthetics possesses a short duration of action and needs early use of rescue analgesia postoperatively. Objective was to assess the efficacy of Dexmedetomidine in adjuvant with bupivacaine for neuraxial anesthesia and postoperative analgesic characteristics. It was a prospective comparative study, conducted at Anesthesia Department, Liaquat National Hospital, Karachi from January to July 2020. Methods: Overall 100 patients conveniently recruited who underwent lower abdominal procedures were allocated into two groups’ by randomization, i.e., 50 in each group and were labeled as Group N and Group D10. Group N consist of 0.5% bupivacaine 10 mg (2 ml) + diluted with 0.5ml normal saline dilution and group D10 consist of 10μg Dexmedetomidine + 0.5% bupivacaine 10 mg (2ml) with 0.5 ml normal saline dilution, total 2.5 ml dose in each group. The duration of block and regression was evaluated. Results: The study showed significant differences in sensory and motor block to reach T10 and Bromage 3 respectively. Patients who were assigned in Group D reported short onset of sensory to reach T10 (5.4±1.17) and motor to reach Bromage 3 (10.4±1.03) as compared to Group N (9.9±2.12 and 17±22) respectively. Participants of Group D required rescue analgesia in less amount throughout intervals as compare to group N. Conclusion: The usage of 10ug Dexmedetomidine adjuvant with 0.5% bupivacaine significantly reduced the onset on sensory T10 and motor Bromage 3 and also prolong duration of sensory and motor regression, moreover minimal adverse effects and less use of rescue analgesic drugs were observed.
Borgeat A, Aguirre J. Update on local anesthetics. Curr Opin Anaesthesiol 2010;23(4):466–71.
Gautam B, Lama SM, Sharma M. Effects of Adding Intrathecal Dexmedetomidine to Hyperbaric Bupivacaine for Saddle Spinal Block in Adults Undergoing Peri-anal Surgeries. J Nepal Health Res Counc 2018;16(1):43–8.
Li YZ, Jiang Y, Lin H, Yang XP. Subarachnoid and epidural dexmedetomidine for the prevention of post-anesthetic shivering: a meta-analysis and systematic review. Drug Des Devel Ther 2019;13:3785–98.
Mohamed T, Susheela I, Balakrishnan BP, Kaniyil S. Dexmedetomidine as Adjuvant to Lower Doses of Intrathecal Bupivacaine for Lower Limb Orthopedic Surgeries. Anesth Essays Res 2017;11(3):681–5.
Weerink MAS, Struys M, Hannivoort LN, Barends CRM, Absalom AR, Colin P. Clinical Pharmacokinetics and Pharmacodynamics of Dexmedetomidine. Clin Pharmacokinet 2017;56(8):893–913.
Buhrer M, Mappes A, Lauber R, Stanski DR, Maitre PO. Dexmedetomidine decreases thiopental dose requirement and alters distribution pharmacokinetics. Anesthesiology 1994;80(6):1216–27.
Amornyotin S. Use of a combination of ketamine and dexmedetomidine (Ketodex) in different clinical cases. J Addict Med Ther Sci 2020;6(1):41–4.
Qinghua Dong,Chunlai Li,Fei Xiao,Yubo Xie. Efficacy and safety of dexmedetomidine in patients receiving mechanical ventilation: Evidence from randomized controlled trials. Pharmacol Res Perspect 2020;8(6):e00658.
Lee S. Dexmedetomidine: present and future directions. Korean J Anesthesiol 2019;72(4):323–30.
Asano T, Dohi S, Ohta S, Shimonaka H, Iida H. Antinociception by epidural and systemic alpha(2)-adrenoceptor agonists and their binding affinity in rat spinal cord and brain. Anesth Analg 2000;90(2):400–7.
Gupta A, Gupta KL, Yadav M. To evaluate the effect of addition of dexmedetomidine to hyperbaric bupivacaine intrathecally in infraumblical surgeries. Int J Contemp Med Res 2016;3(7):2136–8.
Yektas A, Belli E. The effects of 2 microg and 4 microg doses of dexmedetomidine in combination with intrathecal hyperbaric bupivacaine on spinal anesthesia and its postoperative analgesic characteristics. Pain Res Manag 2014;19(2):75–81.
Al-Mustafa MM, Abu-Halaweh SA, Aloweidi AS, Murshidi MM, Ammari BA, Awwad ZM, et al. Effect of dexmedetomidine added to spinal bupivacaine for urological procedures. Saudi Med J 2009;30(3):365–70.
Sun S, Wang J, Bao N, Chen Y, Wang J. Comparison of dexmedetomidine and fentanyl as local anesthetic adjuvants in spinal anesthesia: a systematic review and meta-analysis of randomized controlled trials. Drug Des Devel Ther 2017;11:3413–24.
Gousheh M, Akhondzadeh R, Rashidi M, Olapour A, Moftakhar F. Comparison of Dexmedetomidine and Morphine as Adjuvants to Bupivacaine for Epidural Anesthesia in Leg Fracture Surgery: A Randomized Clinical Trial. Anesth Pain Med 2019;9(4):e91480.
Mahendru V, Tewari A, Katyal S, Grewal A, Singh MR, Katyal R. A comparison of intrathecal dexmedetomidine, clonidine, and fentanyl as adjuvants to hyperbaric bupivacaine for lower limb surgery: A double blind controlled study. J Anaesthesiol Clin Pharmacol 2013;29(4):496–502.