BACKGROUND:The prolongation of spinal anaesthesia by using clonidine through the oral, intravenous and spinal route has been known. The new alpha-2 agonist, dexmedetomidine has been proved to prolong the spinal anaesthesia through the intrathecal route. We hypothesized that dexmedetomidine when administered intravenously following spinal block also prolongs spinal analgesia. A placebo controlled randomized controlled trial study was done. METHODOLOGY: 50 Patients were randomly allocated into two equal groups group D and group C. Both group received spinal hyperbaric bupivacaine 15mg intrathecally. Patients in group D received intravenously a loading dose of 1mcg/kg dexmedetomidine over 10 min followed by C maintenance dose of 0.5mcg/kg/hr till the end of surgery. Patients in group C (The control group) received normal saline. The regression times to reach S1 sensory level and bromage 0 motor scale, hemodynamic changes and the level of sedation were recorded. RESULTS: The duration of sensory block was longer in intravenous dexmedetomidine group compared with control group (264.32+15.3 min vs 164.2+13.12 min, p 0.001). The duration of motor block was longer in dexmedetomidine group than control group (198.8+16.9 min vs 135.8+12.38 min, p 0.001) CONCLUSION: Intravenous dexmedetomidine administration prolonged the sensory and motor blocks of bupivacaine spinal analgesia with good sedation effect and hemodynamic stability. The incidence of bradycardia is significantly high when intravenous dexmedetomidine is used as an adjuvant to bupivacaine spinal anaesthesia. Dexmedetomidine induced bradycardia and hypotension can be easily managed with atropine and mephentermine respectively. Dexmedetomidine provides excellent sedation and postoperative analgesia.
HOW TO CITE THIS ARTICLE: H. L. Rani, I. Upendranath. "Comparative Study of Intravenous Dexmedetomidine Plus Intrathecal
ABSTRACT:Ropivacaine is an enantiomerically pure ('S' Enantiomer) amino amide new local Anesthetic, (1) producing decreased degree of motor block in heavily myelinated (Motor) fibres and faster onset of block in lightly myelinated (Sensory) fibres i.e., greater differential effect. Hence well suited to orthopaedic surgeries because a good sensory motor dissociation may facilitate early rehabilitation. Its pure left isomer and 3 dimensional structure, decreased lipid solubility has less toxic effects on CNS & CVS system. CONTEXT: Regional anaesthesia is noted for it's simplicity, safety and effectiveness. Anaesthesia with an efficient block, having least onset time and which can be prolonged with least complications is one of challenges faced by anaesthesiologist. Sub-arachnoid block is well known for its definitivity. AIM: To compare the onset and duration of 2 different concentrations of Ropivacaine i.e., 0.5% 3ml (15mg) Isobaric Ropivacaine and 0.75% 3ml (22.5mg) isobaric Ropivacaine given intrathecally for subrachnoid block in knee arthoscoy surgeries. (6)
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