A comparative study of two doses of intrathecal dexmedetomidine 10 mcg and 15 mcg as adjuvants to 0.5% hyperbaric bupivacaine for abdominal hysterectomy: a randomized, prospective, double blind study Anjali R. Bhure, Ketaki S. Marodkar*, Sumita Bhargava Pramanik
INTRODUCTIONFear of uncontrolled postsurgical pain is a major concern of patients undergoing abdominal surgery. In an attempt to prevent occurrence of somatic and visceral pain in the intra-operative period and a to provide prolonged analgesia in the post-operative period, numerous neuraxial adjuvants are being used including NMDA antagonists (ketamine, magnesium), GABA agonists (midazolam) and adrenergic agonists (adrenaline), COXinhibitors (ketorolac) and Ach-esterase inhibitor (neostigmine). Though innumerable, each additive has certain specific disadvantage which limits their use in subarachnoid block.Striebel et al stressed upon the effect of α2 adrenergic agonist, Clonidine, on prolongation of analgesia and motor blockade when administered with local anaesthetic intrathecally. 1 Kanazi et al compared low doses of intrathecal clonidine and dexmedetomidine (3µg versus 30 µg) and concluded that the two drugs had equal effect on prolongation of motor and sensory block in these ABSTRACT Background: Neuraxial adjuvants have been used with local anaesthetics to avoid intraoperative pain, prolong the duration of anaesthesia, and avoid side effects and to provide adequate postoperative analgesia. Dexmedetomidine, a highly selective α2-agonist drug, is being routinely used nowadays as a neuraxial adjuvant. The aim of this study was to compare two doses of dexmedetomidine in terms of efficacy in prolonging the subarachnoid block as well as safety. Methods: In this prospective, randomized, double-blind, controlled study on 90 ASA I/II patients undergoing elective abdominal hysterectomy patients were randomly allocated to one of the three groups of 30 each, to receive subarachnoid block with 3.4 ml of 0.5% hyperbaric Bupivacaine along with either normal saline (S) or dexmedetomidine 10 µg (D 10) or dexmedetomidine 15 µg (D 15) and onset and duration of motor and sensory block were monitored along with two segment regression times, postoperative VAS scores and analgesic requirements and occurrence of any untoward effects. Results: Dexmedetomidine significantly decreased the onset times of sensory and motor blocks, prolonged time to two segment regressions, prolonged regression of motor and sensory blocks and time to first rescue analgesic in postoperative period. There was reduction in requirement of analgesics in both the dexmedetomidine groups. Effects were more pronounced in D 15 group than D 10 group. All three group patients were stable haemodynamically with only an insignificant number of patients having bradycardia and hypotension in the D 15 group. Conclusions: Thus dexmedetomidine prolongs the 0.5% hyperbaric Bupivacaine spinal anaesthesia duration. Prolongation of anaesthesia is in a dose dependent manner and groups are comparable in terms of safety pr...
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