A comparative study of dexmedetomidine and clonidine as an adjuvant to intrathecal bupivacaine in lower abdominal surgeries

Abstract

Context:Spinal block is the first choice for lower abdominal surgeries. Bupivacaine is the most common local anesthetic used but has a shorter duration of action. Many adjuvants have been used to improve the quality of analgesia till postoperative period. In this study, we used α2-agonists.Aims:The aim of this study is to compare the effects of intrathecal dexmedetomidine and clonidine as adjuvants to hyperbaric bupivacaine with respect to onset and duration of sensory and motor blockade duration of analgesia and incidence of side effects.Settings and Design:This was a prospective randomized double-blind study.Subjects and Methods:One hundred and fifty patients of physical status American Society of Anesthesiologists Classes I and II were randomly divided into Groups B, C, and D each administered with bupivacaine with normal saline, clonidine, and dexmedetomidine, respectively.Statistical Analysis Used:Data were entered into Microsoft excel data sheet. Analysis software used in this study was SPSS 22 version IBM. Categorical data were represented in the form of frequencies and proportions. Chi-square test was the test of significance. Continuous data were represented as mean and standard deviation. Independent t-test was used for mean difference between two groups. P < 0.05 was statistically significant.Results:Mean sensory onset in Group B was 2.8 ± 0.7 min, in Group C was 1.4 ± 0.5 min, and in Group D was 1.2 ± 0.4 min. Mean sensory regression by two segments in Group B was 78.5 ± 9.9 min, in Group C was 136.7 ± 10.7 min, and in Group D was 136.4 ± 11.7 min.Conclusions:α2-agonists with hyperbaric bupivacaine intrathecally have a faster onset of both motor and sensory block. It also prolongs the duration of analgesia.

The effect of dexmedetomidine and midazolam on combined spinal-epidural anesthesia in patients undergoing total knee arthroplasty

“…Accumulating data suggest that intravenous dexmedetomidine selectively prolonged the duration of sensory block without prolonging motor block, whereas perineural or intrathecal dexmedetomidine significantly prolonged the duration of motor block [ 19 ]. Another study showed that intravenous dexmedetomidine prolonged motor block as well as sensory block in spinal anesthesia, but the prolongation of motor block was less than that of sensory block [ 13 ].…”

Intrathecal dexmedetomidine and postoperative pain: A systematic review and meta‐analysis of randomized controlled trials

“…Duration of sensory blockade, defined in most studies as the time taken for the sensory blockade to regress to the S1 dermatome, was significantly longer in the DEX group in 15 out of 19 studies (Attri et al, 2015;Gupta et al, 2011;Kataria et al, 2018;Li et al, 2015;Mahendru et al, 2013;Munnoli et al, 2016;Naaz et al, 2016;Patro et al, 2016;Rahimzadeh et al, 2018;Ramaiah et al, 2015;Rao et al, 2015;Solanki et al, 2013;Sun et al, 2015;Suthar et al, 2015;Yektaş & Belli, 2014). Total duration of motor blockade, defined in most studies as the time taken for complete motor recovery (Bromage score 0), was significantly longer in the DEX group in 11 out of 21 studies (Attri et al, 2015;Ganesh & Krishnamurthy, 2018;Kataria et al, 2018;Mahendru et al, 2013;Munnoli et al, 2016;Patro et al, 2016;Rahimzadeh et al, 2018;Rao et al, 2015;Solanki et al, 2013;Suthar et al, 2015;Yektaş & Belli, 2014).…”

“…The majority of studies used loss of pinprick sensation and the Bromage scale to assess sensory and motor blockade, respectively. Time to onset of sensory block, defined in most studies as the time taken from intrathecal injection to loss of sensation at the T10 dermatome, was significantly faster in the DEX group in eight out of the twenty studies that reported this outcome (Attri et al, 2015;Ganesh & Krishnamurthy, 2018;Gautam et al, 2018;Kataria et al, 2018;Li et al, 2015;Naaz et al, 2016;Patro et al, 2016;Ramaiah et al, 2015). Onset of motor blockade, defined mostly as the time taken to reach a Bromage score of 3, was significantly faster in the DEX group in seven out of 18 studies (Attri et al, Patro et al, 2016;Ramaiah et al, 2015;Suthar et al, 2015).…”

“…In addition to comparing the effect of intrathecal DEX to placebo, six of the included studies (Ganesh & Krishnamurthy, 2018;Li et al, 2015;Mahendru et al, 2013;Munnoli et al, 2016;Solanki et al, 2013;Suthar et al, 2015) also investigated the effects of intrathecal clonidine with 30 mcg being the most common dose. Five (Li et al, 2015;Rahimzadeh et al, 2018;Rao et al, 2015;Shashikala et al, 2016;Sun et al, 2015) studied intrathecal fentanyl with 25 mcg being the most common dose.…”

“…Our searches retrieved 1,206 citations and after removal of duplicates, there were 674 unique citations. After review, a total of 24 RCTs met our selection criteria and were included in the final analysis (Attri, Bansal, Chatrath, Kaur, & Khetarpal, 2015;Chatterji, Gupta, Sharma, & Chatterji, 2017;Ganesh & Krishnamurthy, 2018;Gautam, Lama, & Sharma, 2018;Gupta et al, 2011;Kataria, Jarewal, Kumar, & Kashyap, 2018;Li et al, 2015;Mahendru et al, 2013;Mohamed, Fares, & Mohamed, 2012;Munnoli et al, 2016;Naaz, Bandey, Ozair, & Asghar, 2016;Nethra et al,…”