Comparison of Epidural Dexmedetomidine and Neostigmine Used as Adjuvant to Ropivacaine in Lower Limb Surgeries

Arora, Major Vishal; Khan, Mohammad Zafeer; Bhadwal, Akritie; Choubey, Major Sanjay; Rasheed, Mohammad Asim; Sarkar, Arindam; Singh, Vivek

doi:10.14260/jemds/2016/1416

jemds

2016

DOI: 10.14260/jemds/2016/1416

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Comparison of Epidural Dexmedetomidine and Neostigmine Used as Adjuvant to Ropivacaine in Lower Limb Surgeries

Major Vishal Arora¹,

Mohammad Zafeer Khan²,

Akritie Bhadwal³

et al.

Abstract: BACKGROUNDSpinal anaesthesia was introduced in clinical practice by Karl August Bier in 1898. More than a century has passed and even today, it is one of the most popular techniques for both elective and emergency surgical procedures, particularly caesarean section, lower abdominal surgeries, orthopaedic and urological surgeries.The aim of this study was to compare the onset and height of sensory and motor block, haemodynamics, duration of analgesia in post-operative period, number of rescue analgesic epidural… Show more

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2017

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Dexmedetomidine as an Adjuvant to Epidural Ropivacaine in Lower Limb Surgeries- A Randomised Control Trial

Sarkar¹,

Chattopadhyay²,

Bhattacharya³

et al. 2017

jemds

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BACKGROUNDEpidural anaesthesia is now increasingly being used for lower limb surgeries for its certain advantages. Different adjuvants have been used with epidural ropivacaine to prolong the intraoperative and postoperative analgesia. Evidence is growing in favour of dexmedetomidine as an epidural adjuvant. Different doses of dexmedetomidine have been used with epidural ropivacaine with variable success in modifying the block characteristics and adverse event profile.The aim of the present study was to compare the block characteristics between epidural ropivacaine with dexmedetomidine (2 µg/kg) as adjuvant and epidural ropivacaine alone in patients undergoing lower limb surgeries. MATERIALS AND METHODSIn this randomised, double-blinded study, 88 adult patients of either sex, aged between 40-65 years, scheduled for elective lower limb surgery under epidural anaesthesia, were randomly allocated into two groups to receive either 0.75% ropivacaine alone (Group A) or dexmedetomidine (2 µg/kg) as an adjuvant to ropivacaine 0.75% (Group B) in epidural space. Data from 40 patients of each group were finally analysed. The time to achieve T6 sensory block (Primary outcome), time to reach maximum sensory block, time to achieve complete motor block, time to two-segment regression of sensory block and duration of analgesia were noted in all cases. The incidences of adverse events such as nausea, vomiting, hypotension, dry mouth, bradycardia, desaturation, respiratory depression, etc. were also noted. Statistical analysis was performed using independent sample Student's 't' test for normally distributed variables and Pearson Chi-square test for categorical data. The level of significance was set as P < 0.05. RESULTSThe time to achieve sensory block at T6 level in group B (9.45±1.04 minutes) was significantly shorter than group A (13.65±1.12 minutes), P<0.05. The time to achieve maximal sensory block and time to achieve complete motor block were also found shorter in dexmedetomidine group. Sensory block regressed later in dexmedetomidine group compared to control (157.03±7.87 versus 118.47±7.32 minutes, respectively, P <0.05). The time to first rescue epidural top-up was prolonged in dexmedetomidine group compared with ropivacaine alone group (346.12±17.29 versus 327.98±17.60 minutes, respectively). Incidences of adverse events were comparable. CONCLUSIONEpidural dexmedetomidine is a reliable adjuvant with ropivacaine (0.75%) to provide early onset of sensory block and longer duration of analgesia in lower limb surgeries.

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Dexmedetomidine as an Adjuvant to Epidural Ropivacaine in Lower Limb Surgeries- A Randomised Control Trial

Sarkar¹,

Chattopadhyay²,

Bhattacharya³

et al. 2017

jemds

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Comparison of Epidural Dexmedetomidine and Neostigmine Used as Adjuvant to Ropivacaine in Lower Limb Surgeries

Cited by 1 publication

References 19 publications

Dexmedetomidine as an Adjuvant to Epidural Ropivacaine in Lower Limb Surgeries- A Randomised Control Trial

Dexmedetomidine as an Adjuvant to Epidural Ropivacaine in Lower Limb Surgeries- A Randomised Control Trial

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