Comparison of levobupivacaine and levobupivacaine with dexmedetomidine in infraumbilical surgeries under spinal anesthesia

Kataria, Amar Parkash; Jarewal, Vishal; Kumar, Rajan; Kashyap, Ankush

doi:10.4103/aer.aer_227_17

Cited by 5 publications

(5 citation statements)

References 16 publications

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“…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,…”

Section: Additional Analyses and Risk Of Bias Across Studiesmentioning

confidence: 99%

“…Eight studies provided data on this outcome (Figure 3) (Attri et al, 2015;Gautam et al, 2018;Kataria et al, 2018;Mohamed et al, 2012;Munnoli et al, 2016;Naaz et al, 2016;Patro et al, 2016;Rahimzadeh et al, 2018). The MD in pain scores was substantially heterogeneous (I 2 > 94%) at 6, 12 and 24 postoperative hours.…”

Section: Postoperative Pain Scoresmentioning

confidence: 99%

“…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).…”

Section: Block Characteristicsmentioning

confidence: 99%

“…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). 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).…”

Section: Block Characteristicsmentioning

confidence: 99%

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

Paramasivan

López-Olivo

Foong

et al. 2020

European Journal of Pain

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Background and Objective: A systematic review and meta-analysis of randomized controlled trials (RCTs) was undertaken to evaluate the effect of intrathecal dexmedetomidine (DEX) on the duration of postoperative analgesia, postoperative pain scores and incidences of adverse effects. Databases and Data Treatment: Database search was performed from inception until January 2019. All RCTs analysing acute postoperative pain characteristics after intrathecal DEX administration in adults undergoing spinal anaesthesia for elective surgery were included. The primary outcome was postoperative analgesic duration, defined as the time to first analgesic request. The secondary outcomes included pain scores at 6, 12 and 24 postoperative hours and rates of hypotension, bradycardia, shivering and postoperative nausea and vomiting. Results: Twenty-four studies comprising a total of 1,460 patients were included. Postoperative analgesic duration was prolonged with intrathecal DEX compared to placebo, with a pooled mean difference (MD) of 191.3 min (95% CI 168.8-213.8). Patients who received intrathecal DEX reported lower Visual Analogue Scale scores at 24 postoperative hours compared with those patients receiving placebo, with a MD (95% CI) of −1.05 (−1.89 to −0.20, p = 0.02). There were no differences in the incidence of adverse effects, except for a lower rate of postoperative shivering in the intrathecal DEX group (pooled relative risk 0.58, 95% CI 0.34-0.98, p = 0.04). Conclusions: Compared to placebo, intrathecal DEX prolonged postoperative analgesic duration, reduced 24-hr pain intensity and reduced the incidence of shivering without an increase in other adverse effects. Significance: The analgesic role of intrathecal DEX is promising due to its ability to significantly increase postoperative analgesic duration when compared with placebo. Its usage can be considered for patients undergoing surgeries with significant postoperative pain, particularly those intolerant of systemic analgesia. However, the optimal dose for various surgeries as well as its long-term neurological effects warrants further studies.

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Section: Additional Analyses and Risk Of Bias Across Studiesmentioning

confidence: 99%

Section: Postoperative Pain Scoresmentioning

confidence: 99%

Section: Block Characteristicsmentioning

confidence: 99%

Section: Block Characteristicsmentioning

confidence: 99%

See 2 more Smart Citations

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

Paramasivan

López-Olivo

Foong

et al. 2020

European Journal of Pain

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“…Because of its quick initiation and longer duration of sensory block, shorter duration of motor block, and reduced cardiac toxicity, levobupivacaine is a preferable local anaesthetic when compared to bupivacaine ( 16 ). Previous research indicated that combining dexmedetomidine with levobupivacaine generates efficient analgesia, extends duration of motor and sensory block, and offer superior postoperative analgesia with less detrimental effects ( 17 ).…”

Section: Discussionmentioning

confidence: 99%

Spinal Anaesthesia for Urological Surgery: A Comparison of Isobaric Solutions of Levobupivacaine and Ropivacaine with Dexmedetomidine

Kame

Kumar

Anand

2023

Ethiop J Health Sci

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BACKGROUND: Subarachnoid block is used in most of urological surgeries and finding the best possible drug has always been a challenge. Bupivacaine’s pure enantiomers ropivacaine and levobupivacaine have lesser systemic toxicity. Isobaric solution has extra benefit of not affecting the intrathecal dispersion of drug. Dexmedetomidine when added intrathecally provides longer duration of analgesia and anaesthesia. Aim of this study is to compare onset, duration of the block with both the drugs along with their hemostability and postoperative analgesia. METHODS: It is a Prospective Randomized Double-Blind Study. It includes 68 patients undergoing urological procedures under subarachnoid block. Group LD: Patients will receive 3.5 ml of Isobaric Levobupivacaine 0.5% + Dexmedetomidine 10 μg (0.1ml) Group RD: will receive 3.5ml of Isobaric Ropivacaine 0.5% + Dexmedetomidine 10 μg (0.1ml) RESULTS: Time taken for onset of sensory and motor block is significantly more in ropivacaine while duration of block is more in levobupivacaine. CONCLUSION: Addition of Dexmedetomidine to Isobaric Levobupivacaine significantly prolongs the duration of analgesia and anaesthesia compared to Ropivacaine and maintains stable hemodynamics. Ropivacaine is a suitable drug for day care whilst levobupivacaine is an excellent agent for longer surgeries. Dexmedetomidine is an effective non-opioid adjuvant which improves effectiveness of block without increasing the risk of side effects.

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Does dexmedetomidine combined with levobupivacaine in inferior alveolar nerve blocks among patients undergoing impacted third molar surgery control postoperative morbidity?

Patil

Jadhav

Bhola

et al. 2022

J Dent Anesth Pain Med

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Background Postoperative analgesia (POA) is an important determinant of successful treatment. Dexmedetomidine (DEX) has recently gained attention as a promising adjuvant to local anesthetics (LA). The present study aimed to evaluate the efficacy and safety of levobupivacaine (LB) as an adjuvant during inferior alveolar nerve block (IANB) in the extraction of lower impacted third molars (LITM). Methods A prospective, randomized, placebo-controlled, triple-blind, parallel-arm, and clinical study was performed on 50 systemically healthy participants who required removal of an asymptomatic LITM. Using a 1:1 distribution, the participants were randomized into two groups (n = 25). Group L (control group) received 1.8 mL of 0.5% LB and 0.2 mL normal saline (placebo) and Group D (study group) received a blend of 1.8 mL of 0.5% LB and 0.2 mL (20 µg) DEX. The primary outcome variable was the duration of POA and hemodynamic stability, and the secondary variable was the total number of analgesics required postoperatively for up to 72 h. The participants were requested to record the time of rescue analgesic use and the total number of rescue analgesics taken. The area under the curve was plotted for the total number of analgesics administered. The pain was evaluated using the visual analog scale. Data analysis was performed using paired students and unpaired t-test, Mann–Whitney U test, Chi-square test, and receiver operating characteristic analysis. Statistical significance was set at P < 0.05. Results The latency, profoundness of anesthesia, and duration of POA were statistically significant (P < 0.05). The differences between mean pain scores at 6, 12, 24, 48, and 72 h were found to be significant (each P = 0.0001). Fewer analgesics were required by participants in group D (2.12 ± 0.33) than in L (4.04 ± 0.67), with a significant difference (P = 0.0001). Conclusion Perineurally administered LA with DEX is a safe, effective, and therapeutic approach for improving latency, providing profound POA, and reducing the need for postoperative analgesia.

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Comparison of levobupivacaine and levobupivacaine with dexmedetomidine in infraumbilical surgeries under spinal anesthesia

Cited by 5 publications

References 16 publications

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

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

Spinal Anaesthesia for Urological Surgery: A Comparison of Isobaric Solutions of Levobupivacaine and Ropivacaine with Dexmedetomidine

Does dexmedetomidine combined with levobupivacaine in inferior alveolar nerve blocks among patients undergoing impacted third molar surgery control postoperative morbidity?

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