Dexmedetomidine as an intrathecal adjuvant for postoperative analgesia

Gupta, Rajni; Bogra, Jaishri; Verma, Reetu; Kohli, Monica; Kushwaha, Jitendra Kumar; Kumar, Sanjiv

doi:10.4103/0019-5049.84841

Cited by 103 publications

(84 citation statements)

References 16 publications

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“…Similar findings are observed by Mahendru et al .,[18] Gupta et al .,[19] and Al-Mustafa et al . [20] The quality of surgical anesthesia was excellent in both groups in the intraoperative period.…”

Section: Discussionsupporting

confidence: 92%

Comparison of dexmedetomidine and magnesium sulfate as adjuvants with ropivacaine for spinal anesthesia in infraumbilical surgeries and postoperative analgesia

et al. 2017

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Introduction:Postoperative pain is a major cause of fear and anxiety in hospitalized patients and so if patients remain pain-free during this period, they can cooperate with the circumstances well, leading to early recovery. Over the last two decades, there has been considerable revival of interest in the use of regional anesthesia techniques for surgery and pain management. As very few studies have been conducted using ropivacaine with dexmedetomidine and magnesium sulfate (MgSO4) as adjuvants, the present study was undertaken with primary aims to compare the hemodynamic stability, onset and duration of sensory and motor block and with secondary aims of the postoperative analgesic effect of dexmedetomidine and MgSO4 along with ropivacaine.Materials and Methods:After getting the Institutional Ethics Committee approval, this study was conducted on fifty patients of the American Society of Anesthesiologists physical Status I and II aged between 20 and 65 years of either sex and scheduled to undergo infraumbilical surgeries under spinal anesthesia. They were divided into two groups of 25 each. Group D patients received 3 ml of 0.75% isobaric ropivacaine hydrochloride with 10 μg of dexmedetomidine whereas Group M patients received 75 mg of MgSO4 in the place of dexmedetomidine. The quality of surgical analgesia and quality of intraoperative muscle relaxation were assessed and graded.Results:We found out that onset of sensory and motor block was earlier in Group D in comparison to Group M. There was a significant reduction in the time to the first rescue analgesia in group receiving intrathecal dexmedetomidine.Conclusion:It is concluded from our study that ropivacaine plus dexmedetomidine group are better than ropivacaine plus MgSO4 in providing early onset of sensory and motor block as well as in providing postoperative analgesia.

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Section: Discussionsupporting

confidence: 92%

Comparison of dexmedetomidine and magnesium sulfate as adjuvants with ropivacaine for spinal anesthesia in infraumbilical surgeries and postoperative analgesia

et al. 2017

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“…Although dexmedetomidine has been approved by the Food and Drug Administration as a sedative for mechanically-ventilated adult intensive care unit patients, it has not been approved for intrathecal use. However, dexmedetomidine used in neuraxial blocks in experimental and clinical studies without neurological deficits has encouraged the use of dexmedetomidine by the intrathecal route with levobupivacaine (2,(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). To the best of our knowledge, this combination has not been used previously by the intrathecal route in humans, which shows the importance of this study.…”

Section: Discussionmentioning

confidence: 92%

The Effects of Dexmedetomidine Added to Spinal Levobupivacaine for Transurethral Endoscopic Surgery

et al. 2013

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While spinal anaesthesia has many advantages, the limited duration of action appears to be one of its downsides. Intrathecal α 2 agonists prolong the duration of action of local anaesthetics and reduce the required dose. The intrathecal use of clonidine, a partial α 2 adrenoceptor agonist, has been shown as an effective and safe procedure (1, 2). Dexmedetomidine is an α 2 receptor agonist and its α 2 /α 1 selectivity is 8 times higher than that of clonidine. In animal models, intrathecal dexmedetomidine has been demonstrated to have an analgesic effect (3). Levobupivacaine is a long-acting local anaesthetic with a pharmacological structure similar to that of bupivacaine. Levobupivacaine has been shown to have a larger safety margin and less neurotoxic and cardiotoxic sideeffects than bupivacaine (4).In this study, we aimed to investigate the influences of dexmedetomidine added to levobupivacaine on the time of onset of spinal block and durations of sensory and motor blocks in patients undergoing transurethral endoscopic surgery by spinal anaesthesia. Materials and MethodsThe present prospective, randomised, double-blind study was approved by the Ethics committee of Erciyes University Medical Faculty, and written informed consent was obtained from the patients. The study was conducted according to the Declaration of Helsinki. Patients were aged between 50-80 years with ASA physical status I-III and were scheduled for elective transurethral endoscopic surgery under spinal anaesthesia. Using the sealed envelope method, the patients were randomly allocated into two groups: Group L (n=30) or Group LD (n=30). Patients who were taking α-adrenergic agonist or antagonist therapy, as well as patients who had labile hypertension, autoimmune disorders, a known allergy to study drugs, heart block/dysrhythmia or any contraindication to spinal anaesthesia were excluded from the study. Pharmacological premedication was not applied to patients. After arrival at the operating theatre, baseline systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR) measurements, peripheral oxygen saturation (SpO 2 ) and electrocardiography monitoring were measured by an ABSTRACTBackground: Intrathecal α2 agonists prolong the duration of action of local anesthetics and reduce the required dose. Dexmedetomidine is an α2 receptor agonist and its α2/α1 selectivity is 8 times higher than that of clonidine.

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“…Fifteen of the included trials reported on the effectiveness of dexmedetomidine on the prevention of perioperative shivering compared with placebo, 11 studies [22–30, 44, 45] administered via spinal route, and 4[36–39] researches via epidural route. Patients investigated in 5 trials [25, 38, 39, 44, 45] were nearly full term parturients selected for cesarean section.…”

Section: Resultsmentioning

confidence: 99%

Dexmedetomidine as a neuraxial adjuvant for prevention of perioperative shivering: Meta-analysis of randomized controlled trials

Zhang

Wang

et al. 2017

PLoS ONE

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BackgroundDexmedetomidine, a highly selective α2-adrenoceptor agonist, has been investigated for anti-shivering effects in some trials. This current meta-analysis was conducted to evaluate the effectiveness of dexmedetomidine as a neuraxial adjuvant in preventing perioperative shivering.MethodsThis systematic review and meta-analysis was registered in PROSPERO [www.crd.york.ac.uk/PROSPERO] with the unique identification number CRD42017055991. The electronic databases PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL) were searched to select high-quality randomized controlled trials (RCTs) that evaluated the anti-shivering efficacy for neuraxial application dexmedetomidine as local anesthetic adjuvant. Effects were summarized using pooled risk ratios (RRs), weighed mean differences (MDs), or standardized mean differences (SMDs) and corresponding 95% confidence intervals (Cls) with random effect model. Heterogeneity assessment, sensitivity analysis, and publication bias were performed. The primary outcome was perioperative shivering.ResultsA total of 1760 patients from 24 studies were included in this meta-analysis. Compared with the placebo, dexmedetomidine reduced the incidence of perioperative shivering (RR: 0.34; 95% Cl: 0.21 to 0.55; P < 0.00001), with a maximum effective dose of 5μg via subarachnoid space injection (RR: 0.55; 95% CI: 0.32 to 0.92; P = 0.02), especially in cesarean section (RR: 0.20; 95% CI: 0.09 to 0.45; P = 0.0001). Dexmedetomidine also could improve the characteristics of the block, with an increase only in the incidence of bradycardia (RR: 2.11; 95% CI: 1.23 to 3.60; P = 0.006). No significant difference could be found compared dexmedetomidine with other adjuvants, except morphine.ConclusionsThis meta-analysis shows that dexmedetomidine as a neuraxial adjuvant had statistically significant efficacy on prevention of perioperative shivering. Moreover, dexmedetomidine could improve the characteristics of the block. However, the potential induction of bradycardia should be taken seriously.

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Dexmedetomidine as an intrathecal adjuvant for postoperative analgesia

Cited by 103 publications

References 16 publications

Comparison of dexmedetomidine and magnesium sulfate as adjuvants with ropivacaine for spinal anesthesia in infraumbilical surgeries and postoperative analgesia

Comparison of dexmedetomidine and magnesium sulfate as adjuvants with ropivacaine for spinal anesthesia in infraumbilical surgeries and postoperative analgesia

The Effects of Dexmedetomidine Added to Spinal Levobupivacaine for Transurethral Endoscopic Surgery

Dexmedetomidine as a neuraxial adjuvant for prevention of perioperative shivering: Meta-analysis of randomized controlled trials

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