Effect of Adding Dexmedetomidine versus Fentanyl to Intrathecal Bupivacaine on Spinal Block Characteristics in Gynecological Procedures: A Double Blind Controlled Study

Abstract

Problem statement:The purpose of this study was to evaluate the onset and duration of sensory and motor block as well as operative analgesia and adverse effects of Dex Metedo Midine (DXM) or fentanyl given intrathecally with plain 0.5% bupivacaine for spinal anesthesia. Approach: seventy six patients classified as American Society of Anesthesiologists (ASA) status I, II and III scheduled for vaginal hysterectomy, vaginal wall repair and tension free vaginal tape were prospectively studied. Patients were randomly allocated to receive intrathecally either 10 mg isobaric bupivacaine plus 5 µg dexmetedomidine (group D n = 38) or 10 mg isobaric bupivacaine plus 25 mg fentanyl (group F n = 38), the onset time to reach peak sensory and motor level, the regression time for sensory and motor block, hemodynamic changes, and side effects were recorded. Results: Patients in group D had significant longer sensory and motor block times than patients in group F. the mean time of sensory regression to S1 was 274±73 min in group D and 179±47 min in group F (P < 0.001). The regression time of motor block to reach modified Bromage 0 was 240±60 min in group D and 155±46 min in group F (P< 0.001). The onset times to reach T10 dermatome and to reach peak sensory level as well as onset time to reach modified Bromage 3 motor block were not significantly different between the two groups. Conclusion: In women undergoing vaginal reconstructive surgery under spinal analgesia, 10 mg plain bupivacaine supplemented with 5 µg dexmetedomidine produces prolonged motor and sensory block compared with 25 µg fentanyl.

Effect of Different Doses of Dexmedetomidine as Adjuvant in Bupivacaine -Induced Subarachnoid Block for Traumatized Lower Limb Orthopaedic Surgery: A Prospective, Double-Blinded and Randomized Controlled Study

“…Use of dexmedetomidine as an adjuvant mixed with local anaesthetics has been performed with neuraxial anesthesia in both adult and paediatric patients [17,27].…”

“…Dexmedetomidine is still under evaluation as an ideal neuraxial adjuvant as it provides stable hemodynamic conditions, good quality of intraoperative and prolonged postoperative analgesia with minimal side effects [16][17][18]. Kanazi et al, demonstrated a significant prolongation in the duration of sensory and motor block with dexmedetomidine used as intrathecal additive for 0.5% heavy bupivacaine [16].…”

“…Previous few other studies have described the intrathecal use of dexmedetomidine in a wide range (2-10 μg) [17][18][19][20].…”

Comparison of effect of intrathecal dexmedetomidine and clonidine as an adjuvant to hyperbaric bupivacaine in patients undergoing surgery for fracture femur and tibia

“…24 In other studies, it was observed that addition of various doses of clonidine to bupivacaine intrathecally significantly prolongs duration of analgesia of bupivacaine, 16,27,28 while others reported that addition of dexmedetomidine to bupivacaine significantly prolongs the duration sensory and motor block and post-operative analgesia. 23,25,[29][30][31] …”

Evaluation of efficacy of bupivacaine and bupivacaine plus clonidine in transversus abdominis plane (TAP) block for postoperative analgesia: a prospective, randomized, double blind, comparative study

“…23 The sedation effect of α2 agonist is postulated to be in the locus ceruleus (a bilateral nucleus that contains many adrenergic receptors) in the brainstem. The locus ceruleus is also the origination site for the descending medullospinal adrenergic pathway, which is known to be a key mechanism in regulating nociceptive neurotransmission.…”