Isobaric ropivacaine with or without dexmedetomidine for surgery of neck femur fracture under subarachnoid block

Abstract

Background and Aims:Dexmedetomidine has a promising role as an intrathecal adjuvant. However it's role as an adjuvant to ropivacaine has not been evaluated extensively. This study is designed to find out the effect of addition of dexmedetomidine 5 μg to isobaric ropivacaine 18.75 mg on block characteristics and hemodynamic parameters in patients undergoing surgeries for fracture neck of femur under subarachnoid block (SAB).Material and Methods:Sixty-one American Society of Anesthesiologists (ASA) Class I or II patients between 18–60 years undergoing surgeries for fracture neck of femur under SAB were recruited and randomized into two groups. Thirty patients in Group RN received 2.5 ml isobaric ropivacaine 0.75% (18.75 mg) with 0.5 ml normal saline (NS) to make a total volume of 3 ml, while 31 patients in Group RD received 2.5 ml isobaric ropivacaine 0.75% with dexmedetomidine 5 μg diluted with NS to make a total volume of 3 ml. The block characteristics, hemodynamic parameters, and side effects were recorded in both the groups.Results:Patients in Group RD had significantly longer duration of sensory block (202.90 ± 50.2 min) compared to Group RN (157.33 ± 31.6 min), P < 0.001. Time to first rescue analgesia request was significantly longer in the Group RD compared to Group RN (265.16 ± 71.4 min vs 203.67 ± 35.6 min, respectively) (P < 0.001). However, the sensory block onset, maximum block height, time to two dermatomal regression, and motor block intensity remained unaltered. Incidence of side effects like hypotension, bradycardia, nausea, vomiting, and shivering were statistically similar in both the groups.Conclusion:Addition of 5 μg dexmedetomidine enhances the analgesic effect of intrathecal 18.75 mg isobaric ropivacaine for the conduct of fracture neck of femur surgeries with minimal adverse events.

Dexmedetomidine as an adjuvant for single spinal anesthesia in patients undergoing cesarean section: a system review and meta-analysis

“…Recently, dexmedetomidine has been commonly applied as an assistant drug for a subarachnoid block during the perioperative period. [37][38][39] A previous meta-analysis by Liu et al 15 considered that the addition of dexmedetomidine could significantly reduce the onset time of spinal anesthesia. However, two trials 14,20 in that metaanalysis did not meet the inclusion criteria because of the combined spinal and epidural anesthesia.…”

“…Recently, dexmedetomidine has been commonly applied as an assistant drug for a subarachnoid block during the perioperative period. 37–39 A previous meta-analysis by Liu et al. 15 considered that the addition of dexmedetomidine could significantly reduce the onset time of spinal anesthesia.…”

Effects of Dexmedetomidine as an Analgesic Adjuvant for Surgery of Femur Fracture: A Systematic Review and Meta-Analysis

“…A total of 158 articles relevant to dexmedetomidine administration in patients undergoing femoral surgery were retrieved. Eventually, as shown in Figure 1, 4 studies with 222 patients were included in this meta-analysis according to the above criteria [15][16][17]20]. Baseline characteristics are shown in Table 1.…”

“…A reduction of doses of anesthetics is also expected to reduce adverse events. At present, a number of studies were conducted in patients with fracture of femur surgery to evaluate the efficacy and side effects of DEX as an adjuvant [15][16][17]. Some provided evidence that treatment with DEX exhibited analgesic and sedative effects, while others did not find the beneficial effect of DEX.…”