Low dose of dexmedetomidine as an adjuvant to bupivacaine in cesarean surgery provides better intraoperative somato-visceral sensory block characteristics and postoperative analgesia

Abstract

ObjectIn this study, we aimed to investigate the beneficial effects of dexmedetomidine on somato-visceral sensory block characteristcs, postoperative analgesia and stress response of intrathecal bupivacaine administration in women undergoing cesarean section, and to find out which dose is better.MethodsSixty parturients with the American Society of Anesthesiologists (ASA) physical status I or II were anesthetized with intrathecal bupivacaine(10mg) alone or in combination with dexmedetomidine (3 μg and 5 μg) to undergo cesarean section. The anesthetic parameters, postoperative analgesia and stress responses were monitored.ResultsCo-administration of dexmedetomidine(3 μg and 5 μg) prolonged the duration of motor and sensory block compared with bupivacaine(10mg) alone. Less supplemental dose of lidocaine and fentanyl were required in dexmedetomidine(3 μg and 5 μg) co-administration groups. Visceral traction response and abdominal muscle relaxation in operation were better in dexmedetomidine(3 μg and 5 μg) co-administration groups. No difference in haemodynamics was detected among groups. There was no significant difference in Apgar scores, neonatal umbilical pH, oxygen pressure, carbon dioxide pressure and lactate level among groups. Postoperative plasma IL-6 and cortisol levels were lower in dexmedetomidine(3 μg and 5 μg) co-administration groups. At 6 hour after operation the visual analogue scale (VAS) was smaller in dexmedetomidine(3 μg and 5 μg) co-administration groups. The uterine contraction pain at 6 and 12 hour after operation and supplemental analgesics had no difference across three groups. No difference of side effects(shivering, nausea and vomiting, itching), the first anal aerofluxus time and intraoperation tramadol dose were detected among the three groups.ConclusionThe use of dexmedetomidine especially at the dose of 3μg as an adjuvant to bupivacaine in cesarean surgery provides better intraoperative somato-visceral sensory block characteristcs and postoperative analgesia, which produced no influence on Apgar scores, side effects and stress response.

Addition of dexmedetomidine to epidural morphine to improve anesthesia and analgesia for cesarean section

“…1 People's Hospital (Jining, China). The effect of dexmedetomidine on visceral pain has also been demonstrated with epidural administration for labor analgesia (12) and with intrathecal administration for cesarean section (31). The similar sensory level at 20 min post-injection indicated that the addition of epidural dexmedetomidine may not affect the cephalad spread of ropivacaine, which was partly supported by Yousef et al (1) and Hanoura et al (2), who reported that epidural dexmedetomidine did not significantly reduce the time to onset of sensory and motor blockade, the time to reach the highest level of sensory block or the time to readiness for surgery, when combined with intrathecal bupivacaine, epidural bupivacaine and fentanyl.…”

Effect of Different Doses of Intrathecal Dexmedetomidine as an Adjuvant Combined With Hyperbaric Ropivacaine in Patients Undergoing Cesarean Section

“…But intrathecal opioids will increase nausea and vomiting (Weigl et al, 2017) and itching (Sun et al, 2001;Chen et al, 2010;Sun et al, 2017) that is an uncomfortable experience and prolong the recovery for the parturients after the surgery. Intrathecal dexmedetomidine, an a 2 -adrenergic receptor agonist used as an adjuvant to bupivacaine, has been found to provide better intraoperative nerve blockade than bupivacaine alone as well as prolong postoperative analgesia and alleviate shivering in patients undergoing cesarean section (Bi et al, 2017;He et al, 2017;Xia et al, 2018;Liu et al, 2019). And this minimal dose of intrathecal dexmedetomidine after absorbed into blood and metabolized by the liver may not cause potential fetal toxicity based on the previous studies (Bi et al, 2017;He et al, 2017;Xia et al, 2018;Liu et al, 2019).…”

“…Intrathecal dexmedetomidine, an a 2 -adrenergic receptor agonist used as an adjuvant to bupivacaine, has been found to provide better intraoperative nerve blockade than bupivacaine alone as well as prolong postoperative analgesia and alleviate shivering in patients undergoing cesarean section (Bi et al, 2017;He et al, 2017;Xia et al, 2018;Liu et al, 2019). And this minimal dose of intrathecal dexmedetomidine after absorbed into blood and metabolized by the liver may not cause potential fetal toxicity based on the previous studies (Bi et al, 2017;He et al, 2017;Xia et al, 2018;Liu et al, 2019). Zhou et al found that dexmedetomidine can reduce the traumatic stress response and immune suppression caused by surgery and has a protective effect on the spinal cord in spinal surgery (Zhou et al, 2017).…”

The Impact of Intrathecal Dexmedetomidine as an Adjuvant to Bupivacaine on Postoperative Pain

“…In the study by Bi et al (2017) all critical appraisal questions were scored "yes" except for one that asked if all the participants who entered the trial were accounted for at its conclusion. During the study if spinal anesthesia failed, participants would be excluded.…”