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

Abstract

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.

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

“…So both the sensory and motor block onset was significantly earlier in group-D 10 than group-D 5 (p <0.05). Our results were quite similar to that of Esmaoglu et al, [28], who found onset of sensory and motor block were earlier in dexmedetomidine group in a statistically significant manner. Again Al-Mustafa et al, [18] also found that dexmedetomidine produced earlier onset of sensory and motor block in a dose dependent manner for the patients with urological operations.…”

“…Other side effects-including hypotension, nausea, vomiting, shivering though noted in both the groups but the difference was not statistically insignificant (p>0.05). Gupta et al, [19] and Esmaoglu et al, [28] also observed similar side effects without any significant difference among two groups.…”

“…Gupta et al, [19] found that sensory block regression was significantly slower with the addition of intrathecal dexmedetomidine as compared to ropivacaine alone, as both time to two segment regressions and time to S2 regression were significantly delayed with intrathecal dexmedetomidine. Esmaoglu et al, [28] also found that addition of dexmedetomidine to levobupivacaine caused a significant delay in sensory as well as motor block regression for the patients undergoing transurethral endoscopic surgery. Eid HEA et al, [29] in their study concluded that 15μg intrathecal dexmedetomidine along with bupivacaine significantly prolonged the time to two segment regression, sensory regression to S1 and regression of motor block to modified Bromage 0 in a dose dependent manner while compared with 10μg dexmedetomidine and saline control group [29].…”

A Study of Clonidine and Dexmedetomidine as Adjuvant to Epidural Levobupivacaine for Post Operative Analgesia in Infraumbilical Surgeries

“…They opined that dexmedetomidine was a good alternative to fentanyl for supplementation with low-dose levobupivacaine in spinal anaesthesia for knee arthroscopy [17] . Aliye Esmaoglu et al concluded that intrathecal dexmedetomidine addition to levobupivacaine for spinal anaesthesia shortens sensory and motor block onset time and prolongs block duration without any significant adverse effects [18] . Our study found similar findings using dexmedetomidine as adjuvant to epidural levobupivacaine.…”

Comparison of 3 Different Dexmedetomidine Doses and Their Effect on the Duration of Spinal Anesthesia

“…Different doses of Intrathecal Dexmedetomidine (from 2.5 to 15 μg (μg) has been tried in combination with different local anesthetics in humans to prolong the duration of the spinal anesthesia and to decrease the required local anesthetic doses [2,3,9,10].…”