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Comparative evaluation of ropivacaine versus dexmedetomidine and ropivacaine in epidural anesthesia in lower limb orthopedic surgeries.

Kaur S, Attri JP, Kaur G, Singh TP - Saudi J Anaesth (2014)

Bottom Line: P < 0.05 was considered to be significant and P < 0.001 as highly significant.Sedation score was significantly more in Group B in the post-operative period.Epidural Dexmedetomidine as an adjuvant to Ropivacaine is associated with prolonged sensory and motor block, hemodynamic stability, prolonged postoperative analgesia and reduced demand for rescue analgesics when compared to plain Ropivacaine.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesia, Government Medical College, Amritsar, Punjab, India.

ABSTRACT

Background: Various adjuvant are being used with local anesthetics for prolongation of intra operative and postoperative analgesia in epidural block for lower limb surgeries. Dexmedetomidine, the highly selective α2 adrenergic agonist is a new neuroaxial adjuvant gaining popularity. The aim of the present study was to compare the hemodynamic, sedative and analgesia potentiating effects of epidurally administered dexmedetomidine when combined with ropivacaine.

Materials and methods: The study was conducted in prospective, randomized double-blind manner in which 100 patients of American Society of Anesthesiologist Grade I and II in the age group of 20-65 years of either sex under going lower limb surgeries were included after taking informed consent. The patients were randomly allocated into two groups of 50 each. Epidural anesthesia was given with 150 mg of 0.75% ropivacaine in Group A (n = 50) and 150 mg of 0.75% ropivacaine with dexmedetomidine (1 μg/kg) in Group B (n = 50). Two groups were compared with respect to hemodynamic changes, block characteristics which included time to onset of analgesia at T10, maximum sensory analgesic level, time to maximum sensory and motor block, time to regression at S1 dermatome and time to the first dose of rescue analgesia for 24 h. At the end of study, data was compiled and analyzed statistically using Chi-square test, Fisher's exact test and Student t-test. P < 0.05 was considered to be significant and P < 0.001 as highly significant.

Results: Significant difference was observed in relation to the duration of sensory block (375.20 ± 15.97 min in Group A and 535.18 ± 19.85 min in Group B [P - 0.000]), duration of motor block (259.80 ± 15.48 min in Group A and 385.92 ± 17.71 min in Group B [P - 0.000]), duration of post-operative analgesia (312.64 ± 16.21 min in Group A and 496.56 ± 16.08 min in Group B [P < 0.001]) and consequently low doses of rescue analgesia in Group B (1.44 ± 0.501) as compared to Group A (2.56 ± 0.67). Sedation score was significantly more in Group B in the post-operative period.

Conclusion: Epidural Dexmedetomidine as an adjuvant to Ropivacaine is associated with prolonged sensory and motor block, hemodynamic stability, prolonged postoperative analgesia and reduced demand for rescue analgesics when compared to plain Ropivacaine.

No MeSH data available.


Related in: MedlinePlus

Mean sedation score of Group A (n = 50) and Group B (n = 50)
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Figure 1: Mean sedation score of Group A (n = 50) and Group B (n = 50)

Mentions: VAS score was recorded intraoperatively and remained less than 3 in both the groups. In the postoperative period, mean VAS score in both the groups was zero for first 2 h. In Group A, VAS score increased more rapidly and patient demanded first dose of rescue analgesia (injection diclofenac sodium 75 mg I/M) between 4th and 5th h (mean VAS was 2.93 ± 1.04 and 3.13 ± 1.00 respectively). At 5th h, mean VAS score in Group A was 3.13 ± 1.00 and in Group B was 0.57 ± 0.62 and the difference between the two groups was highly significant (P = 0.00). In Group B, VAS started increasing at 4th h (0.10 ± 0.30) and patient demanded first dose of rescue analgesia (injection diclofenac sodium 75 mg I/M) between 8th and 9th h (mean VAS was 3.03 ± 1.21 and 3.27 ± 0.78 respectively). Thus requirement of rescue analgesia was delayed in Group B as compared to Group A. In Group A, VAS again increased to more than three between 11th and 12th h (mean VAS 3.45 ± 0.57 and 3.03 ± 1.21 respectively) and injection tramadol 50 mg slow intravenously was given as rescue analgesia. After injection tramadol patients were pain free for 4-5 h and third dose of rescue analgesia (injection diclofenac sodium 75 mg) was given between 18th and 19th h postoperatively. In Group B, after first dose of rescue analgesia VAS decreased to less than three and patients remained pain free for 10-11 h. Second dose of rescue analgesia (diclofenac sodium) was given between 18 and 21 h. At 24 h, mean VAS in Group A was 2.86 ± 0.78 and in Group B was 2.40 ± 0.17 and the difference was statistically significant (P = 0.03). The mean time at which patients demanded first dose of rescue analgesia was delayed in Dexmedetomidine group (496.56 ± 16.086 min) as compared to plain Ropivacaine group (312.64 ± 16.217 min) (P < 0.001). Patients in Group B also required significantly less doses of rescue analgesia as compared to Group A (1.44 ± 0.501 vs. 2.56 ± 0.675) in the post-operative period (P < 0.001). None of the patient in Group B required opioids (injection tramadol) as rescue analgesia in the postoperative period. The mean sedation score was measured at an interval of 10 min for first 30 min. During this interval, patients in both the groups had sedation score in the range of 1-2 and were comparable. After 30 min, sedation score started increasing gradually in Group B (2-3) as compared to Group A (1) and the difference was highly significant in this period (P < 0.001) [Figure 1]. After 180 min sedation score gradually decreased in Group B and was again comparable in both the groups. Hemodynamic parameters remained stable at all measured intervals and were comparable in both the groups [Figure 2]. Only 2 (4%) patients in Group A and 5 (10%) patients in Group B had Bradycardia during first 40 min and was treated by giving injection atropine 0.6 mg intravenously. Later on heart rate remained stable in both the groups. Among 50 patients, 2 (4%) patients in Group A and 4 (8%) patients in Group B had fall in blood pressure (SBP <90 mm of Hg) during first 40 min interval which was corrected by giving oxygen and intravenous fluids. Only 1 (2%) patient in Group A and 3 (6%) patients in Group B required injection ephedrine hydrochloride intravenously and the dose difference was not statistically significant (P > 0.05). Ephedrine was given as 5 mg bolus and repeated according to blood pressure and total Ephedrine given in Group A was 10 mg and in Group B was 15 mg. Later on blood pressure remained stable at all measured intervals. Difference in incidence of nausea was not significant (P = 0.609) as it occurred in 1 (2%) patient in Group A and 3 (6%) patients in Group B during first 40 min. This could be due to fall in blood pressure in these patients as it was relieved by oxygen and stabilization of blood pressure. In the present study incidence of urinary retention could not be compared as patients were catheterized in both groups. None of the patients had respiratory depression, pruritis, dry mouth, headache or backache in both groups in the postoperative period. In Dexmedetomidine group quality of surgical analgesia was excellent in all 50 (100%) patients. In plain Ropivacaine group, in 45 (90%) patients quality of surgical analgesia was excellent and in 5 (10%) patients it was good. In these five patients duration of surgery was more than 2½ h and these patients required injection tramadol 50-100 mg intravenously as supplementary analgesia during intra operative period. The mean of patient satisfaction score in Group A was 3.96 ± 0.968 and in Group B was 4.42 ± 0.498. The difference in the patient satisfaction score in the two groups was found to be statistically significant (P = 0.003).


Comparative evaluation of ropivacaine versus dexmedetomidine and ropivacaine in epidural anesthesia in lower limb orthopedic surgeries.

Kaur S, Attri JP, Kaur G, Singh TP - Saudi J Anaesth (2014)

Mean sedation score of Group A (n = 50) and Group B (n = 50)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4236931&req=5

Figure 1: Mean sedation score of Group A (n = 50) and Group B (n = 50)
Mentions: VAS score was recorded intraoperatively and remained less than 3 in both the groups. In the postoperative period, mean VAS score in both the groups was zero for first 2 h. In Group A, VAS score increased more rapidly and patient demanded first dose of rescue analgesia (injection diclofenac sodium 75 mg I/M) between 4th and 5th h (mean VAS was 2.93 ± 1.04 and 3.13 ± 1.00 respectively). At 5th h, mean VAS score in Group A was 3.13 ± 1.00 and in Group B was 0.57 ± 0.62 and the difference between the two groups was highly significant (P = 0.00). In Group B, VAS started increasing at 4th h (0.10 ± 0.30) and patient demanded first dose of rescue analgesia (injection diclofenac sodium 75 mg I/M) between 8th and 9th h (mean VAS was 3.03 ± 1.21 and 3.27 ± 0.78 respectively). Thus requirement of rescue analgesia was delayed in Group B as compared to Group A. In Group A, VAS again increased to more than three between 11th and 12th h (mean VAS 3.45 ± 0.57 and 3.03 ± 1.21 respectively) and injection tramadol 50 mg slow intravenously was given as rescue analgesia. After injection tramadol patients were pain free for 4-5 h and third dose of rescue analgesia (injection diclofenac sodium 75 mg) was given between 18th and 19th h postoperatively. In Group B, after first dose of rescue analgesia VAS decreased to less than three and patients remained pain free for 10-11 h. Second dose of rescue analgesia (diclofenac sodium) was given between 18 and 21 h. At 24 h, mean VAS in Group A was 2.86 ± 0.78 and in Group B was 2.40 ± 0.17 and the difference was statistically significant (P = 0.03). The mean time at which patients demanded first dose of rescue analgesia was delayed in Dexmedetomidine group (496.56 ± 16.086 min) as compared to plain Ropivacaine group (312.64 ± 16.217 min) (P < 0.001). Patients in Group B also required significantly less doses of rescue analgesia as compared to Group A (1.44 ± 0.501 vs. 2.56 ± 0.675) in the post-operative period (P < 0.001). None of the patient in Group B required opioids (injection tramadol) as rescue analgesia in the postoperative period. The mean sedation score was measured at an interval of 10 min for first 30 min. During this interval, patients in both the groups had sedation score in the range of 1-2 and were comparable. After 30 min, sedation score started increasing gradually in Group B (2-3) as compared to Group A (1) and the difference was highly significant in this period (P < 0.001) [Figure 1]. After 180 min sedation score gradually decreased in Group B and was again comparable in both the groups. Hemodynamic parameters remained stable at all measured intervals and were comparable in both the groups [Figure 2]. Only 2 (4%) patients in Group A and 5 (10%) patients in Group B had Bradycardia during first 40 min and was treated by giving injection atropine 0.6 mg intravenously. Later on heart rate remained stable in both the groups. Among 50 patients, 2 (4%) patients in Group A and 4 (8%) patients in Group B had fall in blood pressure (SBP <90 mm of Hg) during first 40 min interval which was corrected by giving oxygen and intravenous fluids. Only 1 (2%) patient in Group A and 3 (6%) patients in Group B required injection ephedrine hydrochloride intravenously and the dose difference was not statistically significant (P > 0.05). Ephedrine was given as 5 mg bolus and repeated according to blood pressure and total Ephedrine given in Group A was 10 mg and in Group B was 15 mg. Later on blood pressure remained stable at all measured intervals. Difference in incidence of nausea was not significant (P = 0.609) as it occurred in 1 (2%) patient in Group A and 3 (6%) patients in Group B during first 40 min. This could be due to fall in blood pressure in these patients as it was relieved by oxygen and stabilization of blood pressure. In the present study incidence of urinary retention could not be compared as patients were catheterized in both groups. None of the patients had respiratory depression, pruritis, dry mouth, headache or backache in both groups in the postoperative period. In Dexmedetomidine group quality of surgical analgesia was excellent in all 50 (100%) patients. In plain Ropivacaine group, in 45 (90%) patients quality of surgical analgesia was excellent and in 5 (10%) patients it was good. In these five patients duration of surgery was more than 2½ h and these patients required injection tramadol 50-100 mg intravenously as supplementary analgesia during intra operative period. The mean of patient satisfaction score in Group A was 3.96 ± 0.968 and in Group B was 4.42 ± 0.498. The difference in the patient satisfaction score in the two groups was found to be statistically significant (P = 0.003).

Bottom Line: P < 0.05 was considered to be significant and P < 0.001 as highly significant.Sedation score was significantly more in Group B in the post-operative period.Epidural Dexmedetomidine as an adjuvant to Ropivacaine is associated with prolonged sensory and motor block, hemodynamic stability, prolonged postoperative analgesia and reduced demand for rescue analgesics when compared to plain Ropivacaine.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesia, Government Medical College, Amritsar, Punjab, India.

ABSTRACT

Background: Various adjuvant are being used with local anesthetics for prolongation of intra operative and postoperative analgesia in epidural block for lower limb surgeries. Dexmedetomidine, the highly selective α2 adrenergic agonist is a new neuroaxial adjuvant gaining popularity. The aim of the present study was to compare the hemodynamic, sedative and analgesia potentiating effects of epidurally administered dexmedetomidine when combined with ropivacaine.

Materials and methods: The study was conducted in prospective, randomized double-blind manner in which 100 patients of American Society of Anesthesiologist Grade I and II in the age group of 20-65 years of either sex under going lower limb surgeries were included after taking informed consent. The patients were randomly allocated into two groups of 50 each. Epidural anesthesia was given with 150 mg of 0.75% ropivacaine in Group A (n = 50) and 150 mg of 0.75% ropivacaine with dexmedetomidine (1 μg/kg) in Group B (n = 50). Two groups were compared with respect to hemodynamic changes, block characteristics which included time to onset of analgesia at T10, maximum sensory analgesic level, time to maximum sensory and motor block, time to regression at S1 dermatome and time to the first dose of rescue analgesia for 24 h. At the end of study, data was compiled and analyzed statistically using Chi-square test, Fisher's exact test and Student t-test. P < 0.05 was considered to be significant and P < 0.001 as highly significant.

Results: Significant difference was observed in relation to the duration of sensory block (375.20 ± 15.97 min in Group A and 535.18 ± 19.85 min in Group B [P - 0.000]), duration of motor block (259.80 ± 15.48 min in Group A and 385.92 ± 17.71 min in Group B [P - 0.000]), duration of post-operative analgesia (312.64 ± 16.21 min in Group A and 496.56 ± 16.08 min in Group B [P < 0.001]) and consequently low doses of rescue analgesia in Group B (1.44 ± 0.501) as compared to Group A (2.56 ± 0.67). Sedation score was significantly more in Group B in the post-operative period.

Conclusion: Epidural Dexmedetomidine as an adjuvant to Ropivacaine is associated with prolonged sensory and motor block, hemodynamic stability, prolonged postoperative analgesia and reduced demand for rescue analgesics when compared to plain Ropivacaine.

No MeSH data available.


Related in: MedlinePlus