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Intrathecal dexmedetomidine as adjuvant for spinal anaesthesia for perianal ambulatory surgeries: A randomised double-blind controlled study.

Nethra SS, Sathesha M, Dixit A, Dongare PA, Harsoor SS, Devikarani D - Indian J Anaesth (2015)

Bottom Line: Statistical analysis was done using appropriate tests.However, the duration of motor blockade, time to ambulation, and time to void were also significantly prolonged in Group D (323.05 ± 54.58 min, 329.55 ± 54.06 min, 422.30 ± 87.59 min) than in Group N (220.10 ± 63.61 min, 221.60 ± 63.84 min, 328.45 ± 113.38 min).Intrathecal dexmedetomidine 5 μg added to intrathecal bupivacaine 6 mg as adjuvant may not be suitable for ambulatory perianal surgeries due to prolongation of motor blockade.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesiology, Bangalore Medical College and Research Institute, Victoria Hospital, Bengaluru, Karnataka, India.

ABSTRACT

Background and aim: The newer trend in regional anaesthesia for ambulatory anorectal surgeries advocate use of lower dose of local anaesthetic, providing segmental block with adjuvants such as opioids and α2 agonists to prolong analgesia. The current study investigated effects of addition of 5 μg of dexmedetomidine to 6 mg of hyperbaric bupivacaine on duration of analgesia, sensory and motor block characteristics for perianal ambulatory surgeries.

Methods: This study is a prospective randomised controlled double blind study. Forty adult patients between 18 and 55 years of age were divided into 2 groups. Group D received intrathecal 0.5% hyperbaric bupivacaine 6 mg (1.2 ml) with injection dexmedetomidine 5 μg in 0.5 ml of normal saline and Group N received intrathecal 0.5% hyperbaric bupivacaine 6 mg (1.2 ml) with 0.5 ml of normal saline. The parameters assessed were time to regression of sensory blockade, motor blockade, ambulation, time to void, first administration of analgesic. Statistical analysis was done using appropriate tests.

Results: Time for regression of sensory level and time for first administration of analgesic were prolonged in Group D (430.05 ± 89.13 min, 459.8 ± 100.9 min, respectively) in comparison to Group N (301.10 ± 94.86 min, 321.85 ± 95.08 min, respectively). However, the duration of motor blockade, time to ambulation, and time to void were also significantly prolonged in Group D (323.05 ± 54.58 min, 329.55 ± 54.06 min, 422.30 ± 87.59 min) than in Group N (220.10 ± 63.61 min, 221.60 ± 63.84 min, 328.45 ± 113.38 min).

Conclusion: Intrathecal dexmedetomidine 5 μg added to intrathecal bupivacaine 6 mg as adjuvant may not be suitable for ambulatory perianal surgeries due to prolongation of motor blockade.

No MeSH data available.


Related in: MedlinePlus

Post-operative Verbal Rating Scale scores. Data presented as mean ± standard deviation
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Figure 1: Post-operative Verbal Rating Scale scores. Data presented as mean ± standard deviation

Mentions: The groups were comparable with respect to age, weight, height, sex distribution and operative time [Table 1]. All the patients achieved sensory level of at least S1 dermatome block and motor blockade of at least modified Bromage score 4, that is, detectable weakness of hip when they were made supine after completion of 5 min after subarachnoid block. There was no difference between Group D and N in the maximum level of blocks achieved (T10). In all the patients, maximum sensory level recorded at 20 min was similar to or higher than the sensory level recorded immediately post-operatively. Time for regression of sensory level to S1 (301.10 ± 94.86 min and 430.05 ± 89.13 min in Group N and Group D respectively, P < 0.001) and time for first administration of analgesic (321.85 ± 95.08 min, 459.8 ± 100.9 min in Group N and Group D, respectively, P < 0.001) were clinically and statistically prolonged in Group D. The duration of motor blockade (220.10 ± 63.61 min, 323.05 ± 54.58 min in Group N and Group D, respectively, P < 0.001), time to ambulation (221.60 ± 63.84, 329.55 ± 54.06 min in Group N and Group D, respectively, P < 0.001) and time to void (328.45 ± 113.38, 422.30 ± 87.59 min in Group N and Group D, respectively, P < 0.007) were significantly delayed in Group D [Table 2]. The post-operative VRS scores were higher in Group N than in Group D after 180 min in the post-operative period [Figure 1]. Intraoperative HR and BP were comparable between the two groups [Figures 2 and 3]. All patients in both the groups were calm and cooperative and no undue sedation (sedation score > 3) was observed intraoperatively (Group D 2.09 ± 0.38, Group N 1.96 ± 0.24, P < 0.203). The post-operative mean sedation scores were also comparable (Group D 2.14 ± 0.50, Group N 2.02 ± 0.21, P < 0.331). The incidence of side effects was not statistically significant in both the groups [Table 3].


Intrathecal dexmedetomidine as adjuvant for spinal anaesthesia for perianal ambulatory surgeries: A randomised double-blind controlled study.

Nethra SS, Sathesha M, Dixit A, Dongare PA, Harsoor SS, Devikarani D - Indian J Anaesth (2015)

Post-operative Verbal Rating Scale scores. Data presented as mean ± standard deviation
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4378079&req=5

Figure 1: Post-operative Verbal Rating Scale scores. Data presented as mean ± standard deviation
Mentions: The groups were comparable with respect to age, weight, height, sex distribution and operative time [Table 1]. All the patients achieved sensory level of at least S1 dermatome block and motor blockade of at least modified Bromage score 4, that is, detectable weakness of hip when they were made supine after completion of 5 min after subarachnoid block. There was no difference between Group D and N in the maximum level of blocks achieved (T10). In all the patients, maximum sensory level recorded at 20 min was similar to or higher than the sensory level recorded immediately post-operatively. Time for regression of sensory level to S1 (301.10 ± 94.86 min and 430.05 ± 89.13 min in Group N and Group D respectively, P < 0.001) and time for first administration of analgesic (321.85 ± 95.08 min, 459.8 ± 100.9 min in Group N and Group D, respectively, P < 0.001) were clinically and statistically prolonged in Group D. The duration of motor blockade (220.10 ± 63.61 min, 323.05 ± 54.58 min in Group N and Group D, respectively, P < 0.001), time to ambulation (221.60 ± 63.84, 329.55 ± 54.06 min in Group N and Group D, respectively, P < 0.001) and time to void (328.45 ± 113.38, 422.30 ± 87.59 min in Group N and Group D, respectively, P < 0.007) were significantly delayed in Group D [Table 2]. The post-operative VRS scores were higher in Group N than in Group D after 180 min in the post-operative period [Figure 1]. Intraoperative HR and BP were comparable between the two groups [Figures 2 and 3]. All patients in both the groups were calm and cooperative and no undue sedation (sedation score > 3) was observed intraoperatively (Group D 2.09 ± 0.38, Group N 1.96 ± 0.24, P < 0.203). The post-operative mean sedation scores were also comparable (Group D 2.14 ± 0.50, Group N 2.02 ± 0.21, P < 0.331). The incidence of side effects was not statistically significant in both the groups [Table 3].

Bottom Line: Statistical analysis was done using appropriate tests.However, the duration of motor blockade, time to ambulation, and time to void were also significantly prolonged in Group D (323.05 ± 54.58 min, 329.55 ± 54.06 min, 422.30 ± 87.59 min) than in Group N (220.10 ± 63.61 min, 221.60 ± 63.84 min, 328.45 ± 113.38 min).Intrathecal dexmedetomidine 5 μg added to intrathecal bupivacaine 6 mg as adjuvant may not be suitable for ambulatory perianal surgeries due to prolongation of motor blockade.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesiology, Bangalore Medical College and Research Institute, Victoria Hospital, Bengaluru, Karnataka, India.

ABSTRACT

Background and aim: The newer trend in regional anaesthesia for ambulatory anorectal surgeries advocate use of lower dose of local anaesthetic, providing segmental block with adjuvants such as opioids and α2 agonists to prolong analgesia. The current study investigated effects of addition of 5 μg of dexmedetomidine to 6 mg of hyperbaric bupivacaine on duration of analgesia, sensory and motor block characteristics for perianal ambulatory surgeries.

Methods: This study is a prospective randomised controlled double blind study. Forty adult patients between 18 and 55 years of age were divided into 2 groups. Group D received intrathecal 0.5% hyperbaric bupivacaine 6 mg (1.2 ml) with injection dexmedetomidine 5 μg in 0.5 ml of normal saline and Group N received intrathecal 0.5% hyperbaric bupivacaine 6 mg (1.2 ml) with 0.5 ml of normal saline. The parameters assessed were time to regression of sensory blockade, motor blockade, ambulation, time to void, first administration of analgesic. Statistical analysis was done using appropriate tests.

Results: Time for regression of sensory level and time for first administration of analgesic were prolonged in Group D (430.05 ± 89.13 min, 459.8 ± 100.9 min, respectively) in comparison to Group N (301.10 ± 94.86 min, 321.85 ± 95.08 min, respectively). However, the duration of motor blockade, time to ambulation, and time to void were also significantly prolonged in Group D (323.05 ± 54.58 min, 329.55 ± 54.06 min, 422.30 ± 87.59 min) than in Group N (220.10 ± 63.61 min, 221.60 ± 63.84 min, 328.45 ± 113.38 min).

Conclusion: Intrathecal dexmedetomidine 5 μg added to intrathecal bupivacaine 6 mg as adjuvant may not be suitable for ambulatory perianal surgeries due to prolongation of motor blockade.

No MeSH data available.


Related in: MedlinePlus