Facilitatory effects of IV dexmedetomidine on spinal anaesthesia in patients undergoing elective orthopaedic surgery involving lower limb
Journal Title: Medpulse International Journal of Anesthesiology - Year 2018, Vol 8, Issue 2
Abstract
Background: Spinal anaesthesia is at low cost, a surgery of up to two hours duration can be performed.The greatest challenge of the technique is to control the spread of the local anaesthetic through the cerebrospinal fluid (CSF) in order to produce a block that is adequate for the proposed surgery without producing a needless extensive spread.Aims:The present study was aimed to assess the facilitatory effects of intravenous Dexmedetomidine premedication on spinal anaesthesia and analgesia in patients undergoing lower limb surgeries with 0.5% Hyperbaric Bupivacaine.Materials and methods: A one year prospective,double blind, randomized placebo controlled trial.Patients undergoing elective lower limb orthopaedic surgeries under spinal anaesthesia at tertiary care hospital from January 2014 to December 2015.A total of 60 patients divided into two groups using computer randomization. Results: No biphasic change in heart rate or mean arterial pressure or significant cardiovascular variability was observed after administration of Dexmedetomidine. Patients in Dexmedetomidine group had a significantly faster onset of motorblockade(3.64±0.75) compared to placeboand faster onset of sensory blockade(66±44.14seconds) compared to placebo(129.6±102.4seconds) and , higher level of highest sensory block level achieved (T4.8±1.52) as compared to placebo group (T5.8±0.96).Total Duration of Motor Block was significantly prolonged in group D (256.44±53.10minutes) compared to group P (231.16±32.2minutes).Total Duration of Sensory Block in Dexmedetomidine group (234.34±47.82minutes) was significantly longer than placebo group (141.66±30.20minutes). Time to first request for postoperative analgesia was significantly longer in group D (270.17±41.57) when compared to group P (155.73±23.39). Excessive sedation (Ramsay sedation score > 4) was observed in only one patient in Dexmedetomidine group. Even with excessive sedation (score of more than 4), the oxygen saturation remained comparable to the placebo group.Conclusion:Single dose of intravenous Dexmedetomidine given as premedication, prolongs the duration of sensory and motor blockade of bupivacaine-induced spinal anaesthesia. It also prolongs the time to first request for analgesia and provides conscious sedation without ventilatory depression and maintains good hemodynamic stability.
Authors and Affiliations
Uthkala Bhaskar Hegde, N Gangadharaiah, Arjun N R
Keywords
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