Open Access: View PDF

DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.4417.12

Abstract

Background: Intrathecal dexmeditomedine is being used as an adjuvant to the local anesthetic agents. Dexmeditomedine has sedative and analgesic action. This study was carried out with the aim to observe and compare the onset and duration of sensory and motor block, duration of analgesia, hemodynamic changes, level of sedation and side effects between the two groups, i.e. Intrathecal hyperbaric bupivacaine v/s low dose dexmeditomedine and bupivacaine combination in patients posted for routine gynaecological surgeries. Methods: This was a prospective randomized controlled double blind study. Sixty adult female patients were divided into two groups. Group (B+D) received intrathecal 0.5% hyperbaric bupivacaine 17.5 mg (3.5 ml) with inj. Dexmeditomedine 10µg in 0.5 ml of normal saline and group (B+S) received Intrathecal 0.5% hyperbaric bupivacaine 17.5mg (3.5 ml) with 0.5 ml of normal saline. The assessment of the parameters like the onset time for sensory and motor block, regression time of the block to two dermatomes, T10 dermatome, S1dermatome, Bromage 0 motor block and the time for request of first rescue analgesic dose was done in both groups. Also, the incidence of untowards side effects like bradycardia, hypotension, shievering and the sedation score in each patient was noted. Statistical analysis was carried out. Results: There was no statistical difference in the time of onset of sensory and motor block in both the groups. However, the time for regression of sensory block in the dexmeditomedine group to two dermatomes (188.87±81.79 min), T10 dermatome (225.67± 32.51 min ), S1 dermatome (261.80± 79.50 min ) and motor block to Bromage scale 0(326.33±76.80 min ) was significantly prolonged than in group (B+S)(109.67± 25.31,147.67± 32.12, 180.33± 30.73 &203.67± 28.69 min). The time for first request of rescue analgesic dose was significantly longer in dexmeditomedine group (360.67±80.19 min )than in normal saline group(203.66± 48.75 min). Differential Analgesia (DA) was evaluated as the difference between the time for rescue analgesic dose request and recovery of muscle power to Bromage 0 scale. It was significantly longer in (B+D) group (34.33± 30.11 min), whereas its presence was inconsistent (sometimes absent) in (B+S) group (mean value 10.33±18.94 min). Conclusion: Intrathecal dexmeditomedine 10 µg, added to hyperbaric bupivacaine is useful for gynecological surgeries, with minimal and easily treatable side effects and prolonged postoperative analgesia, even after cessation of block (Differential Analgesia). Also, it is helpful to avoid general anesthesia, even if the surgical procedure gets prolonged.

Keywords : Dexmeditomedine; Adjuvant; Intrathecal; Gynecological Surgeries. 

Corresponding Author : Shubhada A. Patil, Associate Professor, Dept. of Anesthesiology, JIIU’s Indian Institute of Medical Sciences & Research, Warudi, Badnapur, Dist. Jalna, Maharashtra 431202, India.