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To Assess the Efficacy and Safety Profile of Pre-emptive Epidural Dexmedetomidine in the Patients Undergoing Upper Abdominal Surgery Under General Anesthesia: A Prospective Randomized Double Blind Study

Sandeep Sharma , Priyanka Gupta , Sandeep Sharma , Indira Kumari

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Indian Journal of Anesthesia and Analgesia 6(6):p 2225-2233, November-December 2019. | DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.6619.55

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Priyanka Gupta, Sandeep Sharma, Indira Kumari. To Assess the Efficacy and Safety Profile of Pre-emptive Epidural Dexmedetomidine in the Patients Undergoing Upper Abdominal Surgery Under General Anesthesia: A Prospective Randomized Double Blind Study. Indian J Anesth Analg. 2019;6(6 Part - II):2225-2233.

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Abstract

Introduction: Effective pain control is the mainstay of treatment in patients who have undergone upper abdominal surgeries as pain has many adverse effects on various systems of body. Epidural analgesia provides not only pain relief but also reduces postoperative stress response, pulmonary complications and duration of hospital stay. Aims and Objectives: To assess the efficacy of epidural dexmedetomidine as an adjuvant to Ropivacaine on analgesia, perioperative hemodynamics and requirement of anesthetic agents in patients undergoing upper abdominal surgeries under general anesthesia. Materials and Methods: 70, ASA Grade I and II patients, 18–60 years of either sex planned for upper abdominal surgery were included and randomly allocated into two Groups: Group RD - Patients received 1 mcg/kg Dexmedetomidine hydrochloride with 0.25% isobaric Ropivacaine hydrochloride (total volume 20 ml). Group R - Patients received 20 ml of 0.25% isobaric Ropivacaine hydrochloride. Prior to induction of anesthesia with injection Midazolam 20 mcg/kg, injection Fentanyl citrate 2 mcg/kg, injection Propofol 2 mg/kg and injection Atracurium 0.5 mg/kg to facilitate endotracheal intubation, epidural catheterization was done. Then, the epidural study medications were injected. Anesthesia was maintained with O2:N2O 1:2, Sevoflurane upto 3% and Atracurium as necessary to achieve muscle relaxation. Pain characteristics, sedation level, intraoperative hemodynamics and requirement of sevoflurane were noted. At end of surgery, patients were extubated and shifted to PACU. Categorical (qualitative) data were presented as number (percentage) and compared using Chi-square test. Continuous variables (quantitative) were presented as mean ± SD and compared using t – test. p value < 0.05 was considered as statistically significant. Result: The duration of analgesia was prolonged in the patients who received Dexmedetomidine as an adjuvant with Ropivacaine (472.14 ± 44.90 mins v/s 309.85 ± 35.72, p – value - 0.000). Number of rescue analgesia doses needed in Group RD was less than Group R (2.11 ± 0.323 v/s 3.14 ± 0.550, p - 0.00). The mean concentration of sevoflurane in Group RD was 2.380 ± 0.22% and in Group R was 2.680 ± 0.278%, and this difference was statistically highly significant (p - 0.000). Vitals remained stable in both the Groups. Conclusion: Epidural Ropivacaine with dexmedetomidine give better and longer postoperative pain relief in upper abdominal surgeries and also reduce requirement of anesthetic agents intraoperatively.

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Priyanka Gupta, Sandeep Sharma, Indira Kumari. To Assess the Efficacy and Safety Profile of Pre-emptive Epidural Dexmedetomidine in the Patients Undergoing Upper Abdominal Surgery Under General Anesthesia: A Prospective Randomized Double Blind Study. Indian J Anesth Analg. 2019;6(6 Part - II):2225-2233.

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DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.6619.55

Keywords

Keywords: Dexmedetomidine; Ropivacaine; Epidural Anesthesia; General Anesthesia.

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