A prospective Randomized Controlled Double Blind Study of the Effects of Intravenous Dexmedetomidine on Subarachnoid Block with Hyperbaric Bupivacaine for Elective Inguinal Hernia Repair in Adult Male Patients. | [Anaesthesia, Pain and Intensive Care • 2017]

Author(s):

1. Arjuna Bhagavatha: Department of Anesthesiology, Mysore Medical College & Research Institute, Karnataka, India

2. Deepa Kattishettar: Department of Anesthesiology, Mysore Medical College & Research Institute, Karnataka, India

3. Aruna Tegginamatha: Department of Anesthesiology, Mysore Medical College & Research Institute, Karnataka, India

Abstract:

Background and objectives: Intravenous (IV) dexmedetomidine is used as an adjuvant to general anesthesia due to its excellent analgesic and sedation properties. These properties may be useful to prolong the duration of sensory and motor block with spinal anesthesia. Hence, this study was designed to assess the effects of IV dexmedetomidine on the onset, duration and the hemodynamic characteristics of subarachnoid block (SAB) with hyperbaric bupivacaine 0.5% for elective inguinal hernia repair in adult male patients. Methodology: This prospective randomized double blind study was conducted in 60 adult male patients belonging to American Society of Anesthesiologists (ASA) class I and II undergoing elective inguinal hernia repair. The enrolled patients were divided into 2 groups (n=30) to receive either 0.5 µg/kg dexmedetomidine intravenous bolus over 10 min (Group D) or saline infusion (Group C) prior to subarachnoid block with 0.5% hyperbaric bupivacaine 12.5 mg. Parameters assessed were the time of onset, highest level of sensory block, time to two segment sensory regression, total duration of analgesia, onset and duration of motor block, in addition to hemodynamic parameters at various intervals. Results: Faster onset time of sensory block (1.29 ± 0.26 min vs. 3.38 ± 0.62 min), prolonged two segment sensory regression time (105.47 ± 8.71min vs. 71.3 ± 9.4 min) and prolonged duration of sensory block (249.5 ± 36.32 min vs 154.17 ± 13.46 min) were observed in Group D compared to Group C. Similarly, rapid onset (2.92 ± 0.73 min vs. 6.52 ± 0.91 min) and prolonged duration of motor block (192 ± 28.44 min vs135.43 ± 12.64 min) were noted in Group D. Mean sedation score in Group D was 3.83 ± 0.379 vs. 1.83 ± 0.379 in Group C. Time of request for rescue analgesia was significantly prolonged in Group D compared to Group C. Hemodynamic parameters and incidence of side effects were similar in both the groups. Conclusion: Premedication with single dose of intravenous dexmedetomidine 0.5 µg/kg prior to subarachnoid blockade with 0.5% hyperbaric bupivacaine hastens the onset and increases duration of sensory and motor block, with maintenance of stable hemodynamics and arousable sedation in infraumbilical surgeries in adult male patients.

Page(s): 134-140

DOI: DOI not available

Published: Journal: Anaesthesia, Pain and Intensive Care, Volume: 21, Issue: 2, Year: 2017

Keywords:

Keywords are not available for this article.

References:

[1] MillerRD,EriksonLI,FleisherLA,Wiener-KronishGP,YoungWI, 2010.Spinal epidural and caudal anesthesia,Miller's Anaesthesia. . Philadelphia PA: Elsevier Churchill Livingstone 7 1624 -

[2] ChilversCR,GoodwinA,VaghadiaH, 2001.Pharmacoeconomic comparison vs general anesthesia,Can J Anaesth 48 279 -83

[3] LiuSS,McDonaldSB, 2001.Current issues in spinal anesthesia,Anesthesiology 94 888 -906

[4] MikkoPitkänen. Spinal,CousinMJ,BridenbaughPO,CarrDB,HorlockerTT, .Subarachnoid) blockade,Neural Blockade in Clinical Anaesthesia and Management of Pain. 4th ed. Philadelphia: Lippincot Williams and Wilkins; 2009 213 -38

[5] RheeK,KangK,KimJ,JeonY., 2003.Intravenous clonidine prolongs bupivacaine spinal anesthesia,Acta Anaesthesiol Scand 47 1001 -5

[6] VennRM,BradshawCJ,Spencer R. P r e l, 1999.i m i n a r y U K e x p e r i e n c e o f dexmedetomidine, a novel agent for postoperative sedation in the intensive care unit,Anaesthesia 54 1136 -142

[7] BromagePR,BurfootMF,CrowellDE,PettigrewRT, 1964.Quality of epidural blockade. I. influence of physical factors,Br JAnaesth 36 34252 -

[8] RamsayMA,SavegeTM,SimpsonBR,GoodwinR, 1974.Controlled sedation with alphaxalone-alphadolone,Br Med J 2 656 -9

[9] HohenerD,BlumenthalS,BorgeatA,r J Anaesth, 2008.Sedation and regional anaesthesia in t h e a d u l t p a t i e n t, 100 8 -16

[10] HelgesonLE, 2005.Sedation during regional anaesthesia: Inhalational versus intravenous,Curr Opin Anaesthesiol 18 534 -9

[11] FeldJM,HoffmanWE,StechertMM,HoffmanIW,AnandaRC, 2006.Fentanyl or dexmedetomidine combined with desflurane for bariatric surgery,J Clin Anesth 18 24 -8

[12] RamseyMA,SahaD,HebelerRF, 2006.Tracheal resection in the morbidly obese patient: The role of dexmedetomidine,J ClinAnesth 18 452 -4

[13] JaakolaML,SalonenM,LehtinenR,ScheininH., 1991.The analgesic action of d e x m e d e t o m i d i n e - a n o v e l á 2 - adrenoceptor agonist-in healthy volunteers,Pain 46 281 -5

[14] ChandrashekharappaK,RavindraC G,KumaraA B,Kiran M. Intravenous Dexmedetomidine, 2015.Premedication on spinal Anaesthesia with Hyperbaric Bupivacaine in Patients Undergoing Total Abdominal Hysterectomies, 5 155 -61

[15] ReddyVS,ShaikNA,DonthuB,Reddy SannalaVK,JangamV, 2013.Intravenous dexmedetomidine versus clonidine for prolongation of bupivacaine spinal a n e s t h e s i a a n d a n a l g e s i a : A randomized double-blind study,J Anaesthesiol Clin Pharmacol 29 342 -7

[16] HarsoorSS,RaniDD,YalamuruB,SudheeshK,NethraSS, 2013.Effect of s u p p l e m e n t a t i o n o f l o w d o s e intravenous dexmedetomidine on characteristics of spinal anaesthesia with hyperbaric bupivacaine,DOI: 10 57 115616 -5049

[17] EbertTJ,HallJE,BarneyJA,UhrichTD,ColincoMD, .The effects of increasing p l a s m a c o n c e n t r a t i o n s o f d e x m e d e t o m i d i n e i n h u m a n s . A n e s t h e s i o l o,g y 2 0 0 0 ; 3 8 2 - 9 4 -

[18] C o, .u r s i n D B , M a c c i o l i G A . Dexmedetomidine,Curr Opin Crit Care2001; 7 2216 -

[19] KayaFN,YavascaogluB,TurkerG,YildirimA,GurbetA,MogolEB, 2010.Intravenous dexmedetomidine, but not midazolam, prolongs bupivacaine spinal anesthesia,Can J Anaes 57 39 -45

[20] TekinM,KatiI,TomakY,KisliE, 2007.Effect of dexmedetomidine IV on the duration of spinal anesthesia with Prilocaine: a double-blind, prospective study in adult surgical patients,Curr Ther Res Clin Exp 68 313 -24

[21] HongJY,KimWO,YoonY,ChoiY,KimSH,KilHK, 2012.Effects of intravenous dexmedetomidine on low-dose bupivacaine spinal anaesthesia in elderly patients,Acta Anaesthesiol Scand 56 382 -7

[22] ElcýcekK,TekinM,KatiI., 2010.The e f f e c t s o f i n t r a v e n o u s dexmedetomidine on spinal hyperbaric ropivacaineanesthesia,J Anesth 24 544 -8

[23] GuptaK,TiwariV,GuptaPK,PandeyMN,AgarwalS,AroraA, 2014.Prolongation of subarachnoid block by intravenous dexmedetomidine for sub umbilical surgical procedures: A prospective control study,Anesth Essays Res 8 175 -8

[24] Kiran KumarS,C , Murthy SGK, 2014.A Comparative Prospective, Randomised, Double Blind Study of the Effect of IV Dexmedetomidine on Subarachnoid Block Versus 0.9 % Normal Saline as Control,Sch J App Med Sci 2 1517 -23

[25] Al-MustafaMM,BadranIZ,Abu AliHM,Al-BarazangiBA,MassadIM, 2009.AlG h a n e m S M . I n t r a v e n o u s dexmedetomidine prolongs bupivacine spinal analgesia,Middle East -

[26] Whizar-LugoV,Gómez-RamírezIA,Cisneros-CorralR,Martínez-Gallegos N, 2007.Intravenous dexmedetomidine vs. intravenous clonidine to prolong bupivacaine spinal anaesthesia. A double blind study,Anestesiaen Mexico 19 143 -6

[27] MasonKP,ZurakowskiD,ZgleszewskiS,Prescilla R. FontainePJ,DinardoJA., 2010.I n c i d e n c e a n d p r e d i c t o r s o f hypertension during high - dose d e x m e d e t o m i d i n e s e d a t i o n f o r paediatric MRI,Paediatr Anaesth 20 -

[28] 2011.S u d h e e s h K , H a r s o o r S . Dexmedetomidine in anaesthesia practice: A wonder drug?,Indian J Anaesth 55 323 -4

[29] HallJE,UhrichTD,BarneyJA,ArainSR,EbertTJ, 2000.Sedative, amnestic, and analgesic properties of small - dose dexmedetomidine infusions,Anesth Analg 90 699 -705

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