Background and Aim:Perineural administration of dexmedetomidine, a α2-adrenoceptor agonist, prolongs the duration of analgesia. We hypothesized that adding dexmedetomidine to bupivacaine would prolong postoperative analgesia after below knee surgery.Materials and Methods:After ethical approval, 60 patients scheduled for below knee surgery under combined femoral-sciatic nerve block were randomly allocated into two groups to have their block performed using bupivacaine 0.5% alone (group B) or bupivacaine 0.5% combined with 100 μg bupivacaine-dexmedetomidine (group BD). Motor and sensory block onset times; durations of blockades and analgesia were recorded.Results:Sensory and motor block onset times were shorter by 20% in group BD than in group B (P < 0.01). Sensory and motor blockade durations were longer in group BD (+45% and +40%, respectively) than in group B (P < 0.01). Duration of analgesia was longer in group BD by 75% than in group B (P < 0.01). Systolic, diastolic arterial blood pressure levels, and heart rate were significantly less in group BD, six patients in group BD, and no patients in group B developed bradycardia (P < 0.05).Conclusion:The addition of dexmedetomidine 100 μg to bupivacaine 0.5% during ultrasound-guided combined femoral and sciatic block for below knee surgery was associated with a prolonged duration of analgesia. However, this may be associated with significant bradycardia requiring treatment.

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Pan African Clinical Trial Registry (PACTR201706002303170), (www.pactr.org).

Background: Epidural analgesia is still the preferred method of postoperative analgesia for total knee arthroplasty in many countries. Dexmedetomidine is a new alpha-2 agonist which had many beneficial effects when administered epidurally. The aim of study was to provide effective postoperative analgesia with hemodynamic stability through reduction of the amount of epidural local anesthetic by adding dexmedetomidine. Methods: 75 patients, 50-70 years old, ASA physical status I-III undergoing total knee arthroplasty were randomly divided into three equal groups, group I received 0.125% bupivacaine 5 ml/h for postoperative analgesia, group II received 4 ml of a mixture of bupivacaine 0.125% and dexmedetomidine 0.2 lg/kg/h and group III received 3 ml of a mixture of bupivacaine 0.125% and dexmedetomidine 0.2 lg/kg/h. Postoperative pain were scored by visual analog scale (VAS), sedation score, postoperative nalbuphine consumption and hemodynamic parameters were recorded every 4 h for 48 h postoperatively. Results: The demographic data were comparable in all groups. VAS (visual analog scale) of pain showed a significant reduction between the two groups II, III and group I with insignificant difference between groups II and III at both rest and movement. The mean of nalbuphine consumption during the study period was significantly reduced in group II, III than in group I with insignificant difference between groups II and III. Sedation scores were significantly higher in groups II and III compared to group I. Heart rate was more reduced in groups II and III than in group I with insignificant difference between the groups. The mean arterial blood pressure was significantly reduced in group I than groups II and III from hour 8 till the end of the study. Conclusion: Dexmedetomidine is an effective adjuvant to epidural bupivacaine for postoperative analgesia after total knee arthroplasty through reducing the amount of local anesthetic.

Background: Spinal anesthesia is the recommended technique in elective cesarean sections. Usage of vasopressors is more widely accepted as an effective method for decreasing postspinal hypotension than fluid loading. However, the ideal vasopressor to prevent spinal hypotension during cesarean section has been a subject of much debate. It should maintain maternal blood pressure and placental perfusion, with minimal adverse effect on fetus and mother. Aim: The primary aim was to compare the effect of prophylactic infusion of phenylephrine versus norepinephrine versus ephedrine in the prevention of postspinal hypotension in elective cesarean section. The secondary aim was to assess their effects on neonate. Methods: Seventy-five patients were enrolled in this study and randomly divided into three groups. Group P received phenylephrine infusion and group N received norepinephrine infusion, while group E received ephedrine infusion. The changes in mean arterial blood pressure and heart rate were recorded throughout the surgery. Maternal and neonatal perioperative complications were controlled and recorded. Results: MAP were higher in the ephedrine group than the phenylephrine and norepinephrine groups. Maternal tachycardia was significantly more common in ephedrine, and bradycardia was more common in phenylephrine group without significant difference. Nausea and vomiting were more common in ephedrine group. Neonatal acidosis was lesser in phenylephrine and norepinephrine groups than in the ephedrine group. Conclusion: Prophylactic infusion of phenylephrine and norepinephrine can be successfully used to prevent postspinal hypotension in parturient undergoing cesarean section with less drawbacks and fetal well-being than ephedrine.