A 98 years old male patient, diagnosed as intertrochanteric fracture femur, was posted for fixation by dynamic hip screw. His weight was 70 Kg, height 160 cm, blood pressure of 130/90 mm of Hg and a pulse of 56 per minute. He was conscious and oriented in time, place and person. There was no history of chest pain or dyspnoea. His investigations revealed haemoglobin, creatinine, TLC, DLC, with in normal range. Serum sodium 132 mEq/litre. His random blood sugar was 94 mg%. Chest x-ray was showing mild emphysematous changes. Electrocardiogram showed ST segment depression of 1 mm and T wave inversion in chest leads V 1& V2. Echocardiography was normal with LVEF 42%. In view of extreme old age and low ejection fraction, epidural anaesthesia was planned. Procedure was explained to the patient and he was kept nil by mouth for 8 hours. Patient was premedicated with inj. Metoclopramide 10 mg half an hour before surgery. Intravenous access was secured with 18G cannula and monitor was attached. ECG, blood pressure, SpO2, respiratory rate and temperature was monitored. Patient was placed in sitting position with legs hanging by the side of the operation table & supported on a footrest and 18G Tuohy needle was inserted by a paramedian approach into L4-L5 interspace using loss of resistance technique. Epidural catheter was introduced through needle up to 5 cm in cephalad direction. 3 Test dose of 2 ml of lidocaine with adrenaline was given, after that drug solution 8 ml lidocaine 2% +6ml of 0.5% Bupivacaine + 50 mg Tramadol) was slowly injected through catheter after negative aspiration. T8 sensory level was achieved and procedure lasted for one and half hour. Intravascular volumes were maintained by giving Ringer lactate and normal saline solutions. Patient remained hemodynamically stable throughout the procedure except two initial episodes of hypotension which were managed by inj. Mephentermine 3 mg. There was no significant blood loss during the surgery. 4 No untoward complication occurred throughout the course of operation. Patient was shifted to intensive therapy unit for postoperative care. Eight hourly supplementations of Inj. Tramadol 100 mg was done through epidural catheter for 3 days for postoperative analgesia. Patient did well postoperatively and was discharged from hospital after one week.

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BACKGROUNDSpinal anaesthesia is the most common and safe anaesthetic procedure performed in parturients for caesarean section. Hyperbaric bupivacaine alone has been used for the last decade for caesarean section. It has rapid onset of action and gives good muscle relaxation & has no adverse effects on foetal APGAR scores. Its limited effects on postoperative analgesia is a matter of concern now a days. Many of the drugs like Tramadol , Butorphanol, Morphine, Fentanyl, Clonidine etc. have been used as an adjuvant to Hyperbaric Bupivacaine in the past; all having their side effects & limitations. Dexmedetomidine is an α -2 adrenoreceptor agonist, benefits of which, when used intrathecally or epidurally as adjuvant, have been proved in many studies. With this background we added 5g of Dexmedetomidine to Hyperbaric Bupivacaine in caesarean section to observe the characteristic of block, post-operative analgesia, sedation and favourable neonatal outcome. METHODSSixty parturients of ASA physical status I & II undergoing caesarean section were assigned to 2 groups (n=30) to receive either 0.5% hyperbaric Bupivacaine 9 mg (1.8 ml) with Dexmedetomidine 5 µ (Group D) or 0.5% hyperbaric Bupivacaine 9 mg (1.8 ml) with saline (Group C). Block characteristics, haemodynamic parameters, sedation scores and neonatal APGAR score were recorded. Data obtained were compiled and analysed with appropriate tests, p-value of ≤ 0.05 was considered significant. RESULTSOnset of sensory and motor block were significantly faster in Group D as compared to Group C. Duration of post-operative analgesia was significantly prolonged in Group D. There was no significant difference in haemodynamic parameters, sedation and neonatal APGAR scores between the groups. CONCLUSIONSThe use of intrathecal 5 µgm Dexmedetomidine as an adjuvant to Bupivacaine for caesarean section produces rapid and prolonged sensory & motor block & allocates better perioperative analgesia without significant maternal and neonatal adverse effects.HOW TO CITE THIS ARTICLE: Royzada B, Kujur S, Royzada A. Assessing the benefits of adding dexmedetomidine to intrathecal hyperbaric bupivacaine for caesarean section.

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BACKGROUND Dexmedetomidine an α 2 adrenergic agonist is well known for potentiating the effect of local anaesthetics in neuraxial blockade and peripheral nerve blocks. It prolongs the duration of analgesia produced by local anaesthetic, as well as reduces the dose of local anaesthetic required to produce the block. This helps in early mobilization and recovery of the patient. We conducted this study to access the effect of adding dexmedetomidine to bupivacaine in transversus abdominis plane (TAP) block in inguinal hernia repair. METHODS 60 patients posted for inguinal hernia repair were divided into two groups of 30 each in randomized double-blind manner. Group B patients (n=30) received 20 ml of 0.25% of bupivacaine and 2ml normal saline for TAP block whereas Group D received 20 ml 0.25% bupivacaine and 0.5 µgm/Kg of dexmedetomidine (2 ml). NPRS scores for postoperative pain, time to request for first analgesic dose, total duration of analgesia, Inj. Diclofenac consumption, haemodynamic parameters and side effects were recorded. RESULTS Numerical pain rating scale scores were significantly lower in group D. Total analgesic requirement was significantly less in group D. Time to request for first analgesic dose was longer in group D as compared to group B. Patients were haemodynamically stable in both the groups. CONCLUSIONS The addition of dexmedetomidine to bupivacaine in TAP block provides prolonged and effective postoperative analgesia with haemodynamic stability.