INTRODUCTIONThe anesthesia of choice most commonly used for gynecological surgery is regional anesthetic technique. Various adjuvants are being used with local anesthetics for prolongation of intraoperative and post-operative analgesia.Most of the clinical studies about the intrathecal alpha2 adrenergic agonist are related to clonidine. 1 Dexmedetomidine, the highly selective alpha2 adrenergic agonist, is used for various procedures in the perioperative period.2 Based on earlier human studies, intrathecal 5 mcg dexmedetomidine would produce longer duration of analgesic effect in spinal anesthesia with minimal side effects. [4][5][6][7] Where gradually evolving studies can build the evidence for its safe use in central neuraxial blocks. ³We explore its usefulness and also compare this new alpha2 adrenergic agonist with the previously established and widely used adjuncts. METHODSWe select 60 adult females belonging to ASA Grades 1 and 2 scheduled for gynecological surgery under subarachnoid block, were enrolled in this prospective and randomized study. Patients with contraindication to regional anesthesia, history of signifi cant co-existing diseases, such as ischemic ABSTRACT Background: Various adjuvants are being used with local anesthetics for prolongation of intraoperative and post-operative analgesia. Dexmedetomidine, a highly selective alpha2 adrenergic agonist, is a new neuraxial adjuvant gaining popularity. The purpose of this study was to compare the onset, duration of sensory and motor block, hemodynamic effects, post-operative analgesia, and adverse effects of dexmedetomidine and clonidine with hyperbaric 0.5% bupivacaine for spinal anesthesia. Methods: 60 patients belonging to ASA Grade 1 and 2 undergoing elective gynecological surgery under spinal anesthesia were studied in this prospective. The patients were allocated in two groups (30 patients each). Group bupivacaine + clonidine (BC) received 17.5 mg of bupivacaine supplemented 45 mcg clonidine and Group bupivacaine + dexmedetomidine (BD) received 17.5 mg bupivacaine supplemented 5 mcg dexmedetomidine. The onset time of sensory and motor level, time to reach peak sensory and motor level, the regression time of sensory and motor level, hemodynamic changes, and side effects were recorded. Results: Patients in Group BD had signifi cantly longer sensory and motor block time than patients in Group BC. The onset time to reach dermatome T4 and modifi ed Bromage3 motor block were not significantly different between two groups. Dexmedetomidine group showed signifi cantly less and delayed requirement of rescue analgesic. Conclusion: Intrathecal dexmedetomidine is associated with prolonged motor and sensory block, hemodynamic stability and reduced demand of rescue analgesic in 24 hrs as compared to clonidine.
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