A comparative evaluation of Equi-sedative doses of dexmedetomidine and propofol for peri-operative sedation in surgeries under regional anaesthesia

Abstract

This study was conducted to compare the effects of equi-sedative doses of dexmedetomidine and propofol in patients undergoing elective surgical procedures after taking place regional anesthesia. Method: A prospective double-blind study was carried out in 80 patients of either sex, aged between 20 to 60 years and American Society of Anaesthesiologist (ASA) grade I, II and III. Patients were randomly allocated into two groups of 40 patients in each group. Group I (D) received i.v. dexmedetomidine (1 μg/kg initial loading dose for 10min, maintenance 0.5-0.7μg/kg/min). GroupII (P) received i.v. propofol (75μg/kg/min for 10min; maintenance 30-60μg/kg/min), two groups were compared in terms of cardio-respiratory effects, time to achieve and terminate sedation (using BIS index and OAA/S score), post-operative analgesia, side effects and complications of these drugs. Results: Both groups were comparable with regard to demographic variables. Time to achieve sedation was early in group II (10-15 min) as compared to group I (25 min). In post-operative period, the value of OAA/S after 5 min was lower (4.22±0.42) in group I as compared to group II (4.45±0.50) and termination of sedation in group I was late as compared to group II. Intraoperatively, fall in mean blood pressure and heart rate were statistically significant in both groups but fall in MBP was more in group II and fall in HR was more in group I (p<0.05). In post-operative period, blood pressure and heart rate remained lower in group I but in group II these parameters reached near the base line value. VAS score remained lower in group I than group II which was statistically significant (p<0.05) and more analgesic doses were recquired in group II (propofol) in recovery period. No significant changes were seen with regards to SpO2, respiratory rate and postoperative nausea vomiting. Conclusion: Dexmedetomidine provided similar levels of sedation to propofol, with a slower onset and offset of sedation with an additional advantage of postoperative analgesia. Thus, Dexmedetomidine with its stable cardio-respiratory profile, better sedation, overall patient's satisfaction, and analgesia could be a valuable adjunct for intraoperative sedation during regional anesthesia especially when postoperative pain might be predicted to be worse than usual.