A comparative study of intrathecal clonidine and dexmedetomidine on characteristics of bupivacaine spinal block for lower limb surgeries

Sarma, Jahnabee; Narayana, P Shankara; Ganapathi, P; Shivakumar, MC

doi:10.4103/0259-1162.153763

Cited by 23 publications

(22 citation statements)

References 19 publications

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“…An ideal local anesthetic agent used in spinal anesthesia should have rapid onset of action, intense analgesia, and adequate motor blockade, long duration of action, adequate postoperative analgesia and minimal cardiovascular changes. 1 Most anesthesiologist concern that reduced dose of local anesthetic may provide insufficient spinal block. Thus there have been many trials to reduce the dose of intrathecal local anesthetics and improve their block quality with co administration of additives such as clonidine and opioids.…”

Section: Discussionmentioning

confidence: 99%

“…7 The binding affinity of dexmedetomidine compared with clonidine is nearly 1:10 Thus it is hypothesized that 3 to 5 µg of intrathecal dexmedetomidine might be equipotent to 30 to 45 µg of intrathecal clonidine. Several studies have been done using different dosage of clonidine and dexmedetomidine to determine the most effective intrathecal administration with minimal side effects 1 . In our study, the intrathecal dose of dexmedetomindine selected was based on previous human studies where no neurotoxic effects have been observed.…”

Section: Discussionmentioning

confidence: 99%

“…1 Uncontrolled post-operative pain may activate the sympathetic nervous system which may increase myocardial oxygen consumption leading to development of various morbidity and mortality like myocardial ischemia and infarction. 2,3 Intrathecal use of hyperbaric bupivacaine 0.5% is an appropriate for surgeries of short duration and may lead to early analgesic intervention in post-operative period.…”

Section: Introductionmentioning

confidence: 99%

“…4,5 In search of adjuvants that prolong the duration of analgesia with lesser side effect, various drugs as opioids, α agonists and midazolam have been tried with local anaesthetics. 1 .…”

Section: Introductionmentioning

confidence: 99%

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Comparative analysis of injection clonidine and injection dexmedetomidine added to injection bupivacaine for spinal anaesthesia in lower abdominal surgeries

et al. 2016

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INTRODUCTIONDespite advances in knowledge of pathophysiology, pharmacology and the development of more effective techniques for the management of peri-operative analgesia, many patients continue to experience distressing pain in post-operative period.1 Uncontrolled post-operative pain may activate the sympathetic nervous system which may increase myocardial oxygen consumption leading to development of various morbidity and mortality like myocardial ischemia and infarction. 2,3 Intrathecal use of hyperbaric bupivacaine 0.5% is an appropriate for surgeries of short duration and may lead to early analgesic intervention in post-operative period. There are many studies done to improve the effect and duration of spinal anesthesia by using various drugs as an ABSTRACT Background: Efficacy of sub-arachnoid block can be improved by addition of various adjuvants to local anesthetics. Intrathecal administration of clonidine or dexmedetomidine has improved the quality of spinal anesthesia in terms of longer duration of post-operative analgesia with comparatively lesser side effects. In present study we compared the onset and duration of motor and sensory block, hemodynamic effects, post-operative analgesia and adverse effects of clonidine and dexmedetomidine used intrathecally with bupivacaine. Methods: Present study was conducted in 150 patients (ASA class I and II) undergoing lower abdominal surgeries. Patients were randomly divided into three group's viz. B, C and D. Group B received bupivacaine (12.5 mg), group C received clonidine (30 µg) with bupivacaine and group D received dexmedetomidine (5 µg) with bupivacaine. Volume of administered drug was set at 3ml in all the groups. The onset time to reach peak sensory and motor block level, regression time to sensory and motor block, hemodynamic changes and side effects if any were assessed and recorded. Results: In our study we observed that there was no significant difference in patient demography and duration of surgical procedure. The time to onset of sensory blockage was similar in all the three groups but time to onset of motor block was shorter in group C and D compared to group B. Total duration of sensory and motor block was significantly higher in group D compared to group C and B. The duration of sensory block in group D was 139.58+14.49, in group C it was 122.46+18.55 and in group B it was 100+13.43 minutes. The duration of motor block in group D was 250.40+27.33, in group C it was 229.28+23.68 and in group B it was 175.64+17.41 minutes. Conclusions: It was concluded that though both clonidine and dexmedetomidine prolonged duration of sensory and motor block of Bupivacaine, Dexmedetomidine is better in terms of longer duration of action.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…4,5 In search of adjuvants that prolong the duration of analgesia with lesser side effect, various drugs as opioids, α agonists and midazolam have been tried with local anaesthetics. 1 .…”

Section: Introductionmentioning

confidence: 99%

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Comparative analysis of injection clonidine and injection dexmedetomidine added to injection bupivacaine for spinal anaesthesia in lower abdominal surgeries

et al. 2016

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“…3 Among alpha adrenergic agonists dexmedetomidine compared to clonidine is a safe and effective alternative when used as an adjuvant to bupivacaine. 4 Studies done using different doses of dexmedetomidine have proven that 5 µg and 10 µg are safe doses when used in sub arachnoid block. These doses were associated with minimal hemodynamic alterations.…”

Section: Introductionmentioning

confidence: 99%

Comparison of two different doses dexmedetomidine as an adjuvant to bupivacaine in sub-arachnoid block for abdominal hysterectomies. A randomized double blinded study.

Prabu

Radhakrishnan

2017

Asian J Med Sci

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Background:Abdominal hysterectomy is often a long duration procedure and warrants intense pain relief in the post-operative period. Dexmedetomidine when added to bupivacaine in subarachnoid block prolongs the duration of surgical anaesthesia, decreases blood loss and prolongs duration of post-operative pain relief. Aims and Objective: To compare two different doses dexmedetomidine as an adjuvant to bupivacaine in sub-arachnoid block in abdominal hysterectomy surgeries. Materials and Methods: 60 patients of age group 30-60 years posted for elective abdominal hysterectomies under American Society of Anaesthesiologists (ASA) physical classification I or II were randomly allocated into 2 groups of 30 each. Group A received 5 micrograms (µg) of dexmedetomidine along with 3.5 ml of 0.5% bupivacaine in sub-arachnoid block. Group B received 10 µg of dexmedetomidine along with 3.5 ml of 0.5% bupivacaine in sub-arachnoid block. Changes in blood pressure, heart rate, respiratory rate, oxygen saturation, ephedrine consumption, blood loss, duration of sensory block, duration of motor block and duration of analgesia were compared between two groups. Results: There was no significant difference in change in heart rate, respiratory rate, oxygen saturation, duration of sensory block, duration of motor block between two groups. Patients in group B had significant decrease in blood pressure, blood loss and significant increase in ephedrine consumption compared to Group A. The duration of analgesia was also prolonged in group B compared to Group A. Conclusion: Dexmedetomidine in dose of 10 µg is a better adjuvant to bupivacaine in sub arachnoid block for abdominal hysterectomy surgeries.

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Effect of 5-μg Dose of Dexmedetomidine in Combination With Intrathecal Bupivacaine on Spinal Anesthesia: A Systematic Review and Meta-analysis

Liu

Zhao

et al. 2020

Clinical Therapeutics

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Purpose: Intrathecal dexmedetomidine (DEX) has been used to improve the quality and duration of spinal anesthesia. The aim of this meta-analysis is to evaluate whether intrathecal DEX could prolong the duration of sensory and motor block during spinal anesthesia. Methods: We searched PubMed, EMBASE, Web of Science, and the Cochrane Library for randomized controlled trials that investigated the facilitatory effects of intrathecal administration of DEX compared with those of a placebo on spinal anesthesia from inception to April 2019. Sensory and motor block durations, sensory and motor block onset times, time to first analgesic request, and DEXrelated adverse effects were evaluated. Results were combined using fixed-effects or random effects modeling when appropriate. Findings: A total of 1478 patients from 25 clinical studies were included in the analysis. Compared with placebo, intrathecal DEX significantly prolonged the durations of both sensory block (weighted mean difference [WMD] ¼ 134.42 min; 95% CI, 109.71e159.13 min; P < 0.001) and motor block (WMD ¼ 114.27 min; 95% CI, 93.18e135.35 min; P < 0.001). It also hastened the onset of sensory block (WMD ¼ −0.80 min; 95% CI, −1.21 to −0.40; P < 0.001) and motor block (WMD ¼ −1.03 min; 95% CI, −1.51 to −0.56 min; P < 0.001). Furthermore, it delayed the time to first analgesic request (WMD ¼ 216.90 min; 95% CI, 178.90e254.90 min; P < 0.001) and reduced the incidence of shivering (risk ratio [RR] ¼ 0.39; 95% CI, 0.27e0.55; P < 0.001). DEX was associated with increased risk of transient bradycardia (RR ¼ 1.59; 95% CI, 1.07e2.37; P ¼ 0.022) and hypotension (RR ¼ 1.40; 95% CI, 1.04e1.89; P ¼ 0.026) but did not increase the incidence of postoperative nausea and vomiting (RR ¼ 0.87; 95% CI, 0.62e1.24; P ¼ 0.45). Implications: Intrathecal DEX can prolong the duration of sensory block, the duration of motor block, and the time to first analgesic request associated with spinal anesthesia.

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A comparative study of intrathecal clonidine and dexmedetomidine on characteristics of bupivacaine spinal block for lower limb surgeries

Cited by 23 publications

References 19 publications

Comparative analysis of injection clonidine and injection dexmedetomidine added to injection bupivacaine for spinal anaesthesia in lower abdominal surgeries

Comparative analysis of injection clonidine and injection dexmedetomidine added to injection bupivacaine for spinal anaesthesia in lower abdominal surgeries

Comparison of two different doses dexmedetomidine as an adjuvant to bupivacaine in sub-arachnoid block for abdominal hysterectomies. A randomized double blinded study.

Effect of 5-μg Dose of Dexmedetomidine in Combination With Intrathecal Bupivacaine on Spinal Anesthesia: A Systematic Review and Meta-analysis

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