A comparison of intrathecal dexmedetomidine verses intrathecal fentanyl with epidural bupivacaine for combined spinal epidural labor analgesia

Dilesh, PK; Eapen, Sarah; Kıran, Sibel; Chopra, V

doi:10.4103/2249-4472.143875

Cited by 9 publications

(8 citation statements)

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“…It is proven that DEX as an effective adjuvant for regional anesthetic agents, increases the duration of spinal anesthesia and prolongs the duration of sensory [ 17 ] and motor block [ 18 ] and increases the quality of analgesia without neurologic sequelae when administered as an adjuvant to local anesthetics [ 19 ]. However, there is no proper consensus regarding the dose of drug to be used for proper blocks.…”

Section: Discussionmentioning

confidence: 99%

Analgesic Characteristics of Bupivacaine Alone and in Combination with Dexmedetomidine or Meperidine in Spinal Anesthesia during Cesarean Section: A Double-Blind Randomized Clinical Trial Study

Azemati

Zarghami²,

Jouybar

et al. 2022

Pain Research and Management

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Background. Comparing bupivacaine’s adjuvants in spinal anesthesia, we assessed the specific blocking characteristics and adverse effects of bupivacaine alone and in combination with dexmedetomidine or meperidine in spinal anesthesia during cesarean section. Methods. In this double-blind randomized clinical trial study, ninety pregnant women were divided into groups to receive 10 mg bupivacaine (group B), 10 mg bupivacaine with 5 μg dexmedetomidine (group BD), or 10 mg bupivacaine with 10 mg meperidine (group BM) intrathecal. Patients were assessed for the quality of analgesia during operations. Durations of sensory and motor blocks and anesthesia-related complications were analyzed using SPSS 21, and p values <0.05 were considered statistically significant. Results. The onset of sensory and motor blocks was essentially the same in all treated groups. Block regression time was significantly prolonged in the BD group compared to the B and BM groups ( p < 0.001 ). The duration of analgesia was significantly longer in the BD and BM groups than in the B group ( p < 0.001 ). The level of sedation in the BD group was higher than in the B group. Shivering occurred in 40% of patients in the B group, which was significantly more than that of the BD (16.6%) and BM (33.3%) groups. Itching happened in 33.3% of women in the BM group which was statistically more than that of the B (3.33%) and BD (0) groups. The incidence of adverse effects was the same in all groups. Conclusion. The combination of bupivacaine with dexmedetomidine significantly prolonged sensory and motor regression time and duration of analgesia.

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Section: Discussionmentioning

confidence: 99%

Analgesic Characteristics of Bupivacaine Alone and in Combination with Dexmedetomidine or Meperidine in Spinal Anesthesia during Cesarean Section: A Double-Blind Randomized Clinical Trial Study

Azemati

Zarghami²,

Jouybar

et al. 2022

Pain Research and Management

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“…There were no significant differences in the three stages of labor, Bromage score, umbilical vein pH, or Apgar score among the three groups, which was in line with previous studies. 28 , 35 …”

Section: Discussionmentioning

confidence: 99%

“…Kiran et al reported that the onset time of intrathecal Dex was 5 minutes, which was shorter than our results. 28 The inconsistency could be explained by the different Dex doses used in each study. Compared with the use of saline, either 5 mg Dex or 5 mg sufentanil resulted in a faster onset time, improved analgesia, and reduced demand for local anesthetics.…”

Section: Discussionmentioning

confidence: 99%

“…The results indicated that Dex as an intrathecal drug combined with epidural anesthesia could provide rapid and effective analgesia, which was consistent with the clinical results previously reported. 28,29 The analgesic effect of Dex is not fully understood. Zhang et al 11 reported that intrathecal injection of Dex displayed a robust analgesic effect by inhibiting spinal extracellular signal-regulated protein kinase 1/2 signaling via an a 2 -receptor-dependent manner.…”

Section: Discussionmentioning

confidence: 99%

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Intrathecal dexmedetomidine improves epidural labor analgesia effects: a randomized controlled trial

Wang²,

et al. 2021

J Int Med Res

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Objective α2‑agonists and opioids have been used as intrathecal adjuvants to local anesthetics for several years, but the effect of intrathecal dexmedetomidine (Dex) or sufentanil combined with epidural ropivacaine in labor analgesia is not fully understood. Methods A total of 108 parturient women receiving combined spinal-epidural labor analgesia were randomly divided into three groups. Group C received l mL saline (0.9%) intrathecally, Group D received 5 µg Dex intrathecally, and Group S received 5 µg sufentanil intrathecally. All parturient women then received 0.1% epidural ropivacaine and 0.2 µg/mL sufentanil for patient-controlled epidural analgesia with standard settings. The visual analog scale score, onset time, duration of intrathecal injection, local anesthetic requirements, and side effects were recorded. Results The labor analgesia effects in Groups D and S were better than those in Group C. Groups D and S displayed significantly shorter onset times, longer durations of intrathecal injection, and reduced local anesthetic requirements compared with Group C. The incidence of shivering and pruritus in Group D was lower than that in Group S. Conclusion Intrathecal administration of 5 µg Dex could improve epidural labor analgesia effects. This randomized controlled clinical trial was registered with the Chinese Clinical Registry Center (ChiCTR-1800014943, http://www.chictr.org.cn/ ).

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“…Labor pain and painful uterine contractions cause hyperventilation and high catecholamine levels resulting in maternal and fetal hypoxemia [1]. Pain relief provides patient's comfort and attenuates the release of stress hormones [2].…”

Section: Introductionmentioning

confidence: 99%

Intrathecal dexmedetomidine-fentanyl for labor analgesia: randomized comparative study

Mohamed¹,

Salem²

2015

J Anesthesiol Clin Sci

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Background: Fentanyl has been used along with bupivacaine for labor analgesia. Dexmedetomidine may be used to alleviate this pain because it has several analgesic properties, lack of respiratory depression and has a high placental retention. This study was aimed to evaluate the efficacy and safety of combination of IT dexmedetomidine and fentanyl on maternal and neonatal outcomes during labor in comparison to IT dexmedetomidine or IT fentanyl. Patients and methods: 90 patients were included aged 19-39 years (ASA physical status I-II) with single uncomplicated pregnancy. Patients were randomly divided into three groups: group D: 30 patients were received IT 10 µg dexmedetomidine in 1 ml of normal saline, group F: 30 patients received IT 20 µg fentanyl in 1 ml of normal saline and group DF: 30 patients received IT 5 µg dexmedetomidine plus 10 µg fentanyl in 1 ml of normal saline. Age, weight, height, parity, gestational age, rupture of membrane, cervical dilatation and progress of labor were noted. The time of onset, duration of analgesia, maternal parameters of heart rate (HR), mean arterial blood pressure (MAP) and Visual analog score (VAS) were recorded. Sideeffects of pruritus, nausea and vomiting, hypotension and bradycardia were recorded. Neonatal outcome in terms of mode of delivery, neonatal Apgar score and umbilical artery pH were recorded. Results: The patient's demographics and labor characteristics were comparable among the studied groups. The dexmedetomidine group and dexmedetomidine and fentanyl mixture group have prolonged duration of analgesia. VAS score was improved in all groups after onset of analgesia. HR and MAP were lowest in dexmedetomidine group than other two groups. The fentanyl group showed significant increase in the adverse effect incidence (pruritus). Conclusion: Addition of 5 µg intrathecal dexmedetomidine to 10 µg fentanyl prolonged the duration of analgesia. The combination decreases the incidence of side effects in comparison to IT 10 µg dexmedetomidine or IT 20 µg fentanyl alone.

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A comparison of intrathecal dexmedetomidine verses intrathecal fentanyl with epidural bupivacaine for combined spinal epidural labor analgesia

Cited by 9 publications

References 1 publication

Analgesic Characteristics of Bupivacaine Alone and in Combination with Dexmedetomidine or Meperidine in Spinal Anesthesia during Cesarean Section: A Double-Blind Randomized Clinical Trial Study

Analgesic Characteristics of Bupivacaine Alone and in Combination with Dexmedetomidine or Meperidine in Spinal Anesthesia during Cesarean Section: A Double-Blind Randomized Clinical Trial Study

Intrathecal dexmedetomidine improves epidural labor analgesia effects: a randomized controlled trial

Intrathecal dexmedetomidine-fentanyl for labor analgesia: randomized comparative study

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