A Randomised, Double-Blind, Placebo-Controlled Trial Comparing Dexmedetomidine and Clonidine as an Adjuvant to Intrathecal Ropivacaine in Lower Limb Surgery

Abstract

BACKGROUNDVarious adjuvants are being used with local anaesthetics for prolongation of intraoperative and postoperative analgesia. This study was taken up to compare the duration of postoperative analgesia, extent of motor and sensory block, adverse effects along with the haemodynamic changes between ropivacaine alone, ropivacaine with clonidine and ropivacaine with dexmedetomidine.

Intrathecal dexmedetomidine and postoperative pain: A systematic review and meta‐analysis of randomized controlled trials

“…Time to onset of sensory block, defined in most studies as the time taken from intrathecal injection to loss of sensation at the T10 dermatome, was significantly faster in the DEX group in eight out of the twenty studies that reported this outcome (Attri et al., 2015; Ganesh & Krishnamurthy, 2018; Gautam et al., 2018; Kataria et al., 2018; Li et al., 2015; Naaz et al., 2016; Patro et al., 2016; Ramaiah et al., 2015). Onset of motor blockade, defined mostly as the time taken to reach a Bromage score of 3, was significantly faster in the DEX group in seven out of 18 studies (Attri et al., 2015; Ganesh & Krishnamurthy, 2018; Munnoli et al., 2016; Naaz et al., 2016; Patro et al., 2016; Ramaiah et al., 2015; Suthar et al., 2015). Duration of sensory blockade, defined in most studies as the time taken for the sensory blockade to regress to the S1 dermatome, was significantly longer in the DEX group in 15 out of 19 studies (Attri et al., 2015; Gupta et al., 2011; Kataria et al., 2018; Li et al., 2015; Mahendru et al., 2013; Munnoli et al., 2016; Naaz et al., 2016; Patro et al., 2016; Rahimzadeh et al., 2018; Ramaiah et al., 2015; Rao et al., 2015; Solanki et al., 2013; Sun et al., 2015; Suthar et al., 2015; Yektaş & Belli, 2014).…”

“…Our searches retrieved 1,206 citations and after removal of duplicates, there were 674 unique citations. After review, a total of 24 RCTs met our selection criteria and were included in the final analysis (Attri, Bansal, Chatrath, Kaur, & Khetarpal, 2015; Chatterji, Gupta, Sharma, & Chatterji, 2017; Ganesh & Krishnamurthy, 2018; Gautam, Lama, & Sharma, 2018; Gupta et al., 2011; Kataria, Jarewal, Kumar, & Kashyap, 2018; Li et al., 2015; Mahendru et al., 2013; Mohamed, Fares, & Mohamed, 2012; Munnoli et al., 2016; Naaz, Bandey, Ozair, & Asghar, 2016; Nethra et al., 2015; Patro, Deshmukh, Ramani, & Das, 2016; Rahimzadeh, Faiz, Imani, Derakhshan, & Amniati, 2018; Ramaiah, Manduri, Lakshmi, & Lalitha, 2015; Rao, Sujani, & Sudhakar, 2015; Samantaray et al., 2015; Shashikala et al., 2016; Singh et al., 2017; Solanki et al., 2013; Sun, Xu, & Wang, 2015; Sushruth & Rao, 2018; Suthar, Sethi, & Sharma, 2015; Yektaş & Belli, 2014).…”

“…Hypotension ‐ Attri 2015, Chatterji 2017, Ganesh 2018, Gautam 2018, Gupta 2011, Kataria 2018, Li 2015, Mahendru 2013, Munnoli 2016, Naaz 2016, Nethra 2015, Patro 2016, Rahimzadeh 2018, Ramaiah 2015, Samantaray 2015, Shashikala 2016, Shushruth 2018, Singh 2017, Solanki 2013, Sun 2015, Suthar 2015, Yektas 2014…”

“…Eight studies provided data on this outcome (Figure 3) (Attri et al, 2015;Gautam et al, 2018;Kataria et al, 2018;Mohamed et al, 2012;Munnoli et al, 2016;Naaz et al, 2016;Patro et al, 2016;Rahimzadeh et al, 2018). The MD in pain scores was substantially heterogeneous (I 2 > 94%) at 6, 12 and 24 postoperative hours.…”

“…In addition to comparing the effect of intrathecal DEX to placebo, six of the included studies (Ganesh & Krishnamurthy, 2018;Li et al, 2015;Mahendru et al, 2013;Munnoli et al, 2016;Solanki et al, 2013;Suthar et al, 2015) also investigated the effects of intrathecal clonidine with 30 mcg being the most common dose. Five (Li et al, 2015;Rahimzadeh et al, 2018;Rao et al, 2015;Shashikala et al, 2016;Sun et al, 2015) studied intrathecal fentanyl with 25 mcg being the most common dose.…”