Comparative addition of dexmedetomidine and fentanyl to intrathecal bupivacaine in orthopedic procedure in lower limbs

Rahimzadeh, Poupak; Faiz, Seyed Hamid Reza; Imani, Farnad; Derakhshan, Pooya; Amniati, Saeed

doi:10.1186/s12871-018-0531-7

Cited by 59 publications

(59 citation statements)

References 21 publications

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“…Evaluation of risk of bias for each included study.analyses did not affect the pooled results. The Begg funnel plot (P ¼ 0.65) and the Egger test (P ¼ 0 20). found no evidence of publication bias.…”

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confidence: 90%

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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confidence: 90%

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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“…A dose of 8 -10 mg is commonly used for bupivacaine (10,11), which is associated with a high prevalence of hypotension and an increase in complications for both mother and baby (12). Bupivacaine alone can prolong the sensory and motor blockades in spinal anesthesia for lower limb surgery, compared with the combination of 10 µg epinephrine and 5 µg sufentanil (13), but the simultaneous use of dexmedetomidine and bupivacaine in spinal anesthesia for intrathecal analgesia has a longer duration of sensory and motor blockage and longer postoperative analgesia with lower side effects (14). Adding intrathecal magnesium sulphate to bupivacaine in patients under lower extremity surgeries is a safe and effective adjuvant therapeutic method for enhancing onset time of motor block (15)(16)(17).…”

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confidence: 99%

Comparing the Effect of Bupivacaine and Ropivacaine in Cesarean Delivery with Spinal Anesthesia

et al. 2020

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Background: Spinal anesthesia is the most common technique used for cesarean delivery due to some advantages compared to regional anesthesia. It is easily performed and provides a rapid onset of block. Though bupivacaine is a generally used long-acting amide type local anesthetic drug for spinal anesthesia, ropivacaine may sometimes be selected. Objectives: This prospective, randomized, double-blinded study was aimed at comparing clinical efficacy and safety between ropivacaine and bupivacaine during cesarean section. Methods: After getting ethical committee approval and written informed consent, 65 women who referred to Imam Khomeini Hospital of Ahvaz, Iran in 2018 were chosen for elective cesarean delivery under spinal anesthesia. They were randomly allocated to receive either ropivacaine 1% (n = 33) or bupivacaine 0.5% (n = 32). Afterwards, the differences in the anesthetic efficacy, vital signs, and hemodynamics of participants between the two groups were recorded. Results: Duration of sensory block was shorter in the ropivacaine group than bupivacaine group (132.5 ± 21.6 min vs. 175.8 ± 26.2 min; P < 0.001). Ropivacaine also produced a shorter duration of motor blockade than bupivacaine (124.8 ± 20.2 min vs. 168.2 ± 21.7 min; P < 0.001). There is no difference between the two groups in terms of systolic and diastolic blood pressure, but the heart rate of patients in the bupivacaine group is significantly higher than the ropivacaine group. Conclusions: The results suggest that ropivacaine and bupivacaine are two efficient drugs in anesthesia in the cesarean section, ropivacaine is a better choice due to little influence on the hemodynamics and shorter duration of sensory block and motor block which are useful for the recovery and also safe to the patients.

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“…Dexmedetomidine is a new generation of alpha-2 adrenergic receptor agonists with high selectivity that had been approved by the US food and drug administration (FDA) by the end of 1999 for administration as a short-term sedation and analgesia agent in intensive care units (ICUs) ( 8 , 9 ). Combining DEX with local anesthetic is an efficient approach to improve the effectiveness of local anesthetic and to decrease their required dosage ( 10 ).…”

Section: Introductionmentioning

confidence: 99%

The Effect of Adding Dexmedetomidine as an Adjuvant to Lidocaine in Forearm Fracture Surgeries by Supraclavicular Block Procedure Under Ultrasound-Guided

et al. 2018

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BackgroundTo improve the brachial plexus block (BPB) performance, different compounds have been used as adjuvants to local analgesics.ObjectivesThe aim of the present study was to investigate the effects of adding DEX to lidocaine on effectiveness of nerve block, and postoperative pain in forearm fracture surgery by supraclavicular BPB undergoing ultrasound-guided.MethodsThis was a double-blinded randomized clinical trial conducted on 72 patients with ASA classes I and II, which were candidates for forearm fracture surgery. In group A, patients received 3 mg/kg of lidocaine 2%. In group B, patients received 3 mg/kg of lidocaine 2% and DEX (1 µg/kg). The ultrasound-guided supraclavicular BPB was performed in all patients. The onset of sensory and motor blocks were evaluated with pin prick test and modified Bromage scale, respectively. The sensory and motor block moment was recorded as the onset of the block. The first analgesic request time, total consumed analgesic, adverse effect, and hemodynamic parameters of patients were recorded. A visual analog scale (VAS) was used for recording the severity of pain.ResultsThe two groups showed no significant difference in the demographic variables. The onset of sensory and motor block in the DEX groups was shorter. The duration of sensory and motor block, and analgesic request was significantly longer than the control groups. Total analgesic consumption 24 hours after surgery in the DEX groups was significantly lower. Moreover, hemodynamic status of patients in both groups was stable and no significant difference was observed between groups. This study showed that DEX, as an adjuvant to lidocaine, improve the characteristics of supraclavicular BPB and decrease the postoperative pain.

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Comparative addition of dexmedetomidine and fentanyl to intrathecal bupivacaine in orthopedic procedure in lower limbs

Cited by 59 publications

References 21 publications

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

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

Comparing the Effect of Bupivacaine and Ropivacaine in Cesarean Delivery with Spinal Anesthesia

The Effect of Adding Dexmedetomidine as an Adjuvant to Lidocaine in Forearm Fracture Surgeries by Supraclavicular Block Procedure Under Ultrasound-Guided

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