Comparing effects of intrathecal adjuvants fentanyl and dexmedetomidine with hyperbaric ropivacaine in patients undergoing elective infraumbilical surgeries: A prospective, double-blind, clinical study

Shashikala, Thuraganur Kapanigowda; S., Sagar; Ramaliswamy, Puttaiah; Hudgi, Vinod V

doi:10.4103/aer.aer_183_18

Cited by 3 publications

(4 citation statements)

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“…Thus, during spinal anesthesia with ropivacaine, anesthesiologists should carefully determine which adjuvants should be administered. Various intrathecal adjuvants, such as opioids and α -2 agonists (clonidine and dexmedetomidine), can be administered along with ropivacaine [ 24 , 25 ]. In a previous study, intrathecal dexmedetomidine demonstrated prolonged duration of sensory block with minimal side effects [ 24 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

“…Various intrathecal adjuvants, such as opioids and α -2 agonists (clonidine and dexmedetomidine), can be administered along with ropivacaine [ 24 , 25 ]. In a previous study, intrathecal dexmedetomidine demonstrated prolonged duration of sensory block with minimal side effects [ 24 , 26 ]. It can also be administered intravenously for sedation during spinal anesthesia and has gained popularity due to the prolonged action of the block and patient satisfaction [ 12 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

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No Difference between Spinal Anesthesia with Hyperbaric Ropivacaine and Intravenous Dexmedetomidine Sedation with and without Intrathecal Fentanyl: A Randomized Noninferiority Trial

Lee

Kim

Choi

et al. 2022

Pain Research and Management

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To enhance the duration of single-shot spinal anesthesia, intrathecal fentanyl and intravenous dexmedetomidine are widely used as adjuvants to local anesthetics. This noninferiority trial evaluated whether hyperbaric ropivacaine alone can produce a noninferior duration of sensory block in comparison to hyperbaric ropivacaine with intrathecal fentanyl in patients under dexmedetomidine sedation. Methods. Fifty patients scheduled for elective lower limb surgery under spinal anesthesia were randomly assigned in a double-blind fashion to receive either hyperbaric ropivacaine 15 mg (Group R) or hyperbaric ropivacaine 15 mg with intrathecal fentanyl 20 μg (Group RF). Intravenous dexmedetomidine (1 μg/kg for 10 min, followed by 0.5 μg/kg/h) was administered in both groups. The primary outcome of this study was the time to two-dermatomal regression of sensory block. The noninferiority margin for the mean difference was −10 min. Characteristics of the block, intraoperative and postoperative side effects, postoperative pain score, and analgesic consumption were assessed as secondary outcomes. Results. There was no difference in the two-dermatomal regressions of sensory block between the two groups (Group R 70.4 ± 10.2 min, Group RF 71.2 ± 12.4 min, p = 0.804) with a mean difference of 0.8 min (−7.2 to 5.6, 95% confidence interval). Thus, the noninferiority of hyperbaric ropivacaine alone was established. There were no significant differences in the secondary outcomes between the two groups. Conclusions. Under intravenous dexmedetomidine sedation, the duration of spinal anesthesia with hyperbaric ropivacaine alone was noninferior to that of hyperbaric ropivacaine with intrathecal fentanyl. This suggests that addition of intrathecal fentanyl to hyperbaric ropivacaine may not be necessary in patients receiving intravenous dexmedetomidine.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

No Difference between Spinal Anesthesia with Hyperbaric Ropivacaine and Intravenous Dexmedetomidine Sedation with and without Intrathecal Fentanyl: A Randomized Noninferiority Trial

Lee

Kim

Choi

et al. 2022

Pain Research and Management

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“…У той же час низка препаратів, що застосовуються при спинномозковій анестезії, мають обмежену тривалість дії, тому в ранньому післяопераційному періоді пацієнтам потрібне додаткове знеболювання [2,3]. Для збільшення аналгетичного ефекту місцевих анестетиків, що використовуються при спинномозковій анестезії, останнім часом широко застосовуються ад'юванти, серед яких великою популярністю користуються опіоїди й агоністи рецепторів α2 [4,5].…”

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Comparative characteristics of the effectiveness of spinal anesthesia with intrathecal administration of bupivacaine and its combination with adjuvants

Shchegolkov

2024

ЕМ

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Background. Currently, there is active discussion regarding the effectiveness of different adjuvants in spinal anesthesia. Objective: to compare the effectiveness of dexmedetomidine and fentanyl as adjuvants in combination with intrathecal bupivacaine administration during biportal endoscopic discectomy. Materials and methods. The study included 150 patients. Using block randomization based on a sample size, patients were divided intro the following groups: 1) group 1 — intrathecal hyperbaric bupivacaine 2.5 ml in 0.5 ml of normal saline; 2) group 2 — intrathecal hyperbaric bupivacaine 2.5 ml with fentanyl 25 µg; 3) group 3 — intrathecal hyperbaric bupivacaine with dexmedetomidine 5 µg. Results. A faster onset of a sensory block up to T8 was observed in group 3 (4.39 ± 0.90 minutes), which was 20.9 ± 1.4 % earlier compared to group 1, where this parameter was 5.55 ± 1.37 minutes (p = 0.00124). When comparing similar data between groups 2 and 3, no statistically significant difference was observed (p = 0.68135). The time to two-segment regression from the highest sensory level was highest during the administration of bupivacaine with dexmedetomidine (group 3), 147.39 ± 24.95 minutes. A similar trend was maintained in the time indicators of sensory regression to S1 from the highest sensory level. The time to Bromage 0 regression in the bupivacaine with dexmedetomidine group (group 3) was on average 90.52 ± 3.25 % higher compared to the bupivacaine and fentanyl group and exceeded similar values in the bupivacaine with normal saline group (group 1) by 133.55 ± 4.18 %. The overall duration of analgesia was highest in group 3 — 482.63 ± 66.85 minutes. This was on average 67.39 ± 2.75 % longer compared to group 2 and 119.55 ± ± 4.14 % longer compared to group 1 (p < 0.001). The pain severity 6 hours after surgery was the lowest in the group of bupivacaine and dexmedetomidine (group 3) — 2.05 ± 0.79 that was 67.04 ± 2.51 % lower than the corresponding value in the bupivacaine and fentanyl group (group 2) and 68.27 ± 2.35 % lower than in the bupivacaine with normal saline group (group 1). Conclusions. Intrathecal administration of hyperbaric bupivacaine with dexmedetomidine 5 µg during spinal anesthesia has the maximum effect in terms of deve-loping motor and sensory blocks, prolongs postoperative analgesia, and reduces the need for postoperative use of narcotic analgesics.

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“…The use of hyperbaric LA agents for intrathecal administration has recently gained popularity due to their predictable block characteristics and reliable spinal anesthesia. 4,5 One advantage of ropivacaine is that it has a lower risk of toxicity to the heart and nervous system compared to bupivacaine. It also has a shorter motor block time so patients can move their legs sooner after the surgery.…”

Section: Introductionmentioning

confidence: 99%

Comparison of clinical efficacy of hyperbaric ropivacaine with hyperbaric bupivacaine in spinal anesthesia for transurethral resection of prostate: A randomized and double-blind study

Savita Gupta,

Isha Yadav,

Anupriya Saxena

et al. 2024

Asian J Med Sci

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Background: Ropivacaine is an ammino-amide local anesthetic agent with properties similar to bupivacaine, but its decreased lipophilicity is associated with reduced incidence of central nervous system toxicity and cardiotoxicity. This study evaluated the safety, efficacy, effects on hemodynamics and complications of spinal anesthesia using 0.5% hyperbaric bupivacaine and 0.75% hyperbaric ropivacaine in patients undergoing transurethral resection of the prostate (TURP). Aims and Objectives: The aim was to evaluate the safety, efficacy, hemodynamic stability, and side effects of spinal anesthesia using 0.5% hyperbaric bupivacaine and 0.75% hyperbaric ropivacaine in patients undergoing TURP. Materials and Methods: Sixty adult patients with physical status classes I and II, as determined by the American Society of Anesthesiologists, scheduled to undergo elective transurethral resection of prostate, were randomly allocated to receive either hyperbaric ropivacaine 0.75% 2.8 mL plus fentanyl 15 mcg or hyperbaric bupivacaine 0.5% 2.8 mL plus fentanyl 15 mcg. The parameters, such as demographic characteristics, duration of surgery, onset of sensory and motor blockade, hemodynamic stability, and complications, were compared in both groups. Results: Hyperbaric ropivacaine exhibited significantly slower onset times for sensory and motor blockade compared to hyperbaric bupivacaine. Patients in the ropivacaine group demonstrated better hemodynamic stability and experienced less hypotension compared to those who received bupivacaine. Moreover, the sensory and motor block lasted significantly longer in the bupivacaine group. Conclusion: About 0.75% hyperbaric ropivacaine is a better choice for spinal anesthesia in elderly patients undergoing TURP as compared to 0.5% hyperbaric bupivacaine.

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Comparing effects of intrathecal adjuvants fentanyl and dexmedetomidine with hyperbaric ropivacaine in patients undergoing elective infraumbilical surgeries: A prospective, double-blind, clinical study

Cited by 3 publications

References 19 publications

No Difference between Spinal Anesthesia with Hyperbaric Ropivacaine and Intravenous Dexmedetomidine Sedation with and without Intrathecal Fentanyl: A Randomized Noninferiority Trial

No Difference between Spinal Anesthesia with Hyperbaric Ropivacaine and Intravenous Dexmedetomidine Sedation with and without Intrathecal Fentanyl: A Randomized Noninferiority Trial

Comparative characteristics of the effectiveness of spinal anesthesia with intrathecal administration of bupivacaine and its combination with adjuvants

Comparison of clinical efficacy of hyperbaric ropivacaine with hyperbaric bupivacaine in spinal anesthesia for transurethral resection of prostate: A randomized and double-blind study

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