Comparing intravenous dexmedetomidine and clonidine in hemodynamic changes and block following spinal anesthesia with ropivacaine in lower limb orthopedic surgery: a randomized clinical trial

Abstract

Dexmedetomidine (DEX) can prolong duration of anesthesia and shorten onset of sensory and motor block relative to clonidine. This study attempted to compare the efficacy of intravenous DEX and clonidine for hemodynamic changes and block after spinal anesthesia with ropivacaine in lower limb orthopedic surgery. In a double-blind randomized clinical trial, 120 patients undergoing spinal anesthesia in lower limb orthopedic surgery were recruited and divided into three groups using balanced block randomization: DEX group ( n = 40; intravenous DEX 0.2 µg/kg), clonidine group ( n = 40; intravenous clonidine 0.4 µg/kg), and placebo group ( n = 40; intravenous normal saline 10 mL) in which pain scores were assessed using visual analogue scales (at recovery, and 2, 4, 6, and 12 hours after surgery) and time to achieve and onset of sensory and motor block. Statistically significant differences were found in mean arterial pressure among the groups at all times except baseline ( P = 0.001), with a less mean arterial pressure and a prolonged duration of sensory and motor block ( P = 0.001) in the DEX group where pain relieved in patients immediately after surgery and at above mentioned time points ( P = 0.001). Simultaneous administration of intravenous DEX with ropivacaine for spinal anesthesia prolongs the duration of sensory and motor block and relieves postoperative pain, and however, can decrease blood pressure. Although intravenous DEX as an adjuvant can be helpful during spinal anesthesia with ropivacaine, it should be taken with caution owing to a lowering of mean arterial pressure in patients especially in the older adults. This study was approved by Ethical Committee of Arak University of Medical Sciences (No. IR.Arakmu.Rec.1395.450) in March, 2017, and the trial was registered and approved by the Iranian Registry of Clinical Trials (IRCT No. IRCT2017092020258N60) in 2017.

Safety of Different Anesthesia Methods Combined with Intravenous Fast Channel Anesthesia in Lower Extremity Orthopedic Surgery of the Elderly

“…Spinal-epidural anesthesia, nerve block, and intravenous fast-track anesthesia are all commonly used anesthesia methods for this kind of operation, each of which has its own advantages; however, there are various shortcomings in its separate application. With the development of propofol, an ultra-short-acting intravenous anesthetic, intravenous fast-track anesthesia has been widely used in cardiovascular and knee replacement operations [ 3 , 4 ]. On the basis of applying intravenous fast-track anesthesia, combining with other anesthesia methods can significantly improve the operation effect, which has been widely recognized in clinic [ 5 , 6 ].…”

Comparative Study of the Adverse Events Associated With Adjuvant Use of Dexmedetomidine and Clonidine in Local Anesthesia

“…Most studies in this regard agree that the use of clonidine or dexmedetomidine with local anesthetics has no significant effect on cardiorespiratory parameters such as HR and MAP and other side effects such as headache and respiratory depression in patients under local anesthesia ( 1 , 6 , 8 – 10 , 13 ). However, some studies have found conflicting findings ( 12 ).…”

Comparison of adding magnesium sulfate, dexmedetomidine and ondansetron to lidocaine for gargling before laryngoscopy and endotracheal intubation to prevent sore throat: a randomized clinical trial

“…Hitherto, diversely published papers and research have focused on the clinical efficacy of magnesium, dexmedetomidine, and ondansetron on analgesia and anti-inflammatory properties. 6 7 8 9 10 11 12 13 14 …”