Dexmedetomidine versus midazolam as adjuvants to intrathecal bupivacaine: A clinical comparison

Shukla, Usha; Prabhakar, T; Malhotra, Kiran Preet; Srivastava, D. N.

doi:10.4103/0970-9185.182105

Cited by 18 publications

(14 citation statements)

References 20 publications

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“…The results indicated that the combined administration of Dex and sufentanil as adjuvants to local anesthetic displayed an improved analgesic effect compared with the use of either drug alone. Both 0.5 µg/ml Dex and 0.5 µg/ml sufentanil have been used as adjuvants in clinical practice (12,27). In the present study, the combination of 0.25 µg/ml Dex + 0.25 µg/ml sufentanil + 0.1% ropivacaine was administered via an epidural for labor analgesia, and the efficiency and safety of the combined treatment was compared with 0.1% ropivacaine + 0.5 µg/ml Dex or 0.5 µg/ml sufentanil.…”

Section: Discussionmentioning

confidence: 99%

Combination of sufentanil, dexmedetomidine and ropivacaine to improve epidural labor analgesia effect: A randomized controlled trial

Xiao

et al. 2020

Exp Ther Med

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Opioids and α2-agonists have been used as epidural adjuvants in local anesthetics for a long time, but the effect of the combination of opioids and α2-agonists as epidural adjuvants is not completely understood. In the present study, the combination of dexmedetomidine (Dex) and sufentanil as adjuvants to ropivacaine for epidural labor analgesia was investigated. A total of 108 parturient women receiving labor epidural analgesia were randomly divided into three groups: i) Group RD received 0.1% ropivacaine + 0.5 µg/ml Dex; ii) Group RS received 0.1% ropivacaine + 0.5 µg/ml sufentanil; and iv) Group RDS received 0.1% ropivacaine + 0.25 µg/ml Dex + 0.25 µg/ml sufentanil. Patients received a 10 ml loading dose followed by a maintenance by patient controlled epidural analgesia. The visual analog scale scores, onset time, local anesthetic requirements, motor blockage and adverse effects were recorded. Group RDS displayed an improved labor analgesia effect compared with Groups RD and RS. Group RDS displayed a shorter onset time compared with Groups RD and RS, and a reduced local anesthetic requirement compared with Group RS. The motor blockage in Groups RDS and RS was significantly lower compared with Group RD, and the incidence of pruritus in Groups RDS and RD was lower compared with Group RS. In conclusion, the combined use of 0.25 µg/ml Dex and 0.25 µg/ml sufentanil as adjuvants to 0.1% ropivacaine for epidural labor analgesia displayed an improved analgesia effect compared with the use of either 0.5 µg/ml sufentanil or 0.5 µg/ml Dex alone. The present study was registered with the Chinese Clinical Trial Registry Center on 23 February, 2018 (registration no. ChiCTR-IOR-1800014943).

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Section: Discussionmentioning

confidence: 99%

Combination of sufentanil, dexmedetomidine and ropivacaine to improve epidural labor analgesia effect: A randomized controlled trial

Xiao

et al. 2020

Exp Ther Med

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“…[32][33][34][35] Recently, many studies have demonstrated that intrathecal ropivacaine or bupivacaine-dexmedetomidine may increase the duration and efficacy of analgesia and decrease postoperative analgesic use, without notable adverse effects. 11,12,36) The use of dexmedetomidine as an adjuvant to bupivacaine for covering Cesarean delivery provided better intra-operative analgesia and did not affect Apgar scores or caused any noticeable side effects. 13,28) The intrathecal doses of dexmedetomidine used in our study were based on previous human studies wherein no neurotoxic effects were documented at these doses.…”

Section: Discussionmentioning

confidence: 99%

Intrathecal Dexmedetomidine Alleviates Shivering during Cesarean Delivery under Spinal Anesthesia

Liu

et al. 2017

Biological & Pharmaceutical Bulletin

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Shivering associated with spinal anesthesia during Cesarean delivery is an uncomfortable experience for the parturient, which may also cause adverse effects. In this prospective, randomized, double-blind, placebocontrolled study, we sought to evaluate the effect of intrathecal dexmedetomidine, administered as an adjunct to hyperbaric bupivacaine for Cesarean delivery, on the incidence and severity of shivering associated with spinal anesthesia. Patients undergoing Cesarean delivery were randomly allocated to three groups of 30 patients each. Experimental treatments were added to hyperbaric bupivacaine as follows: Patients in group I (control) were administered isotonic saline. Patients in groups II and III received dexmedetomidine (2.5, 5 µg, respectively), mixed with isotonic saline. Shivering was observed in 11, 10 and 2 patients in groups I, II and III, respectively. The incidence of shivering in group III was significantly lower than that in groups I (p 0.005) and II (p 0.01). The severity of shivering was significantly different between the three groups (p 0.01). There were no significant inter-group differences with respect to mean arterial pressure and heart rate at any time point after administration of intrathecal local anesthesia (p>0.05). Intrathecal dexmedetomidine (5 µg) administered as an adjunct to hyperbaric bupivacaine during Cesarean delivery significantly reduced the incidence and intensity of shivering associated with spinal anesthesia.

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“… 45 Forty patients undergoing vaginal hysterectomies received intrathecal administration of 3 mL of 0.5% hyperbaric bupivacaine with 5 μg dexmedetomidine in 0.5 mL of normal saline, exhibited a significantly longer duration of sensory block, and reduced doses of postoperative analgesic agents with comparable side effects when compared to the intrathecal administration of 3 mL of 0.5% hyperbaric bupivacaine with 2 mg midazolam in 0.4 mL and 0.1 mL normal saline. 46 Adding 1 μg/kg dexmedetomidine to 0.75% ropivacaine in 35 patients undergoing arthroscopic shoulder surgery with ultrasound-guided single-dose interscalene block prolonged the interscalene block, and provided better postoperative pain control during the first 24 h, compared to that produced by clonidine. 47 The addition of 2 mL of 0.5 μg/kg dexmedetomidine to 20 mL of 0.3% ropivacaine for ultrasound-guided bilateral transversus abdominis plane block for postoperative analgesia after abdominal hysterectomy surgery potentiated the analgesic properties of ropivacaine, reduced sufentanil consumption, and provided better pain control.…”

Section: Effect Of Postoperative Dexmedetomidine On Perioperative Paimentioning

confidence: 99%

Dexmedetomidine in perioperative acute pain management: a non-opioid adjuvant analgesic

Tang¹,

Xia²

2017

JPR

106

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Many nociceptive, inflammatory, and neuropathic pathways contribute to perioperative pain. Although opioids have long been a mainstay for perioperative analgesia, other non-opioid therapies, and dexmedetomidine, in particular, have been increasingly used as part of a multimodal analgesic regimen to provide improved pain control while minimizing opioid-related side effects. This article reviews the evidence supporting the preoperative, intraoperative, and postoperative efficacy of dexmedetomidine as an adjuvant, and the efficacy of intravenous, spinal canal, and nerve block analgesia with dexmedetomidine for perioperative acute pain treatment. While there have not been any large-scale clinical trials conducted, the current body of evidence suggests that dexmedetomidine is suitable for use as an adjuvant analgesic at all perioperative stages. However, there are potential adverse effects, such as hypotension and bradycardia, which must be taken into consideration by clinicians.

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Dexmedetomidine versus midazolam as adjuvants to intrathecal bupivacaine: A clinical comparison

Cited by 18 publications

References 20 publications

Combination of sufentanil, dexmedetomidine and ropivacaine to improve epidural labor analgesia effect: A randomized controlled trial

Combination of sufentanil, dexmedetomidine and ropivacaine to improve epidural labor analgesia effect: A randomized controlled trial

Intrathecal Dexmedetomidine Alleviates Shivering during Cesarean Delivery under Spinal Anesthesia

Dexmedetomidine in perioperative acute pain management: a non-opioid adjuvant analgesic

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