Effect of intrathecal dexmedetomidine versus intravenous dexmedetomidine on subarachnoid anesthesia with hyperbaric bupivacaine

Abstract

Background and Aim: Alpha-2 agonists such as dexmedetomidine when given intravenously or intrathecally as an adjuvant potentiate subarachnoid anesthesia. We studied the difference in subarachnoid anesthesia when supplemented with either intrathecal or intravenous dexmedetomidine. Material and Methods: Seventy-five patients posted for lower limb and infraumbilical procedures were enrolled for a prospective, randomized, double-blind, placebo-controlled study and divided into three groups: Group B ( n = 25) received intravenous 20 mL 0.9%N aCl over 10 min followed by intrathecal 2.4 mL 0.5%bupivacaine + 0.2 mL sterile water; Group B DexIT ( n = 25) received intravenous 20 mL 0.9%N aCl over 10 min followed by intrathecal 2.4 mL 0.5%b upivacaine + 0.2 mL (5 μg) dexmedetomidine; Group B DexIV ( n = 25) received intravenous dexmedetomidine 1 μg/kg in 20 mL 0.9%N aCl over 10 min followed by intrathecal 2.4 mL 0.5%b upivacaine + 0.2 mL sterile water. Onset and recovery from motor and sensory blockade, and sedation score were recorded. Onset of sensory and motor blockade was assessed using Kruskal–Wallis test, whereas 2-segment regression and recovery was analyzed using ANOVA and post hoc Tukey's test to determine difference between the three groups. P value <0.05 was considered statistically significant. Results: Although onset of sensory and motor block was similar in the three groups, motor recovery (modified Bromage scale 1) and two-segment sensory regression was prolonged in Group B DexIT > Group B DexIV > Group B ( P < 0.001). Patients in Group B DexIT and Group B DexIV were sedated but easily arousable. Conclusion: Intrathecal dexmedetomidine prolongs the effect of subarachnoid anesthesia with arousable sedation when compared with intravenous dexmedetomidine.

Successful Management of Parkinson's Disease Dyskinesia During Local Anesthesia With Dexmedetomidine

“…There are also two reports that the combined use of DEX with local anaesthesia prolonged the effect of the local anaesthetic [12,13]. Although it is not a common method of administration and is still in the research stage, there is a report that DEX administered into the subarachnoid region of the spinal cord produced a mild sedative effect while enhancing the effects of spinal anaesthesia [14]. Therefore, we suggest that DEX is among the most suitable sedatives for local anaesthesia in patients with PD who present dyskinesia.…”

The Density of Different Local Anesthetic Solutions, Opioid Adjuvants and Their Clinically Used Combinations: An Experimental Study

“…Moreover, it is worth stressing that LA-A solution density is only one of the numerous factors affecting the final spread of the spinal block. Our study included only opioid adjuvants, however, in current practice other non-opioid additives are also being used through intrathecal route, i.e., alpha 2 agonists [ 28 ]. The reason was that those drugs are not registered for spinal anesthesia in our country and the authors decided to concentrate only on LA-A compositions used in everyday practice.…”

Recent Advances in the Clinical Value and Potential of Dexmedetomidine

“…In effect, intrathecal dexmedetomidine prolongs the influence of anesthesia with arousable sedation as compared with intravenous dexmedetomidine. 33 …”