Effect of Intrathecal Ropivacaine With Dexmedetomidine for Operative and Post Operative Analgesia: A Prospective Randomized Study

Abstract

BACKGROUND: This prospective randomized double blind study was conducted to evaluate the effect and safety of intrathecal dexmedetomidine added to isobaric ropivacaine. MATERIALS AND METHODS: 120 adult female patients, who underwent vaginal hysterectomies, were randomly allocated to receive intrathecally either 3 ml of 0.75% isobaric ropivacaine + 0.5 ml normal saline (Group R) or 3 ml of 0.75% isobaric ropivacaine +5 μg dexmedetomidine in 0.5 ml of normal saline (Group D). Following intrathecal administration, duration of onset of sensory and motor blockade, maximum dermatomal level achieved, duration of analgesia, hemodynamic parameters and incidence of side effects were observed. RESULTS: Duration of onset of sensory block upto T10, T8 and the highest level of block achieved i. e. T6 were similar in both the groups. The mean time of sensory regression to S2 was 297.71±34.11 min in group D and 221.35±22.70 min in group R. Time to achieve Bromage score 0 was significantly slower with the addition of dexmedetomidine (229.37±28.74 min in group R vs. 258.55±30.46 min in group D). Duration of postoperative analgesia was significantly greater in group D (270.00±38.75 min) as compared to group R (174.77±22.31 min). The maximum VAS score for pain was less in group D (4.42±0.69) as compared to group R (7.03±0.78). There were no significant difference in hemodynamic parameters and incidence of side effects in both the groups. CONCLUSION: The addition of dexmedetomidine to ropivacaine intrathecally produces significantly longer sensory and motor blockade along with better postoperative analgesia, and excellent hemodynamic stability without any significant side effects.

A prospective randomised double-blind study of comparison of efficacy and safety of dexmedetomidine and clonidine as adjuvants to intrathecal isobaric ropivacaine 0.75% in lower limb surgeries

“…Parmar NK et al, observed that in the group R time was 5.46±0.91 min, in the group D it was 5.54±0.85 min and the p value for difference was 0.60. 16 The time taken in the present study was longer compared to the study by Parmar NK et al 16 CONCLUSION…”

“…Parmar NK et al, carried out a study among patients undergoing vaginal hysterectomy. 16 They added dexmedetomidine as an adjuvant to intrathecal ropivacaine. They also noted that in terms of peak sensory block level achieved, patients in the two groups were comparable.…”

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“…Other studies also demonstrated that addition of dexmedetomidine or fentanyl to ropivacaine in spinal anaesthesia accelerated the sensory onset but has no effect on motor block onset. 10,13,16,21 Duration of motor block was significantly longer in Group RD (360.14±16.52 min) as compared to Group R (284.43±16.57min). Duration of motor block was comparable in group R and group RF.…”

“…[8][9][10][11][12] However there is scarcity of data in which ropivacaine has been used in SAB for vaginal hysterectomy in which there is more extensive surgery, needing more relaxation than above mentioned surgeries. 13 This prompted us to plan present study. Local anaesthetic when used alone is associated with short duration of action.…”

“…When fentanyl or dexmedetomedine were added to intrathecal ropivacaine better clinical profile was noted as compared to ropivacaine alone. [9][10][11][12][13][14] However, limited study material available comparing efficacy of fentanyl versus dexmedetomidine as an adjuvant to ropivacaine in spinal anesthesia has been conducted to date. Therefore, we have planned present study using ropivacaine alone and with dexmedetomidine or fentanyl in spinal anesthesia for vaginal hysterectomy.…”