Effects of Adding Intrathecal Dexmedetomidine to Hyperbaric Bupivacaine for Saddle Spinal Block in Adults Undergoing Peri-anal Surgeries

Abstract

Background: Saddle spinal block is the first choice anesthetic technique for adults undergoing peri-anal surgeries. It prevents unnecessary high levels of analgesia and sympathetic block. However, it may not provide prolonged analgesia. This study aims to investigate analgesic effects of dexmedetomidine when added to hyperbaric bupivacaine in saddle spinal block.Methods: Fifty otherwise healthy adults scheduled for uncomplicated peri-anal surgery were randomly allocated into two equal groups in this double-blinded study. Group A received hyperbaric bupivacaine five milligrams; group B received hyperbaric bupivacaine five milligrams plus dexmedetomidine five micrograms intrathecally. Patients remained seated for ten minutes. Time to first analgesic request by patients was the primary end point. Onset and extent of sensory block, and, magnitude and duration of motor block were assessed. Post-operative analgesic consumption and side effects were studied for 24 hours. Student's t-test for quantitative variables and Chi-square test for categorical variables were used for statistical analysis.Results: Patients in group B had a significantly prolonged duration of analgesia (group B, 501 ± 306 minutes; group A, 284 ± 58 minutes) and significantly reduced analgesic requirement than patients in group A. Sensory block in first sacral dermatome appeared significantly earlier in group B. Peak sensory block, magnitude of motor block, and side effects were not significantly different between groups A and B. Conclusions:Dexmedetomidine as an intrathecal adjuvant to hyperbaric bupivacaine in saddle spinal block prolongs duration of analgesia and decreases analgesic requirement with no added side effects.

Intrathecal dexmedetomidine and postoperative pain: A systematic review and meta‐analysis of randomized controlled trials

“…Our searches retrieved 1,206 citations and after removal of duplicates, there were 674 unique citations. After review, a total of 24 RCTs met our selection criteria and were included in the final analysis (Attri, Bansal, Chatrath, Kaur, & Khetarpal, 2015; Chatterji, Gupta, Sharma, & Chatterji, 2017; Ganesh & Krishnamurthy, 2018; Gautam, Lama, & Sharma, 2018; Gupta et al., 2011; Kataria, Jarewal, Kumar, & Kashyap, 2018; Li et al., 2015; Mahendru et al., 2013; Mohamed, Fares, & Mohamed, 2012; Munnoli et al., 2016; Naaz, Bandey, Ozair, & Asghar, 2016; Nethra et al., 2015; Patro, Deshmukh, Ramani, & Das, 2016; Rahimzadeh, Faiz, Imani, Derakhshan, & Amniati, 2018; Ramaiah, Manduri, Lakshmi, & Lalitha, 2015; Rao, Sujani, & Sudhakar, 2015; Samantaray et al., 2015; Shashikala et al., 2016; Singh et al., 2017; Solanki et al., 2013; Sun, Xu, & Wang, 2015; Sushruth & Rao, 2018; Suthar, Sethi, & Sharma, 2015; Yektaş & Belli, 2014).…”

“…The majority of studies used loss of pinprick sensation and the Bromage scale to assess sensory and motor blockade, respectively. Time to onset of sensory block, defined in most studies as the time taken from intrathecal injection to loss of sensation at the T10 dermatome, was significantly faster in the DEX group in eight out of the twenty studies that reported this outcome (Attri et al., 2015; Ganesh & Krishnamurthy, 2018; Gautam et al., 2018; Kataria et al., 2018; Li et al., 2015; Naaz et al., 2016; Patro et al., 2016; Ramaiah et al., 2015). Onset of motor blockade, defined mostly as the time taken to reach a Bromage score of 3, was significantly faster in the DEX group in seven out of 18 studies (Attri et al., 2015; Ganesh & Krishnamurthy, 2018; Munnoli et al., 2016; Naaz et al., 2016; Patro et al., 2016; Ramaiah et al., 2015; Suthar et al., 2015).…”

“…Hypotension ‐ Attri 2015, Chatterji 2017, Ganesh 2018, Gautam 2018, Gupta 2011, Kataria 2018, Li 2015, Mahendru 2013, Munnoli 2016, Naaz 2016, Nethra 2015, Patro 2016, Rahimzadeh 2018, Ramaiah 2015, Samantaray 2015, Shashikala 2016, Shushruth 2018, Singh 2017, Solanki 2013, Sun 2015, Suthar 2015, Yektas 2014…”

“…Our searches retrieved 1,206 citations and after removal of duplicates, there were 674 unique citations. After review, a total of 24 RCTs met our selection criteria and were included in the final analysis (Attri, Bansal, Chatrath, Kaur, & Khetarpal, 2015;Chatterji, Gupta, Sharma, & Chatterji, 2017;Ganesh & Krishnamurthy, 2018;Gautam, Lama, & Sharma, 2018;Gupta et al, 2011;Kataria, Jarewal, Kumar, & Kashyap, 2018;Li et al, 2015;Mahendru et al, 2013;Mohamed, Fares, & Mohamed, 2012;Munnoli et al, 2016;Naaz, Bandey, Ozair, & Asghar, 2016;Nethra et al,…”

“…Eight studies provided data on this outcome (Figure 3) (Attri et al, 2015;Gautam et al, 2018;Kataria et al, 2018;Mohamed et al, 2012;Munnoli et al, 2016;Naaz et al, 2016;Patro et al, 2016;Rahimzadeh et al, 2018). The MD in pain scores was substantially heterogeneous (I 2 > 94%) at 6, 12 and 24 postoperative hours.…”