Effects of intrathecal dexmedetomidine as an additive to low-dose bupivacaine in patients undergoing transurethral resection of prostate

Abstract

Background and Aims:In patients undergoing transurethral resection of prostate (TURP), it is vital to restrict the level of block to T10dermatome during spinal anaesthesia. Low-dose bupivacaine causes minimum haemodynamic alterations, but may provide insufficient surgical anaesthesia. Dexmedetomidine, a selective α2-adrenoreceptor agonist, is a potent anti-nociceptive agent when given intrathecally. The aim of this study was to compare the adjuvant effects of intrathecal dexmedetomidine with low-dose bupivacaine spinal anaesthesia versus a higher dose of bupivacaine in patients undergoing TURP.Methods:The study was designed as a prospective, double-blind, randomised trial that included sixty patients of American Society of Anesthesiologists Grade I–III scheduled for TURP. They were allocated into two groups: Group I receiving only hyperbaric bupivacaine intrathecally and Group II receiving dexmedetomidine with low dose bupivacaine. The time to regression of two dermatomes from the peak sensory block level was the primary outcome of the study.Results:With comparable baseline and demographic attributes, both groups had similar peak sensory block levels (T9). Patients in Group II had quicker onset with the time to reach T10being faster (10.72 ± 3.50 vs. 12.72 ± 3.90 min, P = 0.041), longer duration of motor block (200 ± 18.23 vs. 190 ± 10.15 min, P = 0.011) and increased time to first analgesic requirement (300 ± 25.30 vs. 220 ± 15.12 min, P = 0.0001).Conclusion:Intrathecal dexmedetomidine with low-dose bupivacaine provides faster onset, prolonged sensory and motor block and reduced rescue analgesic requirement in patients undergoing TURP.

<p>Subarachnoid and epidural dexmedetomidine for the prevention of post-anesthetic shivering: a meta-analysis and systematic review</p>

“…Studies were performed in India (11),26–36 China (7),37–43 Iran (2),44,45 Nepal (1)46 and Egypt (1) 47. Surgical categories included Cesarean sections (7),37,38,40–43,45 lower limb (6),27,33–36,44 gynecological (4),33,39,46 urinary (3),28,31,33 lower abdominal (3)30,46,47 and others. Injection of DEX was over SSR (14)27–33,36–41,43–47 and ESR (3) 26,34,35,42.…”

“…Data from 10 studies28–30,33,37,39,41,43,44,46 with 675 patients were available to pool. This result showed S&E DEX prolonged the time to fall to a score of 0 on the Bromage scale or modified Bromage scale (SMD, 3.60; 95% CI, 2.22–4.97; Z =5.13, P <0.00001, I 2 =98%).…”

Effectiveness of Nalbuphine with Ropivacaine in Supraclavicular Brachial Plexus Block in Patients Undergoing Upper Limb Surgeries

“…11,12 We found no significant difference regarding body mass index and ASA class I and II. A study by Chattopadhyay et al 13 regarding efficacy of nalbuphine as an adjuvant to 0.5% bupvicaine reported that mean BMI of nalbuphine with bupvicaine group patients was 21.63±3.21 and in other group it was 20.58±2.78 kg/m 2 .…”

Low Dose Hyperbaric Bupivacaine and Dexmedetomidine as an Adjuvant in Spinal Anaesthesia, Caesarean Section: A Randomized Controlled Trial

“…that was supported by other reports in literature. [21][22][23][24] The mechanism of action of dexmedetomidine could be due to binding to pre-synaptic C-bres and post-synaptic dorsal horn neurons which causes decreased release of C-bres neurotransmitters and hyperpolarization of post-synaptic dorsal horn neurons. [25,26] Regarding motor block, our results showed a weak degree of block 2 degree according to modi ed Bromage score [18] which is suitable for that LD of hyperbaric bupivacaine and help early ambulation postoperative and regaining the muscle power which is reported to be 206 (60.9) min.…”