Efficacy of premixed versus sequential administration of clonidine as an adjuvant to hyperbaric bupivacaine intrathecally in cesarean section

Sachan, Prachee; Kumar, Nidhi; Sharma, J. P.

doi:10.4103/0259-1162.128898

Cited by 5 publications

(3 citation statements)

References 21 publications

(23 reference statements)

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“…Besides fentanyl, other drugs like clonidine and dexmedetomidine have also been studied in many trials to see the quality of spinal anaesthesia with hyperbaric bupivacaine in premixed and separate syringe sequential administration technique and found that separate administration of adjuvants with bupivacaine have beter haemodynamic and analgesic outcome 6,14 which is similar to our study.…”

Section: Discussionsupporting

confidence: 88%

Study of effectiveness of two syringe spinal anaesthesia technique for caesarean section

Acharya,

Bhandari,

Bhandari

2023

Nep. Med. Coll. J.

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Spinal anaesthesia using hyperbaric bupivacaine is the most popular method for caesarean section. Adjuvents like fentanyl which enhances the sensory block and provide stable haemodynamics are usually premixed with bupivacaine in a single syringe. Fentanyl when added to hyperbaric bupivacaine, decreases the density of solution to extent of 0.0006 which alters the spread of local anesthetics in CSF. If we inject both the drugs separately in different syringe, it may minimize the effect of the changes in densities and PH of both the drugs and produce their maximum effect with minimal haemodynamic alteration. Therefore this study was conducted to see the quality of sensory block and haemodynamic response by sequential intrathecal administration of fentanyl and hyperbaric bupivacaine in two different syringe for patients undergoing caesarian section. This interventional study was carried out in Seventy nine Patients undergoing caesarean section under spinal anesthesia with 0.5% hyperbaric bupivacaine 9mg (1.8 ml) and fentanyl 20 mcg in two different syringe administered sequentially. Out of 79 parturients only 22 (27.85%) had hypotension requiring vasopressor treatment during caesarean section and maximum amount of vasopressor used was 15 mg of mephentermine. The mean level of maximum sensory block after 20 mins of spinal anaesthesia was T2 in 20 (25.32%) patients, T3 in 19 (24.05%) patients, T4 in 32 (40.51%) patients, T5 in 1 (1.27%) patient and T6 in 7 (8.86%) Patients. Intraoperative quality of surgical anaesthesia was very satisfactory to the patients. Only 6 (7.59%) patients had mild discomfort whithout requirement of any medical treatment. The result of this study concluded that separate intrathecal injection of fentanyl and hyperbaric bupivacaine provides better haemodynamic stability, improves quality of surgical anaethesia allowing it to work at higher levels in the spinal cord with minimal other side effects in patient undergoing caesarean section.

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Section: Discussionsupporting

confidence: 88%

Study of effectiveness of two syringe spinal anaesthesia technique for caesarean section

Acharya,

Bhandari,

Bhandari

2023

Nep. Med. Coll. J.

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“…This may be due to the change in the concentration and/or the chemistry of local anesthetics. [ 25 ]…”

Section: Discussionmentioning

confidence: 99%

Analgesic effect of adding magnesium sulfate to epidural levobupivacaine in patients with pre-eclampsia undergoing elective cesarean section

Elsharkawy

Farahat

Abdelhafez

2018

J Anaesthesiol Clin Pharmacol

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“…Several studies have explored intrathecal nonopioids as novel alternatives, such as α 2 -adrenergic receptor agonists [ 21 ] and neostigmine [ 22 ]. Dexmedetomidine is a highly selective α 2 -adrenergic receptor agonist that has sedative, analgesic, anxiolytic, sympatholytic, amnestic, anti-shivering, and opioid-sparing effects [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Intrathecal dexmedetomidine as an adjuvant to plain ropivacaine for spinal anesthesia during cesarean section: a prospective, double-blinded, randomized trial for ED50 determination using an up-down sequential allocation method

Mo,

Huang,

et al. 2023

BMC Anesthesiol

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Background Intrathecal dexmedetomidine, as an adjuvant to local anesthetics, has been reported to improve the quality of spinal anesthesia and reduce the required local anesthetic dose. However, the optimal dosage regimen for intrathecal dexmedetomidine combined with plain ropivacaine for cesarean section (CS) remains undetermined. The present study aimed to determine the median effective dose (ED50) of intrathecal dexmedetomidine as an adjuvant to plain ropivacaine for spinal anesthesia during CS. Methods Sixty parturients undergoing CS were randomly assigned to either group: plain ropivacaine 8 mg (Group Rop8) or plain ropivacaine 10 mg (Group Rop10). The initial dosage of intrathecal dexmedetomidine in each group was 5 µg. The effective dose was defined as a bilateral sensory block at the level of T6 or above to pinprick attained within 10 min after intrathecal injection, without the need for supplementary intraoperative epidural anesthesia. Effective or ineffective responses were determined, followed by a 1 µg increment or decrement in the dose of intrathecal dexmedetomidine for the next parturient using up-down sequential allocation. ED50 were calculated using probit regression. Results The ED50 of intrathecal dexmedetomidine with plain ropivacaine was 5.9 µg (95% confidence interval [CI], 4.9–7.4 µg) in Group Rop8 and 3.1 µg (95% CI, 0.1–4.8 µg) in Group Rop10 (P < 0.05). Hemodynamic stability, side effects, patient satisfaction and neonatal outcomes were comparable between the two groups. Conclusions The present data suggested that the ED50 of intrathecal dexmedetomidine as an adjuvant to 8 mg and 10 mg plain ropivacaine in spinal anesthesia during cesarean section was approximately 6 µg and 3 µg, respectively. Trial registration Chinese Clinical Trial Registry, identifier: ChiCTR2200055928.

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Efficacy of premixed versus sequential administration of clonidine as an adjuvant to hyperbaric bupivacaine intrathecally in cesarean section

Cited by 5 publications

References 21 publications

Study of effectiveness of two syringe spinal anaesthesia technique for caesarean section

Study of effectiveness of two syringe spinal anaesthesia technique for caesarean section

Analgesic effect of adding magnesium sulfate to epidural levobupivacaine in patients with pre-eclampsia undergoing elective cesarean section

Intrathecal dexmedetomidine as an adjuvant to plain ropivacaine for spinal anesthesia during cesarean section: a prospective, double-blinded, randomized trial for ED50 determination using an up-down sequential allocation method

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