Evaluation of low-dose dexmedetomidine and neostigmine with bupivacaine for postoperative analgesia in orthopedic surgeries: A prospective randomized double-blind study

Abstract

Background and Aims:Neuraxial adjuants to local anesthetics is an effective technique of improving the quality and duration of postoperative analgesia. The safety and efficacy of drugs like dexmedetomidine and neostigmine as epidural medications have been sparsely investigated.Material and Methods:Combined spinal-epidural anesthesia was performed in 60 American Society of Anesthesiologists I and II patients who required lower limb surgeries of ≤3 h duration. The epidural drug was administered at the end of surgery with patients randomized into three groups. Group I, II and III received 6 ml of 0.25% bupivacaine alone, with 1 ug/kg of neostigmine and with 0.5 ug/kg of dexmedetomidine + 1 ug/kg of neostigmine, respectively. The patients were prescribed 50 mg tramadol intravenous as rescue analgesic. Patients were assessed for hemodynamic parameters, pain scores, duration of analgesia, rescue analgesic requirements and the incidence of side-effects over the next 10 h. Data was analyzed using SPSS® version 17.0 (Chicago, IL, USA). P < 0.05 was considered as statistically significant.Results:Patients in Group III had significantly longer mean duration of analgesia (273.5 min) compared to Group II (176.25 min) and Group I (144 min). There was increased requirement of fluids to maintain blood pressures in Group III. Neostigmine did not cause significant incidence of gastrointestinal side effects.Conclusions:Epidurally administered dexmedetomidine and neostigmine exhibit synergism in analgesic action. The incidence of drug-related side-effects was low in our study.

Effects of dexmedetomidine versus midazolam for premedication in paediatric anaesthesia with sevoflurane: A meta-analysis

“…The analgesia may be concentrated on the alleviation of inflammatory and oxidation reactions, 31 activation of central α 2 -adrenergic receptors in the locus coeruleus, 32 sedation, and prevention of EA. Consistent with other studies, 9 , 33 , 34 our results also prove that DEX favours reduction in the need for rescue analgesia during anaesthesia.…”

Dexmedetomidine in perioperative acute pain management: a non-opioid adjuvant analgesic

“…However, there was also an increased requirement of fluids to maintain blood pressure. 45 Forty patients undergoing vaginal hysterectomies received intrathecal administration of 3 mL of 0.5% hyperbaric bupivacaine with 5 μg dexmedetomidine in 0.5 mL of normal saline, exhibited a significantly longer duration of sensory block, and reduced doses of postoperative analgesic agents with comparable side effects when compared to the intrathecal administration of 3 mL of 0.5% hyperbaric bupivacaine with 2 mg midazolam in 0.4 mL and 0.1 mL normal saline. 46 Adding 1 μg/kg dexmedetomidine to 0.75% ropivacaine in 35 patients undergoing arthroscopic shoulder surgery with ultrasound-guided single-dose interscalene block prolonged the interscalene block, and provided better postoperative pain control during the first 24 h, compared to that produced by clonidine.…”

A Prospective Randomized Double Blind Study on Efficacy of Dexmedetomidine and Ketamine as Adjuvant to Epidural Ropivacaine in Lower Abdominal and Lower Limb Surgery

“…Bromage scale for motor blockade: 0-No block,1-inability to raise extended leg, 2-inability to flex knee,3-inability to flex ankle and foot. [7] HR, SBP, DBP, MAP and SpO₂ was recorded every 5 minutes till the end of first hour and then every 15 minutes till the end of surgery. After the surgery, patients were referred to the post anesthesia care unit.…”