Intrathecal dexmedetomidine as adjuvant for spinal anaesthesia for perianal ambulatory surgeries: A randomised double-blind controlled study

Abstract

Background and Aim:The newer trend in regional anaesthesia for ambulatory anorectal surgeries advocate use of lower dose of local anaesthetic, providing segmental block with adjuvants such as opioids and α2 agonists to prolong analgesia. The current study investigated effects of addition of 5 μg of dexmedetomidine to 6 mg of hyperbaric bupivacaine on duration of analgesia, sensory and motor block characteristics for perianal ambulatory surgeries.Methods:This study is a prospective randomised controlled double blind study. Forty adult patients between 18 and 55 years of age were divided into 2 groups. Group D received intrathecal 0.5% hyperbaric bupivacaine 6 mg (1.2 ml) with injection dexmedetomidine 5 μg in 0.5 ml of normal saline and Group N received intrathecal 0.5% hyperbaric bupivacaine 6 mg (1.2 ml) with 0.5 ml of normal saline. The parameters assessed were time to regression of sensory blockade, motor blockade, ambulation, time to void, first administration of analgesic. Statistical analysis was done using appropriate tests.Results:Time for regression of sensory level and time for first administration of analgesic were prolonged in Group D (430.05 ± 89.13 min, 459.8 ± 100.9 min, respectively) in comparison to Group N (301.10 ± 94.86 min, 321.85 ± 95.08 min, respectively). However, the duration of motor blockade, time to ambulation, and time to void were also significantly prolonged in Group D (323.05 ± 54.58 min, 329.55 ± 54.06 min, 422.30 ± 87.59 min) than in Group N (220.10 ± 63.61 min, 221.60 ± 63.84 min, 328.45 ± 113.38 min).Conclusion:Intrathecal dexmedetomidine 5 μg added to intrathecal bupivacaine 6 mg as adjuvant may not be suitable for ambulatory perianal surgeries due to prolongation of motor blockade.

Low dose of dexmedetomidine as an adjuvant to bupivacaine in cesarean surgery provides better intraoperative somato-visceral sensory block characteristics and postoperative analgesia

“…Furthermore in our study on significant difference in the incidence of side effects such as pruritus, nausea and vomiting were noted across the three groups. Similar results were reported in previous studies [ 10 , 32 , 33 ]. There has been much debate regarding problems with breastfeeding after anesthesia.…”

Dexmedetomidine as a neuraxial adjuvant for prevention of perioperative shivering: Meta-analysis of randomized controlled trials

“…Side effects were reported in 15 studies, comprising neurological complications [24, 25, 28, 30], respiratory depression [22, 24–26, 28–30, 38, 44, 45], bradycardia [22–30, 36, 38, 44, 45], hypotension [22–27, 29, 30, 36, 38, 44, 45], nausea/vomiting [22–30, 36–39, 44, 45]. None of the studies reported mortality and major cardiovascular complications, such as non-fatal myocardial infarction, stroke, or cardiac arrest.…”

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

“…A total of 18 studies reported the presence of bradycardia, and data from 12 studies26,27,30,32,33,36,39,40,44–47 with 797 patients were available to pool. The incidence of bradycardia increased from 5.84% in the control group to 11.13% in the DEX group (RR, 2.49; 95% CI, 1.45–4.28; Z =3.30, P =0.001, I 2 , 9%).…”

“…Data from 12 studies26–30,32,33,36,40,42,44,46 with 711 patients were available to pool. This result showed S&E DEX prolonged the time of the patient request for first analgesic rescue (SMD, 4.43; 95% CI, 3.00–5.86; Z =6.09, P <0.00001, I 2 =97%).…”