Intrathecal Dexmedetomidine Combined With Ropivacaine in Cesarean Section: A Prospective Randomized Double-Blind Controlled Study

Abstract

ObjectiveThis study aimed to find the best dose of dexmedetomidine in spinal anesthesia for cesarean section.Methods120 American Society of Anesthesiologists (ASA) Class I and II parturients undergoing elective cesarean delivery under spinal anesthesia were randomly allocated into four groups treated with intrathecal ropivacaine (12 mg) alone (Group R) or in combination with dexmedetomidine 5 μg (Group RD1), 7.5 μg (Group RD2) and 10 μg (Group RD3). Characteristics of spinal anesthesia, hemodynamic changes, adverse effects, stress reactions and neonatal outcomes were recorded in the four groups.ResultsPatients in Group RD1, RD2, and RD3 had significantly longer sustained sensory and motor block time than patients in Group R. All four groups had comparable onset times of sensory and motor block. The time for the level of sensory block to lower to S1 was longer in Group RD1 (411.07 ± 106.66 min), Group RD2 (397.03 ± 125.39 min) and Group RD3 (468.63 ± 116.43 min) than in Group R (273.60 ± 88.34 min) (p < 0.001). The time to recover from motor block to a Bromage score of IV was longer in Group RD1 (353.60.07 ± 137.28 min), Group RD2 (350.57 ± 118.01 min) and Group RD3 (404.67 ± 112.83 min) than in Group R (232.70 ± 93.29) (p < 0.01). The incidence of chills was significantly lower in the Group RD1, RD2, and RD3 than in the Group R (p < 0.001). There was no significant difference in the incidence of adverse effects such as hypotension, bradycardia, nausea, vomiting, hypoxemia and pruritus in the four groups (p > 0.05). There was no statistically significant visceral traction response or fentanyl use in the four groups (p > 0.05). Phenylephrine dosing was significantly higher in Group RD2 and RD3 than in Group R (p < 0.05), and there was no significant difference in phenylephrine dosing between Group RD1 and Group R (p > 0.05). There were no statistical differences in postnatal Apgar scores (1 min, 5 min after birth) (p > 0.05). The postoperative concentrations of β-endorphin (β-EP), cortisol (Cor) and tumor necrosis factor-α (TNF-α) in the Group RD1, RD2, and RD3 were lower than that in Group R (p < 0.05).ConclusionIntrathecal 5μg of dexmedetomidine as an adjuvant to ropivacaine relieved intraoperative chills, did not increase intraoperative and postoperative adverse effects, did not increase the amount of intraoperative vasoconstrictor used, and reduced intraoperative stress reactions as well as prolonged the duration of maternal sensory and motor block, so this dose is appropriate for cesarean section.Clinical Trial Registration:[www.chictr.org.cn/], identifier [ChiCTR2200056052].

Effects of Dexmedetomidine on Basic Cardiac Electrophysiology in Adults; a Descriptive Review and a Prospective Case Study

“…DEX has a wide therapeutic dose window and can be administered intravenously, subcutaneously, intranasally and sublingually in doses [8]. Spinal and sublingual administration of DEX are currently examined [9,10]. The common dosage of DEX has been 0.25-1 mcg/kg iv, followed by an infusion of 0.2-1.4 mcg/kg/h titrated to the intended effect [11][12][13].…”

Study of caudal ropivacaine with or without dexmedetomidine for postoperative analgesia in pediatric genitourinary infraumbilical surgery: A double-blinded randomized controlled trial

“…It is correlated with the concentration of dexmedetomidine in the cerebrospinal fluid but not that in the plasma 4 , 27 . Intrathecal dexmedetomidine inhibits spinal ERK1/2 signalling which results in potent analgesia effects in a manner dependent on α2 receptors 28 . Thus further research should be done about the pharmacodynamics of this mixture before using them clinically.…”

Efficacy and Safety of Dexmedetomidine Combined with Bupivacaine in Infants’ Surgeries: A Randomized Controlled Trial

“…In contrast to our study, Zhang et al, in a recent prospective, randomized, double-blind, placebo-controlled study, evaluated 120 ASA I and II patients undergoing elective cesarean delivery under SA. Pa- tients were randomized into four groups to be treated with intrathecal ropivacaine 12 mg alone or in combination with dexmedetomidine 5 g, 7.5 g, and 10 g. There was no statistically significant onset of sensory and motor block in all four groups, while dexmedetomidine prolonged the duration of sensory and motor block compared to the control group (16) . To our surprise, the time to discharge from PACU was not statistically significantly different between the studied groups.…”