To Evaluate the Efficacy of Intrathecal Isobaric 0.75% Ropivacaine With the Combination of Isobaric 0.75% Ropivacaine and Dexmedetomidine in Geriatric Hypertensive Patients Undergoing Urological Surgeries : A Prospective, Randomised, Controlled, Double - Blind Study

Abstract

ABSTRACT:Spinal Anaesthesia is the most common approach for geriatric patients undergoing urological surgeries. Efforts to find a better adjuvant in regional anaesthesia are underway since long. Various adjuvants have been used with local anesthetics in spinal anesthesia to improve quality of intraoperative analgesia and to provide prolonged postoperative analgesia with haemodynamic stability and minimal sideeffects. Dexmedetomidine, the new highly selective α2-agonist drug, is now being used as a neuraxial adjuvant. AIM: The aim of this study was to evaluate the efficacy of intrathecal isobaric 0.75% Ropivacaine with the combination of isobaric 0.75% Ropivacaine and 5µg of Dexmedetomidine in Geriatric Hypertensive patients undergoing Urological surgeries. MATERIALS AND METHODS: Fifty patients classified in American Society of Anesthesiologists classes II and III scheduled for Urological surgeries were studied. Patients were randomly allocated to receive either. Group R: 1.9 ml of 0.75% isobaric Ropivacaine + 0.1 ml normal saline. Group D: 1.9 ml volume of 0.75% isobaric ropivacaine +5 µg Dexmedetomidine (0.1ml). RESULTS: Patients in Dexmedetomidine group (D) had a significantly longer sensory and motor block time than patients in Normal Saline group (R). The mean time of the two segment regression time in group D (115.6 ± 14.5 min) was significantly higher than group R (57.4 ± 6.3 min) (P<0.001). The regression time of motor block to reach modified Bromage 0 was (246.4 ± 25.7 min) in group D and 140.1 ± 32.3 min in group R (P<0.001).The meantime of rescue analgesia is (425.4±18.9 min) in group D when compared to group R (210.3 ± 14.2). CONCLUSIONS: Intrathecal dexmedetomidine as a adjuvant is improved the quality of intraoperative analgesia and postoperative analgesia better, produced prolonged motor and sensory block, hemodynamic stability, and reduced demand for rescue analgesics in 24 hours as compared to control group.

Intrathecal dexmedetomidine and postoperative pain: A systematic review and meta‐analysis of randomized controlled trials

“…Onset of motor blockade, defined mostly as the time taken to reach a Bromage score of 3, was significantly faster in the DEX group in seven out of 18 studies (Attri et al., 2015; Ganesh & Krishnamurthy, 2018; Munnoli et al., 2016; Naaz et al., 2016; Patro et al., 2016; Ramaiah et al., 2015; Suthar et al., 2015). Duration of sensory blockade, defined in most studies as the time taken for the sensory blockade to regress to the S1 dermatome, was significantly longer in the DEX group in 15 out of 19 studies (Attri et al., 2015; Gupta et al., 2011; Kataria et al., 2018; Li et al., 2015; Mahendru et al., 2013; Munnoli et al., 2016; Naaz et al., 2016; Patro et al., 2016; Rahimzadeh et al., 2018; Ramaiah et al., 2015; Rao et al., 2015; Solanki et al., 2013; Sun et al., 2015; Suthar et al., 2015; Yektaş & Belli, 2014). Total duration of motor blockade, defined in most studies as the time taken for complete motor recovery (Bromage score 0), was significantly longer in the DEX group in 11 out of 21 studies (Attri et al., 2015; Ganesh & Krishnamurthy, 2018; Kataria et al., 2018; Mahendru et al., 2013; Munnoli et al., 2016; Patro et al., 2016; Rahimzadeh et al., 2018; Rao et al., 2015; Solanki et al., 2013; Suthar et al., 2015; Yektaş & Belli, 2014).…”

“…Our searches retrieved 1,206 citations and after removal of duplicates, there were 674 unique citations. After review, a total of 24 RCTs met our selection criteria and were included in the final analysis (Attri, Bansal, Chatrath, Kaur, & Khetarpal, 2015; Chatterji, Gupta, Sharma, & Chatterji, 2017; Ganesh & Krishnamurthy, 2018; Gautam, Lama, & Sharma, 2018; Gupta et al., 2011; Kataria, Jarewal, Kumar, & Kashyap, 2018; Li et al., 2015; Mahendru et al., 2013; Mohamed, Fares, & Mohamed, 2012; Munnoli et al., 2016; Naaz, Bandey, Ozair, & Asghar, 2016; Nethra et al., 2015; Patro, Deshmukh, Ramani, & Das, 2016; Rahimzadeh, Faiz, Imani, Derakhshan, & Amniati, 2018; Ramaiah, Manduri, Lakshmi, & Lalitha, 2015; Rao, Sujani, & Sudhakar, 2015; Samantaray et al., 2015; Shashikala et al., 2016; Singh et al., 2017; Solanki et al., 2013; Sun, Xu, & Wang, 2015; Sushruth & Rao, 2018; Suthar, Sethi, & Sharma, 2015; Yektaş & Belli, 2014).…”

“…The majority of studies used loss of pinprick sensation and the Bromage scale to assess sensory and motor blockade, respectively. Time to onset of sensory block, defined in most studies as the time taken from intrathecal injection to loss of sensation at the T10 dermatome, was significantly faster in the DEX group in eight out of the twenty studies that reported this outcome (Attri et al., 2015; Ganesh & Krishnamurthy, 2018; Gautam et al., 2018; Kataria et al., 2018; Li et al., 2015; Naaz et al., 2016; Patro et al., 2016; Ramaiah et al., 2015). Onset of motor blockade, defined mostly as the time taken to reach a Bromage score of 3, was significantly faster in the DEX group in seven out of 18 studies (Attri et al., 2015; Ganesh & Krishnamurthy, 2018; Munnoli et al., 2016; Naaz et al., 2016; Patro et al., 2016; Ramaiah et al., 2015; Suthar et al., 2015).…”

“…Time to onset of sensory block, defined in most studies as the time taken from intrathecal injection to loss of sensation at the T10 dermatome, was significantly faster in the DEX group in eight out of the twenty studies that reported this outcome (Attri et al., 2015; Ganesh & Krishnamurthy, 2018; Gautam et al., 2018; Kataria et al., 2018; Li et al., 2015; Naaz et al., 2016; Patro et al., 2016; Ramaiah et al., 2015). Onset of motor blockade, defined mostly as the time taken to reach a Bromage score of 3, was significantly faster in the DEX group in seven out of 18 studies (Attri et al., 2015; Ganesh & Krishnamurthy, 2018; Munnoli et al., 2016; Naaz et al., 2016; Patro et al., 2016; Ramaiah et al., 2015; Suthar et al., 2015). Duration of sensory blockade, defined in most studies as the time taken for the sensory blockade to regress to the S1 dermatome, was significantly longer in the DEX group in 15 out of 19 studies (Attri et al., 2015; Gupta et al., 2011; Kataria et al., 2018; Li et al., 2015; Mahendru et al., 2013; Munnoli et al., 2016; Naaz et al., 2016; Patro et al., 2016; Rahimzadeh et al., 2018; Ramaiah et al., 2015; Rao et al., 2015; Solanki et al., 2013; Sun et al., 2015; Suthar et al., 2015; Yektaş & Belli, 2014).…”

“…Hypotension ‐ Attri 2015, Chatterji 2017, Ganesh 2018, Gautam 2018, Gupta 2011, Kataria 2018, Li 2015, Mahendru 2013, Munnoli 2016, Naaz 2016, Nethra 2015, Patro 2016, Rahimzadeh 2018, Ramaiah 2015, Samantaray 2015, Shashikala 2016, Shushruth 2018, Singh 2017, Solanki 2013, Sun 2015, Suthar 2015, Yektas 2014…”