Dexmedetomidine as an Additive to Spinal Anaesthesia in Orthopaedic Patients Undergoing Lower Limb Surgeries: A Randomized Clinical Trial Comparing Two Different Doses of DexmedetomidineCorrespondence Address :
Dr. Arati Rai,
Assistant Professor, Department of Anaesthesia, Sikkim Manipal Institute of Medical Science, Gangtok, Sikkim, India.
Introduction: Use of dexmedetomidine as an additive to spinal anaesthesia is gaining popularity; but there seems to be no clear consensus on the ideal dose to be used. Because of dose related prolongation of duration of motor blockade along with increase in the incidence of side effects of dexmedetomidine namely hypotension and bradycardia, use of higher doses is not recommended.
Aim: To evaluate the efficacy of two different doses of dexmedetomidine (3 µg and 5 µg) given in combination with 0.5% hyperbaric bupivacaine via intrathecal route with regard to the quality of anaesthesia namely the time to attain highest sensory and motor blockade, side effects of dexmedetomidine and time to first rescue analgesia.
Materials and Methods: Sixty American Society of Anaesthesiologist (ASA) Grade I and II orthopaedic patients undergoing lower limb surgeries between the ages of 20-60 years and height >150 cm were randomly divided into two groups of 30 patients each: Group D3 to receive 3 µg of Inj. Dexmedetomidine (0.5 ml, reconstituted using normal saline) along with 12.5 mg (2.5 ml) of 0.5% hyperbaric bupivacaine and Group D5 to receive 5 µg of inj. Dexmedetomidine (0.5 ml, reconstituted using normal saline) along with 12.5 mg (2.5 ml) of 0.5% hyperbaric bupivacaine keeping the total volume of study drug constant in all 60 patients (3 ml). Data recordings were done for time to reach best sensory and motor block, intraoperative haemodynamic changes and time to first postoperative rescue analgesia. Statistical analysis was done using students t-test and Chi-square test with p-value of <0.05 considered to be significant.
Results: The two groups analysed were similar in terms of demographic profile, time to reach highest sensory block (T10) dermatome, time to reach Bromage scale 4, time to surgical incision after spinal and the total duration of surgery (p>0.05). The change in haemodynamics was similar (p>0.05). A statistically significant difference (p<0.001) was observed in time to first rescue analgesia after skin closure with Group D3 having 206.47 minutes while in Group D5 the time was 271.33 minutes.
Conclusion: Used in a dose of 5 µg (in 0.5 ml volume) as an additive in spinal anaesthesia maximal beneficial effect of dexmedetomidine can be obtained without any side effects.
Bromage scale, Lumbar puncture, Motor blockade, Postoperative rescue analgesia
Arati Rai, Meyong Pincho Bhutia. DEXMEDETOMIDINE AS AN ADDITIVE TO
SPINAL ANAESTHESIA IN ORTHOPAEDIC PATIENTS UNDERGOING LOWER LIMB SURGERIES:
A RANDOMIZED CLINICAL TRIAL COMPARING TWO DIFFERENT DOSES OF DEXMEDETOMIDINE. Journal of Clinical and Diagnostic Research [serial online] 2017 April [cited: 2017 May 25 ]; 11:UC09-UC12. Available from
Date of Submission: Dec 22, 2016
Date of Peer Review: Jan 17, 2017
Date of Acceptance: Feb 09, 2017
Date of Publishing: Apr 01, 2017
Financial OR OTHER COMPETING INTERESTS: None.
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