DOI: http://dx.doi.org/10.18203/2319-2003.ijbcp20151350

A comparison of intrathecal dexmedetomidine and clonidine as adjuvants to hyperbaric bupivacaine for gynecological surgery

Dipti N. Anandani, Sejal D. Shelat, Jaydeep Vaniya, Parth Patel

Abstract


Background: Various adjuvants are being used with local anesthetics for prolongation of intraoperative and post-operative analgesia. Dexmedetomidine, a highly selective alpha2 adrenergic agonist, is a new neuraxial adjuvant gaining popularity. The purpose of this study was to compare the onset, duration of sensory and motor block, hemodynamic effects, post-operative analgesia, and adverse effects of dexmedetomidine and clonidine with hyperbaric 0.5% bupivacaine for spinal anesthesia.

Methods: 60 patients belonging to ASA Grade 1 and 2 undergoing elective gynecological surgery under spinal anesthesia were studied in this prospective. The patients were allocated in two groups (30 patients each). Group bupivacaine + clonidine (BC) received 17.5 mg of bupivacaine supplemented 45 mcg clonidine and Group bupivacaine + dexmedetomidine (BD) received 17.5 mg bupivacaine supplemented 5 mcg dexmedetomidine. The onset time of sensory and motor level, time to reach peak sensory and motor level, the regression time of sensory and motor level, hemodynamic changes, and side effects were recorded.

Results: Patients in Group BD had significantly longer sensory and motor block time than patients in Group BC. The onset time to reach dermatome T4 and modified Bromage3 motor block were not significantly different between two groups. Dexmedetomidine group showed significantly less and delayed requirement of rescue analgesic.

Conclusion: Intrathecal dexmedetomidine is associated with prolonged motor and sensory block, hemodynamic stability and reduced demand of rescue analgesic in 24 hrs as compared to clonidine.


Keywords


Alpha2 adrenergic receptor agonist, Bupivacaine, Clonidine, Dexmedetomidine, Spinal anesthesia, Group BC=bupivacaine + clonidine, Group BD=bupivacaine + dexmedetomidine

Full Text:

PDF

References


Elia N, Culebras X, Mazza C, Schiffer E, Tramèr MR. Clonidine as an adjuvant to intrathecal local anesthetics for surgery: systematic review of randomized trials. Reg Anesth Pain Med. 2008;33(2):159-67.

Grewal A. Dexmedetomidine: new avenues. J Anaesthesiol Clin Pharmacol. 2011;27(3):297-302.

Mantz J, Josserand J, Hamada S. Dexmedetomidine: new insights. Eur J Anaesthesiol. 2011;28(1):3-6.

Kanazi GE, Aouad MT, Jabbour-Khoury SI, Al Jazzar MD, Alameddine MM, Al-Yaman R, et al. Effect of low-dose dexmedetomidine or clonidine on the characteristics of bupivacaine spinal block. Acta Anaesthesiol Scand. 2006;50(2):222-7.

Al-Ghenam SM, Massad IM, Al-Mustafa MM, AL-Zabar KR, Quidaisat IY, Qatawaneh AM, et al. Effect of adding dexmedetomidine vs. fentanyl to intrathecal bupivacaine on spinal block characteristics in gynecological procedures: a double blind controlled study. Am J Appl Sci. 2009;6:882-7.

Al-Mustafa MM, Abu-Halaweh SA, Aloweidi AS, Murshidi MM, Ammari BA, Awwad ZM, et al. Effect of dexmedetomidine added to spinal bupivacaine for urological procedures. Saudi Med J. 2009;30(3):365-70.

Gupta R, Verma R, Bogra J, Kohli M, Raman R, Kushwaha JK. A Comparative study of intrathecal dexmedetomidine and fentanyl as adjuvants to Bupivacaine. J Anaesthesiol Clin Pharmacol. 2011;27(3):339-43.

Katz J, Melzack R. Measurement of pain. Surg Clin North Am. 1999;79(2):231-52.

Bromage PR. A comparison of the hydrochloride and carbon dioxide salts of lidocaine and prilocaine in epidural analgesia. Acta Anaesthesiol Scand Suppl. 1965;16:55-69.

De Kock M, Wiederkher P, Laghmiche A, Scholtes JL. Epidural clonidine used as the sole analgesic agent during and after abdominal surgery. A dose-response study. Anesthesiology. 1997;86(2):285-92.

Lawhead RG, Blaxall HS, Bylund DB. Alpha-2A is the predominant alpha-2 adrenergic receptor subtype in human spinal cord. Anesthesiology. 1992;77(5):983-91.

Gertler R, Brown HC, Mitchell DH, Silvius EN. Dexmedetomidine: a novel sedative-analgesic agent. Proc (Bayl Univ Med Cent). 2001;14(1):13-21.

Murthy TV, Singh R. Alpha-2 adrenoreceptor agonist-dexmedetomidine role in anaesthesia and intensive care: a clinical review. J Anaesth Clin Pharmacol. 2009;25:267-72.

Bajwa SJ, Bajwa SK, Kaur J, Singh G, Arora V, Gupta S, et al. Dexmedetomidine and clonidine in epidural anaesthesia: a comparative evaluation. Indian J Anaesth. 2011;55(2):116-21.

Salgado PF, Sabbag AT, Silva PC, Brienze SL, Dalto HP, Módolo NS, et al. Synergistic effect between dexmedetomidine and 0.75% ropivacaine in epidural anesthesia. Rev Assoc Med Bras. 2008;54(2):110-5.

Elhakim M, Abdelhamid D, Abdelfattach H, Magdy H, Elsayed A, Elshafei M. Effect of epidural dexmedetomidine on intraoperative awareness and post-operative pain after one-lung ventilation. Acta Anaesthesiol Scand. 2010;54(6):703-9.

Saadawy I, Boker A, Elshahawy MA, Almazrooa A, Melibary S, Abdellatif AA, et al. Effect of dexmedetomidine on the characteristics of bupivacaine in a caudal block in pediatrics. Acta Anaesthesiol Scand. 2009;53(2):251-6.

El-Hennawy AM, Abd-Elwahab AM, Abd-Elmaksoud AM, El-Ozairy HS, Boulis SR. Addition of clonidine or dexmedetomidine to bupivacaine prolongs caudal analgesia in children. Br J Anaesth. 2009;103(2):268-74.

Racle JP, Benkhadra A, Poy JY, Gleizal B. Prolongation of isobaric bupivacaine spinal anesthesia with epinephrine and clonidine for hip surgery in the elderly. Anesth Analg. 1987;66(5):442-6.

Niemi L. Effects of intrathecal clonidine on duration of bupivacaine spinal anaesthesia, haemodynamics, and postoperative analgesia in patients undergoing knee arthroscopy. Acta Anaesthesiol Scand. 1994;38(7):724-8.

De Kock M, Gautier P, Fanard L, Hody JL, Lavand’homme P. Intrathecal ropivacaine and clonidine for ambulatory knee arthroscopy: a dose-response study. Anesthesiology. 2001;94(4):574-8.

Merivirta R, Kuusniemi K, Jaakkola P, Pihlajamäki K, Pitkänen M. Unilateral spinal anaesthesia for outpatient surgery: a comparison between hyperbaric bupivacaine and bupivacaine-clonidine combination. Acta Anaesthesiol Scand. 2009;53(6):788-93.

Ibrahim FA. A comparative study of adding intrathecaldexmedetomidine versus sufentanyl to heavy bupivacaine for postoperative analgesia in patients undergoing inguinal hernia repair. Behnam J. 2009;26:207-17.

Hala EA, Shafie MA, Youssef H. Dose related prolongation of hyperbaric bupivacaine spinal anaesthesia by dexmedetomidine. Ain-Shams J Anaesthesiol. 2011;4:83-95.

Eisenach JC, De Kock M, Klimscha W. Alpha2-adrenergic agonists for regional anesthesia. A clinical review of clonidine (1984-1995). Anesthesiology. 1996;85(3):655-74.

Mahendru V, Tewari A, Katyal S, Grewal A, Singh MR, Katyal R. A comparison of intrathecal dexmedetomidine, clonidine, and fentanyl as adjuvants to hyperbaric bupivacaine for lower limb surgery: a double blind controlled study. J Anaesthesiol Clin Pharmacol. 2013;29(4):496-502.