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Intravenous Versus Epidural Dexmedetomidine: Comparison of Effect on Prolongation of Analgesia

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Introduction: Subarachnoid block is the most common technique amongst regional anesthesia for lower abdomen and lower limb surgeries. Dexmedetomidine, a new highly selective α2-agonist, is under evaluation as a neuraxial adjuvant as it provides stable hemodynamic conditions, good quality of intraoperative and prolonged postoperative analgesia with minimal side effects. In this study we want to compare efficacy of Epidural Dexmeditomidine with Intravenous Dexmeditomidine in subarachnoid block with Inj. Bupivacaine. Aims and objectives: Primary objective of this study is to compare the duration of post-operative analgesia of IV Dexmeditomidine with epidural Dexmeditomidine in subarachnoid block given for lower limb surgeries. Our secondary objective is to compare the onset of sensory blockade, onset of motor blockade, sedation Score and any complications like bradycardia, hypotension in both groups. Methodology: Sixty patients posted for lower limb surgeries were included in this study. In Group I Inj Dexmeditomidine 0.5 ug/kg diluted in 100 ml NS was given as infusion over 15 minutes and Group E received, 100 ml NS as infusion over 15 minutes. Epidural space was identified with Tuohy needle by LOR resistance and 10 ml NS was given epidurally in Group I and 0.5 ug/kg of Inj dexmedetomidine in 9.5 ml of NS was given epidurally in Group E. Subarachnoid block was given by 25G spinal needle in L3-L4 space in sitting position using all aseptic precautions in both the groups with 3.5 ml 0.5% hyperbaric Bupivacaine. Onset of sensory and motor blockade, pulse rate, MAP, sedation score, time for two segment regression and the time when patients request first analgesic were noted and analysed. Result: The mean time of onset of sensory blockade and mean time of onset of motor blockade were comparable between the groups, in Group I onset of sensory blockade was 7.27±2.75 min while in Group E 8.17±2.03 min with P >0.05 while onset of motor blockade was 11.33±3.45 min in Group I and 12.03±2.07 min in Group E with p >0.05. The time taken for two-segment regression was significantly earlier in Group I 157.5 ±22.35 min than in Group E 171.03±13.01 min. with P <0.006. The mean duration of post-operative analgesia was significantly longer in Group E 447.33±41.78 while in Group I 425.5±27.16 min with P <0.02. The mean of RSS (Ramsay sedation score) in Group I was 3±0.12 and in Group E was 2±0.24, the difference was clinically significant with P = 0.036. Conclusion: Administration of Epidural Dexmeditomidine 0.5 ug/kg leads to prolongation of sensory blockade after intrathecal Bupivacaine and prolongs postoperative analgesia than Intravenous Dexmeditomidine.

Perspectives

Introduction: Subarachnoid block is the most common technique amongst regional anesthesia for lower abdomen and lower limb surgeries. Dexmedetomidine, a new highly selective α2-agonist, is under evaluation as a neuraxial adjuvant as it provides stable hemodynamic conditions, good quality of intraoperative and prolonged postoperative analgesia with minimal side effects. In this study we want to compare efficacy of Epidural Dexmeditomidine with Intravenous Dexmeditomidine in subarachnoid block with Inj. Bupivacaine. Aims and objectives: Primary objective of this study is to compare the duration of post-operative analgesia of IV Dexmeditomidine with epidural Dexmeditomidine in subarachnoid block given for lower limb surgeries. Our secondary objective is to compare the onset of sensory blockade, onset of motor blockade, sedation Score and any complications like bradycardia, hypotension in both groups. Methodology: Sixty patients posted for lower limb surgeries were included in this study. In Group I Inj Dexmeditomidine 0.5 ug/kg diluted in 100 ml NS was given as infusion over 15 minutes and Group E received, 100 ml NS as infusion over 15 minutes. Epidural space was identified with Tuohy needle by LOR resistance and 10 ml NS was given epidurally in Group I and 0.5 ug/kg of Inj dexmedetomidine in 9.5 ml of NS was given epidurally in Group E. Subarachnoid block was given by 25G spinal needle in L3-L4 space in sitting position using all aseptic precautions in both the groups with 3.5 ml 0.5% hyperbaric Bupivacaine. Onset of sensory and motor blockade, pulse rate, MAP, sedation score, time for two segment regression and the time when patients request first analgesic were noted and analysed. Result: The mean time of onset of sensory blockade and mean time of onset of motor blockade were comparable between the groups, in Group I onset of sensory blockade was 7.27±2.75 min while in Group E 8.17±2.03 min with P >0.05 while onset of motor blockade was 11.33±3.45 min in Group I and 12.03±2.07 min in Group E with p >0.05. The time taken for two-segment regression was significantly earlier in Group I 157.5 ±22.35 min than in Group E 171.03±13.01 min. with P <0.006. The mean duration of post-operative analgesia was significantly longer in Group E 447.33±41.78 while in Group I 425.5±27.16 min with P <0.02. The mean of RSS (Ramsay sedation score) in Group I was 3±0.12 and in Group E was 2±0.24, the difference was clinically significant with P = 0.036. Conclusion: Administration of Epidural Dexmeditomidine 0.5 ug/kg leads to prolongation of sensory blockade after intrathecal Bupivacaine and prolongs postoperative analgesia than Intravenous Dexmeditomidine.

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This page is a summary of: Intravenous Versus Epidural Dexmeditomidine: Comparison of Effect on Prolongation of Analgesia after Subarachnoid Block with Bupivacaine in lower limb Surgery, Indian Journal of Anaesthesia and Analgesia, July 2020, Red Flower Publication Private, Ltd.,
DOI: 10.21088/ijaa.2349.8471.7420.16.
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