Effect of intravenous dexmetomidine (0.25mcg/kg) bolus dose for prolonging duration of spinal anaesthesia in patients undergoing elective abdominal hysterectomy
Citation Information :
Choudhary S, Yadav AK, Chhabra A, Bhatt D. Effect of intravenous dexmetomidine (0.25mcg/kg) bolus dose for prolonging duration of spinal anaesthesia in patients undergoing elective abdominal hysterectomy. 2023; 2 (1):20-26.
Background: Spinal anaesthesia is most common technique for patients undergoing abdominal hysterectomy owing to its attributes: rapid onset, adequate motor blockade, easier to administer and cost effectiveness. Dexmedetomidine have been evaluated as neuraxial adjuvant, sedative and also for postoperative pain adjunct.
Objectives: To evaluate effect of intravenous dexmedetomidine (0.25mcg/kg) bolus dose for prolonging duration of spinal anaesthesia in patients undergoing elective abdominal hysterectomy.
Materials & Methods: This prospective, double-blind, randomized study was conducted in adult patients scheduled to undergo abdominal hysterectomy. After 15 minutes of subarachnoid block, they were divided into two equal groups and given either 0.25mcg/kg of intravenous dexmedetomidine (group D) or intravenous normal saline (group C). Sensory block and motor block characteristics along with time for first rescue analgesia requirement postoperatively were recorded. Duration of postoperative analgesia was noted from the time of subarachnoid block to the first demand of rescue analgesia.
Results: There was no significant difference in onset of sensory block in both groups (p>0.05) but there was statistically significant difference for time for reach maximum highest sensory block (T6) between both the groups (p<0.05). Time to get grade 0 from grade 3 blocks was statistically significant in both groups (p<0.01). Time from sensory onset time to first dose of rescue analgesic were significantly prolonged in group D as compared to group C (p<0.01).
Conclusions: This study concluded that intravenous dexmedetomidine 0.25μg/kg was significantly better in terms of sensory, motor block characteristics and postoperative analgesic requirement as compared to placebo.
Das A, Halder S, Chattopadhyay S, Mandal P, Chhaule S, Banu R. Effect of two different doses of dexmedetomidine as adjuvant in bupivacaine induced subarachnoid block for elective abdominal hysterectomy operations: a prospective, double-blind, randomized controlled study. Oman Med J. 2015; 30(4):257-63.
Ok HG, Baek SH, Baik SW, Kim HK, Shin SW, Kim KH. Optimal dose of dexmedetomidine for sedation during spinal anesthesia. Korean J Anesthesiol. 2013;64(5):426-31.
Savola JM, Virtanen R. Central alpha 2-adrenoceptors are highly stereoselective for dexmedetomidine, the dextro enantiomer of medetomidine. Eur J Pharmacol. 1991;195(2):193-9.
Hong JY, Kim WO, Yoon Y, Choi Y, Kim SH, Kil HK. Effects of intravenous dexmedetomidine on low-dose bupivacaine spinal anaesthesia in elderly patients. Acta Anaesthesiol Scand. 2012;56(3):382-7.
Adams R, Brown GT, Davidson M, Fisher E, Mathisen J, Thomson G, Webster NR. Efficacy of dexmedetomidine compared with midazolam for sedation in adult intensive care patients: a systematic review. Br J Anaesth. 2013;111(5):703-10.
Abdallah FW, Abrishami A, Brull R. The facilitatory effects of intravenous dexmedetomidine on the duration of spinal anesthesia: a systematic review and meta-analysis. Anesth Analg. 2013;117(1):271-8.
Guo TZ, Jiang JY, Buttermann AE, Maze M. Dexmedetomidine injection into the locus ceruleus produces antinociception. Anesthesiology 1996;84:873-81.
Gertler R, Brown HC, Mitchell DH, Silvius EN. Dexmedetomidine: a novel sedative-analgesic agent. Proc (Bayl Univ Med Cent). 2001;14(1):13-21.
Giovannitti JA Jr, Thoms SM, Crawford JJ. Alpha-2 adrenergic receptor agonists: a review of current clinical applications. Anesth Prog. 2015;62(1):31-9.
Hodgson PS, Neal JM, Pollock JE, Liu SS. The neurotoxicity of drugs given intrathecally (spinal). Anesth Analg 1999;88:797–809.
Lee MH, Ko JH, Kim EM, Cheung MH, Choi YR, Choi EM. The effects of intravenous dexmedetomidine on spinal anesthesia: comparision of different dose of dexmedetomidine. Korean J Anesthesiol. 2014;67(4):252-7.
Bharthi Sekar E, Vijayaraghavan U, Sadiqbasha A. Effect of intravenous dexmedetomidine on spinal anesthesia. Cureus 2021;13(6):e15708.
Al-Mustafa MM, Badran IZ, Abu-Ali HM, Al-Barazangi BA, Massad IM, Al-Ghanem SM. Intravenous dexmedetomidine prolongs bupivacaine spinal analgesia. Middle East J Anaesthesiol. 2009; 20:225–31.
Jung SH, Lee SK, Lim KJ, et al.: The effects of singledose intravenous dexmedetomidine on hyperbaric bupivacaine spinal anesthesia. J Anesth. 2013, 27:380-4.
Sangma SJ, Singh LK, Singh NR, Singh LC, Pongener AW, Bhutia D. Effect of intravenous dexmedetomidine on bupivacaine spinal analgesia. J Med Soc 2015; 29:96-100.
Fazil K. Effect of intravenous dexmedetomidine on subarachnoid block characteristics, using 0.5% hyperbaric bupivacaine, in patients undergoing unilateral knee arthroscopy - a prospective randomized double blinded placebo controlled study. BMH Med. J. 2019;6(2):47-57.
Kubre J, Sethi A, Mahobia M, Bindal D, Narang N, Saxena A. Single dose intravenous dexmedetomidine prolongs spinal anesthesia with hyperbaric bupivacaine. Anesth Essays Res. 2016;10(2):273-7.
Elcicek K, Tekin M, Kati I: The effects of intravenous dexmedetomidine on spinal hyperbaric ropivacaine anesthesia. J Anesth. 2010;24:544-8.
Sivachalam SN, Puthenveettil N, Rajan S, Paul J, Kumar L. Comparison of Prolongation of Spinal Anesthesia Produced by Intravenous Dexmedetomidine and Midazolam: A Randomized Control Trial. Anesth Essays Res. 2019;13(2):330-3.