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. 2020 Jun;64(6):463-469.
doi: 10.4103/ija.IJA_219_20. Epub 2020 Jun 1.

Comparative analgesic efficacy of intravenous vs intrathecal dexmedetomidine as an adjuvant to hyperbaric bupivacaine in subarachnoid block for below knee orthopaedic surgery

Isha Sharma  1 , Shelly Rana  1 , Bharti Choudhary  1 , Tanvi Dhiman  1 , Sheena Sharma  1 , Mahesh Kumar  1
Affiliations

Comparative analgesic efficacy of intravenous vs intrathecal dexmedetomidine as an adjuvant to hyperbaric bupivacaine in subarachnoid block for below knee orthopaedic surgery

Isha Sharma et al. Indian J Anaesth. 2020 Jun.

Abstract

Background and aim: Intrathecal and intravenous dexmedetomidine has been used as adjuvant in subarachnoid block [SAB]. The aim of this study was to compare the analgesic efficacy of intravenous vs intrathecal dexmedetomidine as adjuvant to intrathecal bupivacaine.

Methods: Ninety patients, aged 20-60 years belonging to American Society of Anaesthesiologists (ASA) physical status I and II, scheduled for below knee orthopaedic surgeries under SAB were enrolled. In group I (n = 45) patients received intravenous dexmedetomidine 0.5 μg/kg in 100 mL 0.9% normal saline [NS] intravenous over a period of 15 minutes given 20 minutes before SAB. Subarachnoid block was given with intrathecal (IT) 0.5% bupivacaine (H) 12.5 mg (2.5 mL) with 0.3 mL of NS. Patients in group II (n = 45) received 100 mL of 0.9% NS over a period of 15 minutes given 20 minutes before subarachnoid block. SAB was given with intrathecal 0.5% heavy bupivacaine 12.5 mg with 3 μg of dexmedetomidine (0.3 mL). The primary outcome was duration of analgesia and rescue analgesic requirement, whereas secondary outcome included pain scores.

Results: The duration of analgesia was prolonged in group II (median [IQR]: 5 (6-7.5) h than in group I (median[IQR]: 4[2-4.5] h, P = 0.000). Median dose of rescue analgesics over period of 24 hours was less in group II as compared to group I (median [IQR]:150 (75-150) mg vs 195 (150-225) mg, P = 0.000). VAS score was lower in group II till 12 h in the postoperative period (P = 0.00).

Conclusion: Intrathecal dexmedetomidine is more efficacious as compared to intravenous dexmedetomidine, due to favourable outcomes in terms of increased duration of postoperative analgesia and reduced rescue analgesic requirement.

Keywords: Adjuvant; analgesia; dexmedetomidine; subarachnoid block.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Flow chart of patients recruited and analysed In two groups
Figure 2
Figure 2
Graphical representation of total pain free period in two groups expressed as median [IQR] and analyzed by Mann–Whitney test. P < 0.05 significant
Figure 3
Figure 3
Depicting total analgesic consumption [mg] in two groups over a period of 24 hrs expressed as median [IQR] and analyzed by Mann–Whitney test. P < 0.05 significant
Figure 4
Figure 4
Depicting total pain free period and rescue analgesic requirement at various time intervals utilizing Kaplan Meier curve in two groups
Figure 5
Figure 5
Graphical representation of pain scores [VAS] in two groups over a period of 24 hrs expressed as mean ± SD. *P < 0.05 significant
See this image and copyright information in PMC

References

    1. Mauermann WJ, Shilling AM, Zuo Z. A comparison of neuraxial block versus general anesthesia for elective total hip replacement: A meta-analysis. Anesth Analg. 2006;103:1018–25. - PubMed
    1. Hurley RW, Wu CL. Acute postoperative pain. In: Miller RD, editor. Miller's Anesthesia. 7th ed. Philadelphia: Churchill Livingstone; 2010. pp. 2757–82.
    1. Borah TJ, Dey S, Yunus M, Dev P, Karim HM, Bhattacharyya P. Effect of different doses of intrathecal nalbuphine as adjuvant to ropivacaine in elective lower limb surgeries: A dose finding study. Indian J Anaesth. 2018;62:865–70. - PMC - PubMed
    1. Ture P, Ramaswamy AH, Shaikh SI, Alur JB, Ture AV. Comparative evaluation of anaesthetic efficacy and haemodynamic effects of a combination of isobaric bupivacaine with buprenorphine vs. isobaric levobupivacaine with buprenorphine for spinal anaesthesia – A double blinded randomised clinical trial. Indian J Anaesth. 2019;63:49–54. - PMC - PubMed
    1. Solanki SL, Bharti NA, Batra YK, Jain A, Kumar P, Nikhar S. The analgesic effect of intrathecal dexmedetomidine or clonidine, with bupivacaine, in trauma patients undergoing lower limb surgery: A randomised, double-blind study. Anaesth Intensive Care. 2013;41:51–6. - PubMed