EFFECT OF INTRATHECAL HEAVY BUPIVACAINE WITH DEXMEDETOMIDINE AND INTRATHECAL HEAVY BUPIVACAINE WITH FENTANYL IN LOWER ABDOMINAL AND GYNAECOLOGICAL SURGERIES
Objective: Spinal or epidural anesthesia techniques provide the best method of anesthesia for lower abdominal and lower limb surgeries. Small doses of adjuvants administered spinally provide profoundly prolonged segmental analgesia with good post-operative pain relief. The objective of the present study is to evaluate the efficacy of dexmedetomidine (10 μg) versus fentanyl (25 μg) as an adjuvant added to bupivacaine in spinal anesthesia for patients undergoing lower abdominal and gynecological surgeries and assessment of duration of post-operative analgesia.
Methods: Hospital-based randomized double-blind controlled study conducted in tertiary teaching hospital of Kakinada and Rajahmundry. The period of study is February 2013–July 2018. Patients were divided into two groups of 25 each. In the first group, dexmedetomidine was added as adjuvant to bupivacaine whereas in the second group fentanyl was added as an adjuvant to bupivacaine. The visual analog scale used to assess the analgesic effect. Time at which the rescue analgesic given was noted which gives the duration of post-operative analgesia.
Results: Results were analyzed in both groups. The software used for statistical analysis was GraphPad for windows 10.0.5. Continuous variables were analyzed with student t-test and analysis of variance. Post-operative analgesia duration is significantly prolonged in the dexmedetomidine group with a mean 308.64±12.50 compared to fentanyl group where the mean is 253.12 min±14.30. There is a statistically significant difference (p<0.0001) between the two groups.
Conclusion: Intrathecal dexmedetomidine supplementation to spinal bupivacaine seems to be a good alternative to intrathecal fentanyl since it produces prolonged post-operative analgesia with minimal side effects and excellent quality of spinal analgesia.
2. Shende D, Cooper GM, Bowden MI. The influence of intrathecal fentanyl on the characteristics of subarachnoid block for caesarean section. Anaesthesia 1998;53:706-10.
3. Hunt CO, Naulty JS, Bader AM, Hauch MA, Vartikar JV, Datta S, et al. Perioperative analgesia with subarachnoid fentanyl-bupivacaine for cesarean delivery. Anesthesiology 1989;71:535-40.
4. Courtney MA, Bader AM, Hartwell B, Hauch M, Grennan MJ, Datta S, et al. Perioperative analgesia with subarachnoid sufentanil administration. Reg Anesth 1992;17:274-8.
5. Palmer CM, Voulgaropoulos D, Alves D. Subarachnoid fentanyl augments lidocaine spinal anesthesia for cesarean delivery. Reg Anesth 1995;20:389-94.
6. Singh H, Yang J, Thornton K, Giesecke AH. Intrathecal fentanyl prolongs sensory bupivacaine spinal block. Can J Anaesth 1995;42:987 91.
7. Hamber EA, Viscomi CM. Intrathecal lipophilic opioids as adjuncts to surgical spinal anesthesia. Reg Anesth Pain Med 1999;24:255-63.
8. Seewal R, Shende D, Kashyap L, Mohan V. Effect of addition of various doses of fentanyl intrathecally to 0.5% hyperbaric bupivacaine on perioperative analgesia and subarachnoid-block characteristics in lower abdominal surgery: A dose-response study. Reg Anesth Pain Med 2007;32:20-6.
9. Kuusniemi KS, Pihlajamäki KK, Pitkänen MT, Helenius HY, Kirvelä OA. The use of bupivacaine and fentanyl for spinal anesthesia for urologic surgery. Anesth Analg 2000;91:1452-6.
10. Bonnet F, Brun-Buisson V, Saada M, Boico O, Rostaing S, Touboul C, et al. Dose-related prolongation of hyperbaric tetracaine spinal anesthesia by clonidine in humans. Anesth Analg 1989;68:619-22.
11. 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;94:574-8.
12. 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;50:222-7.
13. Kalso EA, Pöyhiä R, Rosenberg PH. Spinal antinociception by dexmedetomidine, a highly selective alpha 2-adrenergic agonist. Pharmacol Toxicol 1991;68:140-3.
14. Post C, Gordh T Jr., Minor BG, Archer T, Freedman J. Antinociceptive effects and spinal cord tissue concentrations after intrathecal injection of guanfacine or clonidine into rats. Anesth Analg 1987;66:317-24.
15. Fairbanks CA, Wilcox GL. Spinal antinociceptive synergism between morphine and clonidine persists in mice made acutely or chronically tolerant to morphine. J Pharmacol Exp Ther 1999;288:1107-16.
16. Farag E, Argalious M, Sessler DI, Kurz A, Ebrahim ZY, Schubert A, et al. Use of ?(2)-agonists in neuroanesthesia: An overview. Ochsner J 2011;11:57-69.
17. Gupta R, Bogra J, Verma R, Kohli M, Kushwaha JK, Kumar S, et al. Dexmedetomidine as an intrathecal adjuvant for postoperative analgesia. Indian J Anaesth 2011;55:347-51.
18. Candiotti KA, Bergese SD, Bokesch PM, Feldman MA, Wisemandle W, Bekker AY, et al. Monitored anesthesia care with dexmedetomidine: A prospective, randomized, double-blind, multicenter trial. Anesth Analg 2010;110:47-56.
19. Bajwa SJ, Arora V, Kaur J, Singh A, Parmar SS. Comparative evaluation of dexmedetomidine and fentanyl for epidural analgesia in lower limb orthopedic surgeries. Saudi J Anaesth 2011;5:365-70.
20. 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;30:365 70.
21. Venkatraman R, Sandhiya R. Evaluation of efficacy of epidural butorphanol tartrate for postoperative analgesia. Int J Pharm Pharm Sci 2014;7:52-54.
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