Volume : 7, Issue : 6, June - 2018

A Comparison of Intrathecal Dexmedetomidine and Clonidine as Adjuvant to Hyperbaric Bupivacaine for Postoperative Analgesia in Abdominal Hysterectomy.

Dr Rama Chatterji, Dr Chandra Shekhar Chatterji, Dr Anupama Gupta, Dr Lalit Kumar Kejriwal

Abstract :

<p style="text-align:justify;line-height:16.5pt"><strong><i style="mso-bidi-font-style:&#10;normal"><span style="font-size:10.0pt;color:black;mso-themecolor:text1">Background &amp; Aims</span></i></strong><i style="mso-bidi-font-style:normal"><span style="font-size:10.0pt;color:black;mso-themecolor:text1">: Various adjuvant are being used with intrathecal local anaesthetics for prolongation of duration of analgesia. Dexmedetomidine, the highly selective 2 adrenergic agonist is becoming popular as neuraxial adjuvant. We compared the duration of analgesia, block characteristics and adverse effects along with the hemodynamic changes, following intrathecal administration of dexmedetomidine or clonidine with hyperbaric 0.5% bupivacaine in patients undergoing abdominal hysterectomy under sub arachnoid block.<o:p></o:p></span></i></p> <p class="MsoNormal" style="text-align:justify"><strong><i style="mso-bidi-font-style:&#10;normal"><span style="font-size:10.0pt;line-height:115%;color:black;mso-themecolor:&#10;text1">Material and methods</span></i></strong><i style="mso-bidi-font-style:&#10;normal"><span style="font-size:10.0pt;line-height:115%;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;&#10;color:black;mso-themecolor:text1">: Seventy five patients of ASA grade I or II, ages between 25-60 years, were randomized and allocated into three groups </span></i><i style="mso-bidi-font-style:normal"><span style="font-size:10.0pt;line-height:&#10;115%;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;mso-fareast-font-family:&quot;Times New Roman&quot;;&#10;color:black;mso-themecolor:text1">using sealed envelope technique</span></i><i style="mso-bidi-font-style:normal"><span style="font-size:10.0pt;line-height:&#10;115%;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;color:black;mso-themecolor:text1">. Patients in group B <span style="mso-spacerun:yes">&nbsp;</span>received 15 mg hyperbaric 0.5% bupivacaine + normal saline intrathecally , in group BC <span style="mso-spacerun:yes">&nbsp;</span>received 15 mg hyperbaric 0.5% bupivacaine + 30 mcg clonidine+normal saline intrathecally and in group BD-received 15 mg hyperbaric 0.5% bupivacaine + 5 mcg dexemedetomidine +normal saline intrathecally.Total drug volume was kept constant 3.5 ml in all groups. Outcome measures include total duration of analgesia, onset and duration of sensory-motor block, hemodynamic changes and adverse effects, if any. <o:p></o:p></span></i></p> <p style="text-align:justify;line-height:16.5pt"><strong><i style="mso-bidi-font-style:&#10;normal"><span style="font-size:10.0pt;color:#333333">&nbsp;Results</span></i></strong><i style="mso-bidi-font-style:normal"><span style="font-size:10.0pt;color:#333333">: There was no significant difference in patients demographic and duration of surgery. The total duration of analgesia was longest in group BD (</span></i><i style="mso-bidi-font-style:normal"><span style="font-size:10.0pt;color:black;&#10;mso-themecolor:text1">271.0&plusmn;23.4 min), it was significantly longer than group BC (229.4&plusmn;28.0 min) and group B (155.1&plusmn;12.8 min).</span></i><i style="mso-bidi-font-style:normal"><span style="font-size:10.0pt;color:#333333"> The mean two segment sensory regression time was<span style="mso-spacerun:yes">&nbsp; </span></span></i><i style="mso-bidi-font-style:&#10;normal"><span style="font-size:10.0pt;color:black;mso-themecolor:text1">222.4&plusmn;18.73 min in gr</span></i><i style="mso-bidi-font-style:normal"><span style="font-size:10.0pt;color:#333333">oup BD,</span></i><i style="mso-bidi-font-style:&#10;normal"><span style="font-size:10.0pt;color:black;mso-themecolor:text1"> 188.6&plusmn;22.4</span></i><i style="mso-bidi-font-style:normal"><span style="font-size:10.0pt;color:#333333"> min in Group BC and </span></i><i style="mso-bidi-font-style:normal"><span style="font-size:10.0pt;color:black;&#10;mso-themecolor:text1">135.8&plusmn;11. 6mi</span></i><i style="mso-bidi-font-style:&#10;normal"><span style="font-size:10.0pt;color:#333333">n in Group B. Time to onset of sensory block was comparable between three groups but motor block was early in Group BD and Group BC as compared to Group B. There was no significant difference in other variables like hemodynamic changes and adverse effects between the three groups.<o:p></o:p></span></i></p> <p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;&#10;text-align:justify;line-height:14.0pt"><b><i style="mso-bidi-font-style:normal"><span style="font-size:10.0pt;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;mso-fareast-font-family:&#10;&quot;Times New Roman&quot;;color:black;border:none windowtext 1.0pt;mso-border-alt:none windowtext 0in;&#10;padding:0in">Conclusions:</span></i></b><i style="mso-bidi-font-style:normal"><span style="font-size:10.0pt;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;mso-fareast-font-family:&#10;&quot;Times New Roman&quot;;color:black">Intrathecaldexmedetomidine is associated with prolonged duration of postoperative analgesia, motor and sensory block without causing any significant change in hemodynamic variables and adverse effects as compared to clonidine or lone bupivacaine.<o:p></o:p></span></i></p>