Determining the Effect of Intrathecal Dexmedetomidine on Postoperative Pain Relief after Cesarean Section
DOI:
https://doi.org/10.51985/JBUMDC2021111Keywords:
Cesarean section, Dexmedetomidine, Hyperbaric bupivacaine, Intrathecal spaceAbstract
Objective: To analyze efficacy of intrathecal Dexmedetomidine as adjunct to hyperbaric Bupivacaine in terms of postoperative analgesia after caesarean section.
Study Design & Setting: This randomized controlled trial was conducted at Department of Anesthesia, Rawal Institute
of Health Sciences, Islamabad from20th, October 2018 to 20thApril 2019 after taking Ethical board approval from the
Institute. (letter no RIHS-REC/030/18, dated, 18th October 2018).
Methodology: Total n=120 patients having ASA status I, II undergoing elective cesarean section were randomly divided
into 2groups (60 each) by lottery method. Group-A, was given hyperbaricBupivacaine (0.5%) 12mg alone and group-B,
was given hyperbaricBupivacaine (0.5%) 12mg along with injection Dexmedetomidine 4ug in intrathecal space respectively.
Patients were followed in postoperative period for onset of pain and requirement for rescue analgesia in first 6 hours.
Results: There was statistically significant difference in mean onset of postoperative pain among both the groups-A and
B (178.18 ± 12.51 versus 364.07± 35.58min respectively with p value 0.000), as well as, postoperative analgesic requirement,
in first 6 hours, 39 (65.0 %) versus 31 (51.7 %) with p-value 0.000 respectively. However, on stratification, considering
effect modifiers, like age (20-30 years and 30-40 year and previous history of cesarean section), there was statistically
significant difference in mean onset of pain in both groups, but no significant difference was found regarding rescue
analgesic requirement in both groups.
Conclusion: Intrathecal Dexmedetomidine along with hyperbaric Bupivacaine was better than hyperbaric Bupivacaine
alone in controlling postoperative pain in caesarean section.
References
Shitemaw T, Jemal B, Mamo T, Akalu L. Incidence and
associated factors for hypotension after spinal anesthesia
during cesarean section at Gandhi Memorial Hospital Addis
Ababa, Ethiopia. PLoS One 2020;15(8):e0236755.
doi.org/10.1371/journal.pone.0236755
Moore DC, Bridenbaugh LD. Spinal (Subarachnoid) Block:
A Review of 11,574 Cases.JAMA 1966;195(11):907– 912.
Doi:10.1001/jama.195.11.907
Wu HH, Wang HT, Jin JJ, Cui GB, Zhou KC, Chen Y, Chen
GZ, Dong YL, Wang W. Does dexmedetomidine as a neuraxial
adjuvant facilitate better anesthesia and analgesia? A systematic
review and meta-analysis. PLoS One 2014 ;9(3):e93114. doi:
1371/journal.pone.0093114.
Zahid F, Tarar HM, Tariq M. Intrathecal tramadol as an
adjuvant in subarachnoid block to prolong the duration of
analgesia. PAFMJ 2017; 67(4): 534-39.
Ahmed F, Khandelwal M, Sharma A. A comparative study of
the effect of clonidine, fentanyl, and the combination of both
as adjuvant to intrathecal bupivacaine for postoperative
analgesia in total abdominal hysterectomy. J Anaesthesiol
Clin Pharmacol 2017;33(1):102-106. doi:10.4103/0970-
202194
Bhardwaj S, Devgan S, Sood D, Katyal S. Comparison of
Local Wound Infiltration with Ropivacaine Alone or
Ropivacaine Plus Dexmedetomidine for Postoperative Pain
Relief after Lower Segment Cesarean Section. Anesth Essays
Res 2017;11(4):940-945. doi: 10.4103/aer.AER_14_17
Nie Y, Tu W, Shen X et al. Dexmedetomidine added to
sufentanil patient-controlled intravenous analgesia relieves
the postoperative pain after cesarean delivery:A prospective
randomised controlled multicenter study. Sci Rep 2018; 8:
Ganesh M, Krishnamurthy D. A comparative study of
dexmedetomidine and clonidine as an adjunct to intrathecal
bupivacaine in lower abdominal surgeries. Anesth Essays Res
; 12: 539-545. DOI: 10.4103/aer.AER_54_18
Lee S. Dexmedetomidine: present and future directions.
Korean J Anesthesiol. 2019;72(4):323-330. doi:10.4097
/kja.19259
Javahertalab M, Susanabadi A, Modir H, Kamali A, Amani
A, Almasi-Hashiani A. Comparing intravenous
dexmedetomidine and clonidine in hemodynamic changes
and block following spinal anesthesia with ropivacaine in
lower limb orthopedic surgery: a randomized clinical trial.
Med Gas Res 2020;10(1):1-7. doi:10.4103/2045-9912.279977
Morgan GE, Mikhail MS. Clinical Anesthesiology.6th Edition.
McGraw Hill Education 2018; 18:523.
Yektas A, Belli E. The effects of 2ug and 4ug doses of
dexmedetomidine in combination with intrathecal hyperbaric
bupivaineon spinal anaesthesia and its postoperative analgesic
characteristics. Pain Res Manay 2014; 19(2):75-81. doi:
1155/2014/956825.
Boublik J, Gupta R, Bhar S, Atchabahian A. Prilocaine spinal
anesthesia for ambulatory surgery: A review of the available
studies.Anaesth Crit Care Pain Med 2016 ; 35(6):417-421.
DOI: 10.1016/j.accpm.2016.03.005
Routray SS, Raut K, Pradhan A, Dash A, SorenM.
Comparison of Intrathecal Clonidine and Fentanyl as Adjuvant
to Hyperbaric Bupivacaine in Subarachnoid Block for Lower
Limb Orthopedic Surgery.Anesth Essays Res .2017 ; 11(3):
– 593.doi: 10.4103/aer.AER_91_17.
Qurban F, Qureshi SA, Hassan SI, Azeem Y. Determine the
analgesic effectiveness of Dexmedetomidine with hyperbaric
bupivacaine in spinal anesthesia for patients undergoing lower
limb surgery. Pak J Med Health Sci 2020;14(2):1569-71
Farooq S, Rizvi MFA, Yousuf SMA, Dilshad R, Bashir G,
Dilshad A. Comparing intrathecal dexmedetomidine and
fentanyl as adjuvants to hyperbaric bupivacaine in elective
casarian section, a study. Professional Med J 2022; 29(2):218-
doi.org/10.29309/TPMJ/2022.29.02.6414
Chaney MA. Side effects of intrathecal and epidural opioids.
Can J Anaesth1995; 42:891-903. doi: 10.1007/BF03011037
Bi YH, Cui XG, Zhang RQ, Song CY, Zhang YZ. Low dose
of dexmedetomidine as an adjuvant to bupivacaine in cesarean
surgery provides better intraoperative somato-visceral sensory
block characteristics and postoperative analgesia. Oncotarget
;8(38):63587-63595.doi: 10.18632/oncotarget.18864.
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;
:222-7.
Samantaray A, Hemanth N, Gunnampati K, Pasupuleti H,
Mukkara M, Rao MH. Comparison of the effects of adding
dexmedetomidine versus midazolam to intrathecal bupivacaine
on postoperative analgesia. Pain Physician 2015;18(1):71–77
Bae HB. Dexmedetomidine: an attractive adjunct to anesthesia.
Korean J Anesthesiol 2017;70(4):375-376. doi:10.4097/
kjae.2017.70.4.375
Naaz S, Ozair E. Dexmedetomidine in current anaesthesia
practice- a review.J Clin Diagn Res 2014 ; 8(10):GE01-4.doi:
7860/JCDR/2014/9624.4946.
Patro SS, Deshmukh H, Ramani YR, Das G. Evaluation of
Dexmedetomidine as an Adjuvant to Intrathecal Bupivacaine
in Infraumbilical Surgeries. J Clin Diagn Res 2016;10(3):
UC13-UC16.doi: 10.7860/JCDR/ 2016/ 17987.7379.
Gautam B, Lama SM, Sharma M. Effects of Adding Intrathecal
Dexmedetomidine to Hyperbaric Bupivacaine for Saddle
Spinal Block in Adults Undergoing Peri-anal Surgeries. J
Nepal Health Res Counc 2018 ;16(1):43-48.
Rai A, Bhutia MP. Dexmedetomidine as an Additive to Spinal
Anaesthesia in Orthopaedic Patients Undergoing Lower Limb
Surgeries: A Randomized Clinical Trial Comparing Two
Different Doses of Dexmedetomidine. J Clin Diagn Res
;11(4):UC09-UC12. doi: 10.7860/JCDR/ 2017/ 26241
.9654
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