06Apr 2018

DEXMEDETOMIDINE VERSUS FENTANYL WITH INTRATHECAL BUPIVACAINE FOR POSTOPERATIVE ANALGESIA IN UROLOGICAL PROCEDURES: A DOUBLE BLIND COMPARITIVE STUDY.

  • Consultant Anaesthesiology, Yashoda Hospital, Hyderabad. Dr Shashidhar Matam, DA, FCCS, Dr Mohsin Wazir D. A., DNB.
  • Abstract
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Seventy six patients of American Society of Anaesthesiologists status I and II scheduled for urological procedures were studied to evaluate the onset and duration of Sensory and motor block, postoperative analgesia and adverse effects of Dexmedetomidine and Fentanyl given intrathecally with hyperbaric 0.5% Bupivacaine. Material And Methods: Patients were randomly allocated into two groups. Group I received 12.5 mg 0.5% Bupivacaine + 25 μg Fentanyl. And Group II received 12.5 mg 0.5% Bupivacaine + 5 μg Dexmedetomidine (vol-3ml). The onset, time to reach peak sensory and motor level, the regression time for Sensory and motor block, postoperative analgesia and side effects were recorded. Results: The onset time to reach peak sensory level as well as onset time to reach modified Bromage 3 motor block were insignificant in both the groups. The mean time of sensory regression to S1 in Group I was 276.21 ? 52.23 mins and in Group II was 417.34 ? 38.66 mins (p<0.05)). The regression time of motor block to reach modified Bromage 0 in Group I was 168.28 ? 29.84 mins and in Group II was 267.15 ? 34.40 mins (p<0.05)). The time for rescue analgesic i.e. post-op analgesia in Group I was 320.57 ? 33.00 mins and in Group II it was found to be 423.68 ? 37.58 mins (p<0.05)). The hemodynamics, sedation scores and side effects were not significantly different in both groups except for bradycardia noted with Dexmedetomidine. Conclusion: 5 μg Dexmedetomidine provides better hemodynamic stability, minimal side effects, and excellent quality of postoperative analgesia as an adjuvant to spinal Bupivacaine in urological procedures.


  1. Bier A. Versuche fiber Cocainisirung des Rfickenmarkes. Deutsche Zeitschriftir Chirurgie 1899; 51: 361?9
  2. Kuusniemi ks, pihlajamaki kk, pitkanen mt, helenius hy, kirvela oa: The use of bupivaca?ne and fentanyl for spinal anesthesia for urologic surgey. Anesth Analg; 91:1452-6,2000
  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.?[PubMed]
  4. G E Kanazi, M T Aouad, S I Jabbour-Khoury,M D Al-Jajjar, M M Alameddin, R Al-Yaman, M Bulbul and A S Baraka. Effect of low dose dexmedetomidine or clonidine on the characteristics of bupivacaine spinal block. Acta Anaesthesiol Scand; 2006; 50 : 222
  5. Al Ghanem SM, Massad IM, Al-Mustafa MM, Al-Zaben KR, Qudaisat IY, Qatawneh AM,?et al. Effect of adding dexmedetomidine versus fentanyl to intrathecal bupivacaine on spinal block characteristics in gynecological procedures: A double blind controlled study. Am J Appl?????? Sci2009;6:882-7.
  6. 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. [PUBMED]
  7. Gupta R, Verma R, Bogra J, Kohli M, Raman R, Kushwaha JK. A Comparative study of intrathecal dexmedetomidine and fentanyl as adjuvants to Bupivacaine. J Anaesthesiol Clin Pharmacol2011;27:339-43.
  8. Liu S, Chiu AA, Carpenter RL et al. Fentanyl prolongs lidocaine spinal anesthesia without prolonging recovery. Anesth Analg 1995; 80: 730?4.
  9. Liu SS. Optimizing spinal anesthesia for ambulatory surgery. Reg Anesth 1997; 22: 500?10
  10. Ben-David B, Solomon E, Levin H, Admoni H, Goldik Z. Intrathecal fentanyl with small-dose dilute bupivacaine: better analgesia without prolonging recovery. Anesth Analg 1997; 85: 560?5.
  11. Goel S, Bhardwaj N, Grover VK. Intrathecal fentanyl added to intrathecal bupivacaine for day case surgery: a randomised study. Eur J Anaesth 2003; 20: 294?7.
  12. Choi DH, Ahn HJ, Kim MH. Bupivacaine-sparing effect of fentanyl in spinal anesthesia for cesarean delivery. Reg Anesth Pain Med 2000; 25: 240?5.
  13. Stocks GM, Hallworth SP, Fernando R, England AJ, Columb MO, Lyons G. Minimum local analgesic dose of intrathecal bupivacaine in labor and the effect of intrathecal fentanyl. Anesthesiology 2001; 94: 593?8.
  14. Reuben SS, Dunn SM, Duprat KM, O?Sullivan P. Anintrathecal fentanyl dose?response study in lower extremity revascularization procedures. Anesthesiology 1994; 81: 1371?5.
  15. Dahlgren G, Hultstrand C, Jakobsson J, Norman M,Eriksson EW, Martin H. Intrathecal sufentanil, fentanyl, or placebo added to bupivacaine for cesarean section. AnesthAnalg 1997; 85: 1288?93.
  16. Asano T, Dohi S, Ohta S, Shimonaka H, Iida H. Antinociception by epidural and systemic alpha 2 adrenoreceptor agonists and their binding affinity in rat spinal cord and brain. Anesth Analg 2000; 90: 400?7.
  17. Coursin D B, Coursin D B, Maccioli G A. Dexmedetomidine. Current Opinion in Critical Care 2001, 7:221?226
  18. Fragen RJ, Fitzgerald PC. Effect of dexmedetomidine on the minimum alveolar concentration (MAC) of sevoflurane in adults age 55-70 years. J Clin Anesth 1999; 11:46670 J. Applied Sci., 6 (5): 882-887, 2009
  19. Martin E, Ramsay G, Mantz J, Sum-Ping ST. the role of the alpha2-adrenreceptor agonist dexmedetomidine in post-surgical sedation in the intensive care unit. J intensive Care Med2000; 18: 29-34. DOI: 10.1177/0885066602239122
  20. Chiari A, Lorber C, Eisenach JC, Wildling E, Krenn C, Zavrsky A, Kainz C, Germann P, Klimscha W. Analgesic and hemodynamic effects of intrathecal clonidine as the sole analgesic agent during first stage of labor: a dose response study. Anesthesiology. 1999; 91(2): 388-96
  21. Fogarty DJ, Carabine UA, Milligan KR: Comparison of the analgesic effects of intrathecal clonidine and intrathecal morphine after spinal anaesthesia in patients undergoing total hip replacement. Br J Anaesth. 1993;71(5):661-4.
  22. Strebel S, Gurzeler JA, Schneider MC, Aeschbach A, Kindler CH: Small-dose intrathecal clonidine and isobaric bupivacaine for orthopedic surgery: a dose-response study. Anesth Analg. 2004; 99(4): 1231-8.
  23. Van Tuijl I, Giezeman MJ, Braithwaite SA, Hennis PJ, Kalkman CJ, van Klei WA: Intrathecal low dose hyperbaric bupivacaine-clonidine combination in outpatient knee Prolongation of Bupivacaine by Dexmedetomidine Eid MD, et al94 arthroscopy: a randomized controlled trial. Acta Anaesthesiol Scand. 2008; 52(3): 343-9.
  24. Juli?o MC, Lauretti GR. Low-dose intrathecal clonidine combined with sufentanil as analgesic drugs in abdominal gynecological surgery. J Clin Anesth. 2000; 12(5): 357-62.
  25. Kalso E, Poyhia R, Rosenberg P. Spinal antinociception by dexmedetomidine, a highly selective a2-adrenergic agonist. PharmacolToxicol 1991; 68: 140?3
  26. Mahendru V, Tewari A, Katyal S, Grewal A, Singh M R, Katyal R. A comparison of intrathecal dexmedetomidine, clonidine, and fentanyl as adjuvants to hyperbaric bupivacaine for lower limb surgery: A double blind controlled study. J Anaesthesiol Clin Pharmacol 2013;29:496-502
  27. Ibrahim FA. A comparative study of adding intrathecal dexmedetomidine versus sufentanil to heavy bupivacaine for postoperative analgesia in patients undergoing inguinal hernia repair. Benha M.J 2009;26:207-17
  28. Hala EA, Shafie MA, Youssef H. Dose-related prolongation of hyperbaric bupivacaine spinal anesthesia by dexmedetomidine. Ain Shams J Anesthesiol 2011;4:83-95.
  29. Lawhead RG, Blaxall HS, Bylund BD. Alpha-2A is the predominant -2 adrenergic receptor subtype in human spinal cord. Anesthesiology 1992;77:983-91.

[Ashwini K. Ukey D. A and DNB Anaesthesiology. (2018); DEXMEDETOMIDINE VERSUS FENTANYL WITH INTRATHECAL BUPIVACAINE FOR POSTOPERATIVE ANALGESIA IN UROLOGICAL PROCEDURES: A DOUBLE BLIND COMPARITIVE STUDY. Int. J. of Adv. Res. 6 (Apr). 363-368] (ISSN 2320-5407). www.journalijar.com


DR ASHWINI K UKEY
CONSULTANT ANAESTHESIOLOGIST, YASHODA HOSPITAL,HYDERABAD

DOI:


Article DOI: 10.21474/IJAR01/6868      
DOI URL: https://dx.doi.org/10.21474/IJAR01/6868