Perioperative effect of epidural dexmedetomidine with intrathecal bupivacaine on haemodynamic parameters and quality of analgesia
Divya Jain, R M Khan, Devesh Kumar, Nishant Kumar
South Afr J Anaesth Analg 2012;18(1):105-109
Abstract
Background: The present study was a randomised controlled trial designed to evaluate the perioperative effect of epidural dexmedetomidine, in conjunction with intrathecal bupivacaine. Method: In this trial, 60 male patients of American Society of Anesthesiologists' grades I and II, between 20-50 years of age, and posted for elective lower limb orthopaedic surgery, were selected. After written informed consent was obtained and a thorough preanaesthetic check-up carried out, the patients were randomly divided into two groups using the manual envelope randomisation technique. Group I received 2.5 ml of 0.5% bupivacaine intrathecally, plus 10 ml normal saline (NS) epidurally (control). Group II received 2.5 ml of 0.5% bupivacaine intrathecally, plus 2.0 μg/kg dexmedetomidine epidurally, made up to 10 ml with NS (study). Results: We observed a significant prolongation in the duration of analgesia to 424.1 minutes (Group II) in patients receiving epidural dexmedetomidine, in comparison to 140.0 minutes in patients receiving saline (Group I). There was a significant fall in the pulse rate and mean arterial pressure five minutes following epidural dexmedetomidine in Group II patients, which lasted throughout the study period. The majority of the patients in Group II were sedated, yet arousable, by verbal commands or light tactile stimulus (sedation scale 3-4) 10 ± 5 minutes following administration of dexmedetomidine in the epidural space. This decrease in the level of consciousness lasted for 45 ± 5 minutes. Conclusion: The addition of 2 μg/kg dexmedetomidine epidurally to 2.5 ml of intrathecal bupivacaine prolongs the duration of analgesia, and decreases the requirement of rescue analgesics in patients undergoing lower-limb orthopaedic surgery, with a significant fall in pulse rate and mean arterial pressure.
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