Comparative study of intrathecal dexmedetomidine and intrathecal magnesium sulphate used as adjuvants with hyperbaric bupivacaine in lower abdominal and lower limb surgeries
Journal Title: Medpulse International Journal of Anesthesiology - Year 2018, Vol 5, Issue 3
Abstract
Background: Subarachnoid block is the most commonly used regional anesthetic technique for lower abdominal and lower limb surgeries. Intrathecal adjuvants have gained popularity with the aim of prolonging the duration and quality of block, better success rate and faster recovery. The purpose of the study was to evaluate the onset and duration of sensory and motor blocks well as perioperative analgesia of dexmedetomidine and magnesium sulphate when given intrathecally with 0.5% hyperbaric bupivacaine for spinal anesthesia. Materials and Methods: A randomized controlled trial in which 90 patients satisfying inclusion criteria were randomly allocated to 3 groups of 30 each (A,B,C ) by lot method. Group A received intrathecally 15mg hyperbaric bupivacaineand 0.1 ml (10mcg) dexmedetomidine while Group B received 15 mg hyperbaric bupivacaine and 0.1 ml (50 mg) magnesium sulphate and Group C received 15 mg hyperbaric bupivacaine plus 0.1ml saline (control). Onset time of sensory and motor block, regression time for sensory and motor block, duration of analgesia, hemodynamic changes and side effects were recorded. The data obtained were statistically analysed. The level of significance used was p<0.05. Results and Discussion: The onset of sensory and motor block was rapid in Group A ( 2.0+/-0.4 and 3.5+/-0.6 min) as compared to both Group B (6.0+/-0.6 and 7.4+/-0.6 min) and Group C (3.9+/- 0.4 and 5.1+/-0.5 min). The onset of sensory and motor block was significantly prolonged in Group B when compared to Group A and Group C. Also, duration of sensory and motor block was significantly prolonged in Group A (335.3 +/- 18.3 and 293 +/-13.4 min) than patients in Group B (274.8+/- 13.2 and 232.3+/- 11.5 min ), which was greater than control Group C ( 178.0+/-16.6 and 134.8+/- 15.6 min ). Duration of analgesia was prolonged in Group A (214.7 +/-9.6 min ) and Group B ( 194.7+/-13.1 min ) when compared to Group C ( 150.5 +/-15.1 min). Statistical analysis of data obtained, showed a significant difference between the three groups regarding onset and duration of sensory and motor blockade and duration of analgesia. There were no significant differences in patient characteristics between the groups. It was found that onset of anaesthesia was rapid and of prolonged duration in th dexmedetomidine group (A ). In the magnesium sulphate group (B), although onset of block was delayed, the duration of analgesia was significantly prolonged as compared to control group (C), but to a lesser degree than the dexmedetomidine group (A).T he groups were similar with respect to hemodynamic parameters and there were no significant side effects seen in either of these groups. Conclusion: Intrathecal dexmedetomidine seems to be a good alternative to intrathecal magnesium sulphate as it produces rapid onset and prolonged duration of sensory and motor blockade and longer duration of analgesia without significant hemodynamic variations and side effects. Intrathecal magnesium sulphate also prolongs duration of spinal analgesia but to a lesser degree than intrathecal dexmdetomidine and has a delayed onset. Further studies are required to substantiate whether larger doses of intrathecal magnesium sulphate can produce greater potentiation of analgesia and decrease opioid requirements in patients.
Authors and Affiliations
Divya Dhananjayan, Amrutha Sadasivan K
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