Effect of Dexmedetomidine on Post Operative Analgesia and Haemodynamics when added to Bupivacaine 0.5% in Epidural Block for Pelvic and Lower Limb Orthopedic Surgeries
Journal Title: International Journal of Contemporary Medical Research - Year 2016, Vol 3, Issue 8
Abstract
Introduction: Epidural blockade is one of the best procedures, providing better intra operative hemodynamic control, post operative pain relief and rapid recovery from surgery specially pelvic surgeries and orthopedic surgeries. Selective alpha 2 adrenergic agonist used as adjuvant in epidural blockade. Dexmedetomidine a more powerful and highly selective alpha 2 adrenoceptor agonist than clonidine. This study was designed to investigate appropriate doses 1.0, 1.5, 2.0 mcg/kg of dexmedetomidine added to bupivacaine for epidural block to prolong postoperative pain relief and reduce the requirement of rescue analgesia in pelvic and lower limb orthopedic surgeries with least side effects. Material and methods: In our randomized control trial study, total 100 ASA class I and II patients of age between 15 to 65 years undergoing lower limb orthopedic and pelvic surgeries were given epidural block and studied for addition of dexmedetomidine on intra operative hemodynamic and post operative analgesia. Patients received 0.5% bupivacaine 20 ml alone in one group and with added Dexmedetomidine 1.0, 1.5, 2.0 mcg/kg in the other 3 groups respectively. All the patients were monitored for onset of sensory and motor blockade, intra operative hemodynamic, post operative analgesia, adverse effect and complications. Result: Onset of sensory and motor blockade was same in all four groups. Addition of Dexmedetomidine increases the post operative pain free period significantly with all doses of dexmedetomidine. An increase of dose beyond 1.5 mcg/Kg did not further improved pain free period and in fact lowered by 1.24 hours and the incidences of complications started appearing which were absent up to 1.5 mcg/Kg dose. The incidence of side effects like hypotension, Bradycardia and shivering were not seen in patients receiving 1.0 and 1.5 mcg/Kg of Dexmedetomidine with bupivacaine. In patients receiving 2.0 mcg/Kg dexmedetomidine with bupivacaine 24 % of the patients had hypotension and Bradycardia and 4 % had shivering. Conclusion: Addition of Dexmedetomidine in dose range of 1.0 to 1.5 mcg/Kg substantially prolongs postoperative analgesia without altering block characteristics offered by Bupivacaine for epidural blockade with no side effects and appears to be safe and reliable adjuvants.
Authors and Affiliations
Vivek Chakole, Praveen Kumar, Meera Sharma
Keywords
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