A clinical comparative study between dexmedetomidine v/s clonidine with bupivacaine intrathecally in major orthopaedic lower limb surgery

Background: We compared intrathecal Bupivacaine with either Dexmedetomidine or Clonidine. Aims: 1. To review the literature 2. Sensory and Motor Characteristics and 3. Total duration of Post-op analgesia. Material and Methods: 90 patients of either sex, age 20-50 years, ASA grade I or II undergoing orthopedic lower limb surgery were randomly divided in group D (0.5%Bupivacaine15mg+Dexmedetomidine3μg) and group C (0.5%Bupivacaine15mg+Clonidine30μg) intrathecally. All parameters were recorded. Results: Mean time for onset of sensory block at shin of tibia and onset of motor block were comparable. The mean time to achieve T10 sensory blockade was 5.822 ±2.38 minutes in group D while 6.5 ±2.33minutes in Group C. With regard to the highest sensory level attained, both groups were comparable. Mean time to achieve complete motor block was 8.177 ±2.124 minutes in group D while 9±2.044 minutes in group C. The time for two segment regression was also comparable in both the groups. The mean of total duration of motor block in group D was 254.44±40.65minutes compared to 262.22±34.23 minutes in clonidine group. The time for sensory block was 296.889±38.3063 minutes in group D and 306.22±35.63 minutes in group C. Total duration of postoperative analgesia was also same in both groups. Haemodynamic stability was maintained and side effects were comparable. Conclusion: We conclude that both Dexmedetomidine and Clonidine when used as an adjuvant to intrathecal hyperbaric Bupivacaine cause early onset of motor and sensory block, increases two segment regression time, prolonged motor, sensory blockade and post-operative analgesia with hemodynamic stability and no side-effects

Comparison between isobaric levobupivacaine 0.5% and hyperbaric bupivacaine 0.5% in spinal anesthesia in lower limb surgeries and lower abdominal surgeries in adult patients

 Background: The aim of our study was to compare sensory and motor block characteristics and hemodynamic changes following intrathecal hyperbaric bupivacaine (0.5%) and isobaric levobupivacaine (0.5%) in elective lower limb and lower abdominal surgeries.Methods: 60 patients of either sex, aged 18-60 years, ASA grade I or II scheduled for elective lower abdominal and lower limb surgeries were randomized into two groups, group B (n=30) and group L (n=30) and received either 3 ml of intrathecal hyperbaric bupivacaine or isobaric levobupivacaine intrathecally.Results: The mean time of onset of sensory block at shin of tibia in both the groups was comparable i.e. levobupivacaine (1.19±0.2 minutes) and bupivacaine (1.1+0.2 minutes). The mean time for total duration of sensory block was 211.1±8.2 minutes in group L, while 193.13±13.7 minutes in group B. Time for total duration of motor block in group L was 198.76±8.428 minutes and in group B was 182.6±13.989 minutes. Statistically significant difference was observed in total duration of sensory and motor block in both levobupivaciane and bupivacaine group (p<0.0001). Patients in group L were hemodynamically more stable with significantly less decrease in pulse rate, systolic blood pressure and diastolic blood pressure as compared to group B.Conclusions: We observed that 0.5% isobaric levobupivacaine provided better hemodynamic stability, longer duration of sensory and motor block as compared to bupivacaine.

A comparative evaluation of dexmedetomidine and fentanyl with ropivacaine (0.75%) for epidural anesthesia in lower limb orthopedic surgery

Background: The aim of the study was to compare sensory and motor block characteristics, sedation score, post-operative analgesia and hemodynamic changes following epidural ropivacaine 15 ml (0.75%) supplemented with either dexmedetomidine (1 µg/kg) or fentanyl (1 µg/kg) in lower limb orthopedic surgery.Methods: The study was conducted in 60 patients of either sex belonging to ASA status I , II or III, aged 20 to 60 years undergoing lower limb orthopedic surgeries. In this prospective, randomized controlled study patients were divided into two different groups. Group RD receiving dexmedetomidine 1 mcg/kg+15 ml ropivacaine (0.75%) and group RF receiving fentanyl 1 mcg/kg+15 ml ropivacaine (0.75%). Each group included 30 patients.Results: The onset of sensory analgesia at shin of tibia was significantly early with dexmedetomidine (251.7±131.9 secs) as compared to fentanyl (503±63 secs) and similarly the onset of motor block was significantly early in group RD (533±239.6 secs) as compared to group RF (712.66±90.25 secs). Time for complete motor blockade was also significantly faster with group RD (57.1±5.1 mins) as compared to (61.5±3.2 mins) in group RF. The mean time for two segment regression was 274.3±43.6 mins in group RD, while 243.2±19.2 mins in group RF which was statistically significant (p<0.05). The decrease in heart rate, systolic, diastolic blood pressure and mean arterial blood pressure was significantly more in group RD as compared to RF.Conclusions: Addition of dexmedetomidine to epidural ropivacaine produces rapid onset of sensory and motor blockade, prolonged duration of analgesia, with better hemodynamic stability as compared to fentanyl, hence being a useful alternative adjuvant

A COMPARATIVE STUDY BETWEEN DEXMEDETOMIDINE AND CLONIDINE USED AS ADJUNCTS TO BUPIVACAINE FOR POST-OPERATIVE ANALGESIA BY CAUDAL BLOCK IN PAEDIATRIC PATIENTS

Caudal anaesthesia/analgesia is simple to perform, reliable and safe. Various adjuvants are tried with local anaesthetic to prolong duration of post-operative analgesia in caudal block in paediatric patients with variable results. This prospective study was designed to assess and compare the efficacy of clonidine and dexmedetomidine used as an adjuvants to bupivacaine for caudal analgesia in paediatric patients. A 100 patients of ASA grade I or II ,age group of 6 months to 6 years undergoing infra-umblical surgeries were included in one of the following two groups. Group D received 1 μg/kg Dexmedetomidine while group C received 1 μg/kg Clonidine both with Bupivacaine plain 0.25% 1 ml/kg. Post-operative analgesia was assessed using CRIES scale. The mean duration of post-operative analgesia in group D was 14.16 ± 1.65 hours and in group C it was 11.24 ± 2.48. The prolongation of post-operative analgesia was significantly longer in group D compared to group C and the requirement of rescue analgesic doses in the first 24 post-operative hours was less in group D compared to group C. The incidence of adverse effects were statistically insignificant between the two groups.The addition of both dexmedetomidine and clonidine with bupivacaine administered caudally significantly increase the duration of post-operative analgesia