Dexmedetomidine as an adjuvant for single spinal anesthesia in patients undergoing cesarean section: a system review and meta-analysis

Objective Previous studies reported the effect of dexmedetomidine on intrathecal anesthesia. In this review, we explored the impact of dexmedetomidine as an adjunct for lumbar anesthesia in patients undergoing cesarean section. Methods Two authors searched eligible random controlled trials in electronic databases, including PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, the Chinese BioMedical database, Chinese Scientific Journal Database, and the Wanfang database. Results Ten trials comprising 970 patients were included in this review. Intrathecal dexmedetomidine significantly reduced the onset time of sensory block (standardized mean difference (SMD), −1.50, 95% confidence interval (CI) −2.15, −0.85, I2 = 92%) and motor block (SMD −0.77, 95% CI −1.50, −0.49, I2 = 60%) and prolonged the block duration time (sensory block: SMD 2.02, 95% CI 1.29, 2.74, I2 = 93%; motor block: SMD 1.90, 95% CI 1.07, 2.74, I2 = 94%). Patients who received dexmedetomidine showed a lower incidence of shivering. No significant difference was reported for the neonatal Apgar score and other complications. Conclusion The use of intrathecal dexmedetomidine during cesarean section can shorten the onset time of spinal anesthesia and enhance the effect of local anesthetic. It has no significant impact on neonates and there were no other adverse events.

Download Full-text

Comparative Study of Effect of Spinal Anesthesia in Sitting and Lateral Positions on the Onset Time of Sensory Block and Hemodynamic Condition in Cesarean Section: A Randomized Clinical Trial

Anesthesiology and Pain Medicine ◽

10.5812/aapm.111483 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Nahid Manouchehrian ◽

Abbas Moradi ◽

Leyla Torkashvand

Keyword(s):

Clinical Trial ◽

Cesarean Section ◽

Spinal Anesthesia ◽

Motor Block ◽

Onset Time ◽

Sensory Block ◽

Lateral Position ◽

Sitting Position ◽

Cesarean Sections ◽

Position Group

Background: Spinal anesthesia is the method of choice for the cesarean section. Hypotension is a common complication of this method. Objectives: This study aimed to compare the effect of spinal anesthesia in the sitting and lateral positions on the onset time of sensory block and hemodynamic condition in cesarean sections. Methods: In this clinical trial, 106 elective cesarean section candidates under spinal anesthesia were selected and randomly divided into two groups: spinal anesthesia in the sitting position (group S) and the lateral position (group L). The onset time of the sensory block, quality of sensory and motor block, hemodynamic condition, frequency of hypotension, nausea, and vomiting, and the doses of ephedrine and atropine were compared between both groups. Data were analyzed with SPSS version 16 software at a 95% confidence level. Results: There was no statistically significant difference between the two groups in terms of age. The frequency of hypotension in L and S groups was 24.5% and 57.7%, respectively (P = 0.001), in minute 6 after spinal anesthesia and 5.7% and 36.5%, respectively (P < 0.001), in minute 8 after spinal anesthesia. The mean time to reach the sensory level of T6 was 1.30 ± 0.43 min versus 4.54 ± 2.12 min (P < 0.001), motor block score in minute 5 was 2.98 ± 0.14 versus 2.82 (P = 0.044), and ephedrine dose was 11.5 mg and 16.92 mg in the L and S groups, respectively (P = 0.010). The maximum sensory-motor block and satisfaction of women with spinal anesthesia were significantly higher in the lateral position than in the sitting position (P < 0.05). Conclusions: Cesarean sections under spinal anesthesia in the lateral position than in the sitting position lead to a more rapid sensory and motor block, reduced ephedrine consumption, and enhanced satisfaction of women.

Download Full-text

Perbandingan Efek 10 Mg dengan 12,5 Mg Levobupivacain 0,5% Isobarik terhadap Onset, Durasi, dan Hemodinamik pada Spinal Anestesi untuk Seksio Sesarea

Jurnal Anestesi Obstetri Indonesia ◽

10.47507/obstetri.v2i2.9 ◽

2020 ◽

Vol 2 (2) ◽

pp. 71-8

Author(s):

Rachmad Ismail ◽

Muh Ramli Ahmad ◽

A. Muh. Takdir Musba

Keyword(s):

Data Analysis ◽

Side Effects ◽

Cesarean Section ◽

Spinal Anesthesia ◽

Motor Block ◽

Sensory Block ◽

Hemodynamic Changes ◽

Group Data ◽

Significant Difference ◽

Sensory Motor

Latar Belakang: Tujuan utama spinal anestesi pada seksio sesarea adalah meminimalkan efek samping pada ibu dan bayi baru lahir. Levobupivacain memiliki mekanisme aksi yang sama dengan anestesi lokal lainnya, akan tetapi memiliki efek toksik pada jantung dan saraf yang lebih kecil. Tujuan: Membandingkan onset/durasi blok sensorik, motorik serta hemodinamik antara 10 Mg dengan 12,5 Mg Levobupivacain 0,5% Isobarik + fentanyl 25 μg pada seksio sesarea dengan anestesi spinal.Metode: Sampel terdiri dari dua kelompok, kelompok pertama menerima 10 Mg Levobupivacain 0,5% Isobarik + fentanyl 25 μg dan kelompok kedua menerima 12,5 Mg Levobupivacain 0,5% Isobarik + fentanyl 25 μg dengan sampel masing-masing kelompok 23 orang. Analisis data menggunakan uji statistik uji T independen.Hasil: Onset blok sensorik lebih cepat pada kelompok 12,5 Mg Levobupivacain (2,30 menit) dibandingkan kelompok 10 Mg Levobupivacain (3,70 menit), hal ini secara statistik menunjukkan perbedaan yang signifikan. Durasi blok sensorik kelompok 12,5 Mg Levobupivacain (187,39 menit), durasi blok motorik (194,57 menit) lebih lama dibandingkan kelompok 10 Mg Levobupivacain durasi blok sensorik (153,48 menit) dan durasi blok motorik (157,83 menit). Tidak ada perbedaan yang signifikan pada perubahan hemodinamik untuk kedua kelompokSimpulan: Onset blok sensorik kelompok 12,5 Mg Levobupivacain lebih cepat dibandingkan kelompok 10 Mg Levobupivacain, durasi blok sensorik dan blok motorik kelompok 12,5 Mg Levobupivacain lebih lama dibandingkan kelompok 10 Mg Levobupivacain. Comparison Effects 10 Mg with 12.5 Mg Levobupivacain 0.5% Isobaric Against Onset, Duration, and Hemodynamics in Spinal Anesthesia of Caesarean Section Abstract Background: The main purpose of spinal anesthesia in cesarean section is to minimize side effects on the mother and newborn baby. Levobupivacaine has the same mechanism of action as other local anesthetics, but has a smaller toxic effect on the heart and nerves.Objective: Comparing the onset / duration of sensory, motor and hemodynamic blocks between 10 Mg and 12.5 Mg Levobupivacain 0.5% Isobaric + 25 μg fentanyl in cesarean section with spinal anesthesia.Methods: The sample consisted of two groups, the first group received 10 Mg Levobupivacain 0.5% Isobaric + fentanyl 25 μg and the second group received 12.5 Mg Levobupivacain 0.5% Isobaric + fentanyl 25 μg with a sample of 23 people each group. Data analysis using independent T test statistical tests.Results: Sensory block onset was faster in the 12.5 Mg Levobupivacain group (2.30 minutes) than the 10 Mg Levobupivacain group (3.70 minutes), this statistically showed a significant difference. The sensory block duration of the 12.5 Mg Levobupivacain group (187.39 minutes), the motor block duration (194.57 minutes) is longer than the 10 Mg Levobupivacain group the duration of the sensory block (153.48 minutes) and the duration of the motor block (157.83 minutes). There were no significant differences in hemodynamic changes for the two groups.Conclusion: The onset of the 12.5 Mg Levobupivacain sensory block was faster than the 10 Mg Levobupivacain group, the duration of the sensory block and motor block of the 12.5 Mg Levobupivacain group was longer than the 10 Mg Levobupivacain group

Download Full-text

Dexmedetomidine versus magnesium sulfate as an adjuvant to local anesthetics in spinal anesthesia: a meta-analysis of randomized controlled trials

Journal of International Medical Research ◽

10.1177/0300060520946171 ◽

2020 ◽

Vol 48 (8) ◽

pp. 030006052094617

Author(s):

Jinguo Wang ◽

Zaitang Wang ◽

Xuesong Song ◽

Na Wang

Keyword(s):

Randomized Controlled Trials ◽

Magnesium Sulfate ◽

Spinal Anesthesia ◽

Local Anesthetics ◽

Sensory Block ◽

Cochrane Library ◽

Controlled Trials ◽

Sensory Blockade ◽

Randomized Controlled ◽

Significant Difference

Objective To compare the efficacy of dexmedetomidine and magnesium sulfate as an adjuvant to local anesthetics in spinal anesthesia. Methods A search of PubMed, Medline, Embase, the Cochrane Library, and Google Scholar was performed. Randomized controlled trials comparing the efficacy of dexmedetomidine and magnesium sulfate as a local anesthetic adjuvant in spinal anesthesia were identified. The primary outcome was sensory block duration. The mean difference (MD) or odds ratio along with the 95% confidence interval (CI) was used to analyze the outcomes. Results Six studies involving 360 patients were included. Intrathecal dexmedetomidine was associated with a significantly longer sensory block duration (MD = −73.62; 95% CI = −101.09 to −46.15), faster onsets of sensory blockade and motor blockade, and a longer motor block duration than intrathecal magnesium sulfate. There was no significant difference between the regarding the rates of hypotension, bradycardia, shivering, and postoperative nausea and vomiting between the groups. Conclusions Dexmedetomidine is superior to magnesium sulfate as an adjuvant to local anesthetics in spinal anesthesia because of its more rapid onset and longer duration of spinal block without significant adverse effects.

Download Full-text

Influence of Positioning on Plain Levobupivacaine Spinal Anesthesia in Cesarean Section

Anesthesiology Research and Practice ◽

10.1155/2010/212696 ◽

2010 ◽

Vol 2010 ◽

pp. 1-4 ◽

Cited By ~ 6

Author(s):

Fabio Gori ◽

Francesco Corradetti ◽

Vittorio Cerotto ◽

Vito Aldo Peduto

Keyword(s):

Cesarean Section ◽

Spinal Anesthesia ◽

Supine Position ◽

Motor Block ◽

Sensory Block ◽

Sensory Level ◽

Physical Status ◽

Gravitational Forces ◽

Block Level ◽

Dermatomal Level

Background. The behaviour of isobaric levobupivacaine in relation to gravity when used in obstetric spinal anesthesia is unclear.Methods. 46 women with ASA physical status 1 undergoing cesarean section were randomly allocated to 2 groups. Spinal anesthesia with 12.5 mg levobupivacaine was performed in the sitting position in all women. Those in the first group were placed in the supine position immediately after the injection, while those in the second group were asked to remain seated for 2 minutes before assuming the supine position. The sensory block level, the onset of sensory and motor blocks, the regression of the sensory block for 2 dermatomes of the sensory block, the first request for analgesics, and the regression of motor block were recorded.Results. No differences in onset times, sensory level, or Bromage score were observed between the two groups. The time of first analgesic request was earlier in the seated group (supine131±42 min, seated106±29 min,P=.02).Conclusion. Isobaric levobupivacaine in women at term produces a subarachnoid block the dermatomal level of which does not depend on gravitational forces.

Download Full-text

Comparison of Racemic Bupivacaine and Levobupivacaine; combined with low dose Fentanyl, through Intrathecal Route for Transurethral Resection of Prostate

International Journal of Clinical and Biomedical Research ◽

10.31878/ijcbr.2018.43.03 ◽

2018 ◽

Vol 4 (3) ◽

pp. 10-13

Author(s):

Debalpana Chandra ◽

Subir Kumar Brahma

Keyword(s):

Transurethral Resection ◽

Motor Block ◽

Onset Time ◽

Sensory Block ◽

Racemic Mixture ◽

Transurethral Resection Of Prostate ◽

Complete Regression ◽

Central Nervous System Toxicity ◽

Suitable Alternative ◽

Significant Difference

Background and Objectives: Bupivacaine is available as a racemic mixture of dextro and levobupivacaine. Many studies show that dextrobupivacaine has greater cardiovascular and central nervous system toxicity than levobupivacaine. The objectives of the present study were to compare the effects of racemic Bupivacaine + Fentanyl and Levobupivacaine + Fentanyl on the complete regression of motor block, onset time to reach T10 level sensory block, duration of T10 level sensory block, onset time of motor block, duration of sensory block.Materials and Method: The study was conducted in 100 patients undergoing transurethral resection of prostate operation, who received either 1.75 ml Bupivacaine (0.5%) + 25 µg Fentanyl (Gr A) or 1.75 ml Levobupivacaine (0.5%) + 25 µg Fentanyl (Gr B) intrathecally.Results: Time to complete regression of motor block, onset time toT10 level sensory block were significantly prolonged in Gr A compared to Gr B. The onset time of motor block was significantly shorter in Gr A compared to Gr B. There was no statistically significant difference between the two groups in respect to the duration of T10 level sensory block, duration of sensory block.Conclusion: Intrathecal Levobupivacaine + Fentanyl used in the present study can be considered as a suitable alternative to Bupivacaine + Fentanyl for spinal anaesthesia in elective TURP surgery.

Download Full-text

Comparison of effects of Bupivacaine and Ropivacaine in patients undergoing elective Caesarean section

Birat Journal of Health Sciences ◽

10.3126/bjhs.v4i3.27042 ◽

2020 ◽

Vol 4 (3) ◽

pp. 859-863

Author(s):

Sangeeta Subba ◽

Arjun Arjun Chhetri ◽

Rupak Bhattarai

Keyword(s):

Cesarean Section ◽

Spinal Anesthesia ◽

Motor Block ◽

Elective Caesarean Section ◽

Sensory Block ◽

Elective Cesarean Section ◽

Hyperbaric Bupivacaine ◽

Safe Alternative ◽

Elective Cesarean ◽

Group B

Introduction: Spinal anesthesia is considered a reasonable choice for cesarean section. Bupivacaine and ropivacaine have been used as intrathecal drugs alone or in combination with various opioids. Ropivacaine is considered a valid and safe alternative to bupivacaine for spinal anesthesia. Objectives: To compare the efficacy and safety of hyperbaric ropivacaine with hyperbaric bupivacaine in spinal anesthesia for elective cesarean section. Methodology: Sixty pregnant women undergoing elective cesarean section were allocated into two groups. Group R received 3 ml of 0.5% hyperbaric ropivacaine (2 ml 0.75% plain ropivacaine mixed with 1 ml of 25 %dextrose) and Group B received 2.5 ml of 0.5% hyperbaric bupivacaine. Both the groups were compared in terms of onset of sensory and motor block, regression of sensory and motor block, duration of analgesia and side effects. Results: The onset of sensory block was comparable in both groups but was statistically insignificant. The onset of motor block in Bupivacaine(7.53 ± 1.72) min was faster when compared to Ropivacaine group(14.33 ± 6.19) min. Regression of sensory and motor block both were faster in Ropivacaine group. Duration of analgesia was longer in Bupivacaine group(131.17 ± 32.95)min than Ropivacaine group(125.33 ± 30.54)min. Conclusion: Ropivacaine can be used as an alternative to Bupivacaine for spinal anesthesia in cesarean section but has a shorter duration of sensory and motor block.

Download Full-text

Addition of low-dose sufentanil to ropivacaine for reducing shivering and visceral traction pain during cesarean section

Journal of International Medical Research ◽

10.1177/03000605211017000 ◽

2021 ◽

Vol 49 (5) ◽

pp. 030006052110170

Author(s):

Xiao-Rong Chen ◽

Tao Gao ◽

Yin Zhang ◽

Ming-Qing Peng

Keyword(s):

Cesarean Section ◽

Spinal Anesthesia ◽

Low Dose ◽

Sensory Block ◽

Controlled Study ◽

Blood Oxygen Saturation ◽

Time Duration ◽

Significant Difference ◽

Block Time ◽

Time Motor

Objective To investigate the efficacy of low-dose sufentanil for preventing shivering and visceral traction pain during cesarean section under spinal anesthesia. Methods This was a prospective, randomized, controlled study. A total of 112 full-term parturients who underwent elective caesarean delivery were randomly divided into two groups. Group R received 0.75% isobaric ropivacaine intrathecally and group RS received 0.75% isobaric ropivacaine plus 5 µg sufentanil intrathecally. Results There were no significant differences in the maximum sensory block time, motor block time, duration of the surgery, and heart rate, mean arterial pressure, and blood oxygen saturation before and 1, 5, and 10 minutes after spinal anesthesia, and at the end of the surgery between the two groups. Shivering was significantly more common in group R (n = 30) than in group RS (n = 8). The incidence of visceral traction pain in group R (46.43%) was significantly higher than that in group RS (14.29%). There was no significant difference in the newborns’ Apgar scores between the groups. Conclusion Adding low-dose sufentanil to ropivacaine can significantly reduce the incidence of shivering and visceral traction pain after spinal anesthesia.

Download Full-text

Phenylephrine Effectiveness in Handling Hypotensive Issues During Spinal Anesthesia Conductance for Cesarean Section Deliveries

Journal of Anesthesia & Pain Medicine ◽

10.33140/japm.04.03.02 ◽

2019 ◽

Vol 4 (3) ◽

Keyword(s):

Cesarean Section ◽

Spinal Anesthesia ◽

Research Group ◽

Elective Cesarean Section ◽

Control Group ◽

P Values ◽

Management Protocol ◽

Significant Difference ◽

Elective Cesarean ◽

The Impact

Background: Hypotension is frequent clinical challenge during spinal mode of anesthetic induction for cesarean delivery. Requiring an effective and prompt management mode since it has unfavorable clinical outcomes such as hemodynamic cardiovascular instability issues besides reduced uteroplacental perfusion. Aim: Investigating the impact and effectiveness of different prophylacticdosages of Phenylephrine on hypotensive issues during spinal anesthesia for cesarean section deliveries. Methodology:A prospective, randomized, clinical research study involved 184 cases That are classified as American Society of Anesthesiologists physical status I and II with term singleton pregnancies scheduled for elective cesarean section under spinal anesthesia randomized to receive 0.9% saline 2 mL (Control Group) or phenylephrine1.0 ug/kg (PHE1 research Group), 1.5 ug/kg (PHE1.5 research Group), or 2.0 ug/kg (PHE2 research Group) immediately after induction of spinal anesthesia. Results: The adverse effects of prophylactic bolus ofPhenylephrine among the research groups control, Phenylephrine 1, 1.5,2 in which there was statistically significant difference as regards hypotension, rescue Phenylephrine,lowest SBP,highest SBP,early highest SBP,mean SBP, occurrence of hypertension (p values= <0.001, <0.001, 0.002, <0.001, <0.001, <0.001, <0.001consecutively) there was no statistical significant difference as regards nausea and bradycardia (p values=0.929, 0.823consecutively). Conclusions: The research findings obtained denote and imply that a prophylactic Phenylephrine 1.5 ug/kg bolus followed by additional boluses when necessary could be an alternative management protocol to decrease the frequency of hypotensive issues occurrence during spinal anesthetic mode for cesarean deliveries.

Download Full-text

Comparative evaluation of intrathecal bupivacaine alone and bupivacaine combined with dexmedetomidine in cesarean section using spinal anesthesia: a meta-analysis

Journal of International Medical Research ◽

10.1177/0300060518797000 ◽

2019 ◽

Vol 47 (7) ◽

pp. 2785-2799 ◽

Cited By ~ 3

Author(s):

Xin Liu ◽

Xiongjie Zhang ◽

Xujian Wang ◽

Jinyan Wang ◽

Hao Wang

Keyword(s):

Confidence Interval ◽

Cesarean Section ◽

Spinal Anesthesia ◽

Outcome Measure ◽

Meta Analysis ◽

Sensory Block ◽

Cochrane Library ◽

Secondary Outcome ◽

Control Group ◽

Block Level

Objective This meta-analysis was performed to evaluate the effect of spinal anesthesia (SA) using bupivacaine combined with dexmedetomidine (DEX) in cesarean section, analyze the adverse drug reactions induced by this mixture, and provide a reference for rational drug use. Methods Randomized controlled trials were obtained from the PubMed, Cochrane Library, and Embase databases. The primary outcome measure was the time to the highest sensory block level (min), and the secondary outcome measure was adverse effects. Results The time to the highest sensory block level was significantly shorter in the bupivacaine-DEX group than in the control group (standardized mean difference, −0.23; 95% confidence interval, −0.43 to −0.03). The incidence of shivering during the process of anesthesia, especially at a dose of 5 µg DEX, was significantly lower in the bupivacaine-DEX group than in the control group (odds ratio, 0.26; 95% confidence interval, 0.14–0.49). No significant differences were observed in the symptoms of hypotension, bradycardia, nausea/vomiting, or pruritus. Conclusion Compared with the use of bupivacaine alone for SA in cesarean section, adding dexmedetomidine during SA can significantly shorten the onset time and decrease the rate of shivering during anesthesia.

Download Full-text

The Comparison of Intrathecal Ropivacaine with Bupivacaine for Knee Arthroscopy: A Meta-analysis of Randomized Controlled Trials

The Journal of Knee Surgery ◽

10.1055/s-0039-3402795 ◽

2020 ◽

Author(s):

Zhiwei Xie ◽

Xiaoying Nie ◽

Linlin Pan ◽

Na Zhang ◽

Huiqin Xue

Keyword(s):

Randomized Controlled Trials ◽

Motor Block ◽

Web Of Science ◽

Knee Arthroscopy ◽

Meta Analysis ◽

Onset Time ◽

Sensory Block ◽

Cochrane Library ◽

Controlled Trials ◽

Randomized Controlled

AbstractThe comparison of intrathecal ropivacaine with bupivacaine for knee arthroscopy remains controversial. We conduct a systematic review and meta-analysis to explore the efficacy of intrathecal ropivacaine versus bupivacaine for knee arthroscopy. We search PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through August 2019 for randomized controlled trials (RCTs) assessing the effect of intrathecal ropivacaine versus bupivacaine for knee arthroscopy. This meta-analysis is performed using the random effects model. Five RCTs are included in the meta-analysis. Overall, compared with intrathecal bupivacaine for knee arthroscopy, intrathecal ropivacaine is associated with increased onset time of motor block (mean difference [MD] = 2.05, 95% CI: 1.43–2.67, p < 0.00001) and decreased duration of sensory block (MD = −26.82, 95% CI: −31.96 to −21.67, p < 0.00001) but shows no remarkable influence on onset time of sensory block (MD = −0.09; 95% CI: −1.89 to 1.70, p = 0.92), duration of motor block (MD = −59.76; 95% CI: −124.44 to 4.91, p = 0.07), time to maximum block (MD = 2.35; 95% CI: –0.16 to 4.86, p = 0.07), first urination time (MD = −26.42, 95% CI: −57.34 to 4.51, p = 0.09), or first ambulation time (MD = 3.63, 95% CI: −25.20 to 32.47, p = 0.80).Intrathecal ropivacaine can substantially increase onset time of motor block and decrease the duration of sensory block than intrathecal bupivacaine for knee arthroscopy.

Download Full-text