scholarly journals A comparative study of different adjuncts to enhance the effects of intrathecal bupivacaine

2017 ◽  
Vol 5 (5) ◽  
pp. 2046
Author(s):  
Debajyoti Sur ◽  
Archana Agarwal ◽  
Ajay Kumar Chaudhary ◽  
Jaishri Bogra ◽  
Prithvi Kumar Singh ◽  
...  
Keyword(s):  
Comparative Study ◽  
Spinal Anaesthesia ◽  
Postoperative Analgesia ◽  
Magnesium Sulphate ◽  
Saline Group ◽  
Total Power ◽  
American Society ◽  
Group D ◽  
Single Blind

Background: Spinal anaesthesia is the commonly used technique for lower abdominal surgeries. Adjuvants to bupivacaine have been used to provide good quality of perioperative and postoperative analgesia. The aim of the study was to evaluate the effects of subarachnoid administration of bupivacaine with clonidine, magnesium, dexmedetomidine and saline group.Methods: The prospective, comparative single blind study included 120 patients in American society of anaesthesiologist (ASA) grade I and II, scheduled for lower abdominal surgeries were allocated in four groups. Each group included 15 mg bupivacaine with various adjuvants (30 µg clonidine, 50 mg magnesium sulphate and 3µg dexmedetomidine) were compared with saline group (group S).Results: Time of onset was earlier in groups D and C but delayed in group M. The total power regains (B0) in group D (250.8±18.87), group M (235.23±24.66) and group C (242.70±25.98) were significantly delayed (p<0.05) as compare with group S (180.07±18.53). Demand of analgesia was significantly earlier in group S as compared with groups C, M and D. Similarly, the time of two segment regression was significantly earlier in group S as compared with groups C, M and D (p<0.001). Patients were hemodynamically stable in groups D, C and M as compared to Group S.Conclusions: Dexmedetomidine and clonidine were equally effective and better as compared to magnesium as an adjunct to intrathecal bupivacaine.

Comparative study of hemodynamic effects, quality of extubation and emergence - agitation response of the patients with dexmedetomidine versus lignocaine during and following the endotracheal extubation

2021 ◽  
Vol 19 (3) ◽  
pp. 91-95
Author(s):  
Manasi Panat ◽  
Keyword(s):  
Comparative Study ◽  
Stress Responses ◽  
Tracheal Extubation ◽  
Emergence Agitation ◽  
Quality Of Recovery ◽  
Group 12 ◽  
The Difference ◽  
Group D ◽  
Endotracheal Extubation

Background: Endotracheal extubation is the translaryngeal removal of a tube from the trachea via the nose or mouth. It is associated with hemodynamic changes because of reflex sympathetic discharge caused by epipharyngeal and laryngopharyngeal stimulation. Various drugs and techniques have been tried to attenuate the airway and stress responses during tracheal extubation. In present study, we have compared the effects of dexmedetomidine and intravenous lignocaine on the hemodynamic and recovery profiles during endotracheal extubation. Material and Methods: Present study was prospective randomised comparative study, conducted in patients from age group of 18-45 years, ASA grade I/II, scheduled for elective abdominal surgeries. The patients were categorised into two different groups using the sealed envelope method as Group D and group L. Results: In present study, patients were divided in following 2 groups with 50 patients in each group as group D (Dexmedetomidine) and group L (Lignocaine). Age, gender, mean BMI were comparable in both groups and difference was not significant statistically. The difference between mean heart rate, systolic BP, diastolic BP and mean arterial BP during extubation, after extubation at 1, 3, 5, 10, 15, 20, 25, 30 minutes in dexmedetomidine group and lignocaine group was statistically significant. In Dexmedetomidine group, 12% of the patients had no cough during extubation, 72% of the patients had smooth extubation with minimal cough while in Lignocaine group, 22% of the patients had smooth extubation with minimal cough, 74 % of the patients had moderate cough during extubation. Statistical analysis of the Emergence agitation score shows better results in group D. Conclusion: Administration of Dexmedetomidine before tracheal extubation was more effective in maintaining the hemodynamic stability, facilitated smooth tracheal extubation and had a better quality of recovery as compared to Lignocaine.

scholarly journals Attenuation of extubation responses: Comparison of prior treatment with verapamil and dexmedetomidine

2016 ◽  
Vol 03 (01) ◽  
pp. 033-039 ◽  
Author(s):  
Tuhin Mistry ◽  
Shobha Purohit ◽  
Gunjan Arora ◽  
Nitesh Gill ◽  
Jaya Sharma
Keyword(s):  
Blood Pressure ◽  
Stress Response ◽  
Tracheal Extubation ◽  
Group V ◽  
Airway Response ◽  
Significant Attenuation ◽  
American Society ◽  
Airway Responses ◽  
Group D

Abstract Background: Tracheal extubation is almost always associated with stress response, airway response, and arrhythmias. There are many ways to attenuate this stress response. We have compared verapamil and dexmedetomidine on attenuation of these responses. Materials and Methods: Thirty patients (American Society of Anaesthesiologists Grade I, II) scheduled for spinal surgeries under general anaesthesia were randomly divided into two groups. At the end of surgery, after return of spontaneous efforts (bispectral index >80), in “Group V” verapamil 0.1 mg/kg and in “Group D” dexmedetomidine 0.3 mcg/kg were administered as bolus intravenously over one minute. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were recorded just before (T0) and 2 min after intravenous administration of study medications (TM), just after oral suction (TS), immediately after extubation (TE) and 1, 3, 5 and 10 min postextubation (E1, E3, E5, E10). Duration of emergence and extubation, quality of extubation, Richmond Agitation Sedation Scale (RASS) score and time to reach modified Aldrete score ≥9 were compared. Results: HR, SBP, DBP, MAP were higher in Group V than Group D, but statistically insignificant (P > 0.05). Extubation quality scores was 1 for 20%, 2 for 60% and 3 for 20% patients in Group V, whereas 1 in 80%, 2 in 20% in Group D. There was occurrence of bradycardia within 2 min of administration of drug in one patient in Group D. RASS score was in the range of -1 to +1 in >90% patient in Group V, whereas -3 to -1 in 80% cases in Group D. Conclusion: Single dose of dexmedetomidine (0.3 mcg/kg) given before extubation produced significant attenuation of circulatory and airway responses during extubation as compared to verapamil (0.1 mg/kg).

scholarly journals Evaluating the effect of dexmedetomidine premedication on the quality of subarachnoid block, haemodynamics and sedation in patients undergoing lower limb surgeries: a prospective randomized controlled trial

2017 ◽  
Vol 5 (12) ◽  
pp. 5410
Author(s):  
Sandeep Sharma ◽  
Mahesh Somani ◽  
Madhan Chandramohan ◽  
Lalit Kumar Raiger
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Diastolic Blood Pressure ◽  
Spinal Anaesthesia ◽  
Lower Limb ◽  
Motor Block ◽  
Control Group ◽  
Sensory Blockade ◽  
Group D

Background: Present study was designed to evaluate the effect of intravenous dexmedetomidine on haemodynamics, sedation and quality of spinal anaesthesia with 0.5% hyperbaric bupivacaine.Methods: Sixty ASA grade 1 and 2, 18-60 years aged patients scheduled for elective lower limb surgeries were randomly divided into two groups: Group C (Control) and Group D (Study), received intravenous normal saline 10ml and intravenous dexmedetomidine 1μg/kg in dilution of 10ml respectively over 10minutes duration, 10minutes before subarachnoid block with 2.5ml of 0.5% hyperbaric bupivacaine. The heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), quality of sensory and motor block and level of sedation were monitored intraoperatively and postoperatively.Results: The heart rate was statistically significantly decreased in group D both intraoperatively and postoperatively. Intraoperative and postoperative SBP and DBP were lower in dexmedetomidine group but clinically that was insignificant. Intraoperative Ramsay sedation scores were significantly higher in dexmedetomidine group (3.49±0.240) as compared to control group (2.51±0.249) (p<0.001) but the patients were easily arousable. The duration of sensory blockade (208.83±9.53 min vs 162.83±9.62 min), duration for 2 dermatomal regression of sensory blockade (146.5±10.013min vs 98±8.57min) and the duration for motor block regression to Modified Bromage scale 0 (167.33±10.5min vs 137.83±11.94min) were significantly prolonged in dexmedetomidine group as compared to control group. The highest level of sensory blockade was also significantly higher in dexmedetomidine group (T6.90±0.759 vs T7.60±0.621). There was no difference in the time for attaining highest level of sensory blockade, time taken for motor blockade to reach Modified Bromage Scale 3 between both the groups. Average 24hr mean VAS score was significantly lower in dexmedetomidine group (1.37±0.15 vs1.72±0.17, p<0.001). Time to first request for rescue analgesic was also significantly longer in dexmedetomidine group (mean 174.33min vs 143.5min). Average 24hour consumption of tramadol analgesic was significantly higher in control group as compared to dexmedetomidine group (391.86±111.62mg vs 279.86±80.55mg, p<0.001).Conclusions: Intravenous dexmedetomidine significantly prolongs the duration of sensory and motor block of bupivacaine spinal anaesthesia. It provides excellent sedation and analgesia. Dexmedetomidine induced decrease in heart rate, systolic/diastolic blood pressure are not clinically significant. 

scholarly journals Comparative study between the effect of dexmedetomidine and lidocaine infusion in lumbar fixation on hemodynamics, fentanyl requirements, and postoperative analgesia

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Nayera S. Mohammed ◽  
Mariam K. Habib ◽  
Essam A. Abbas ◽  
Sahar M. Mahmoud ◽  
Ibraheem A. Ramadan
Keyword(s):  
Postoperative Pain ◽  
Comparative Study ◽  
Postoperative Analgesia ◽  
Rating Scale ◽  
Hospital Costs ◽  
Treatment Modalities ◽  
Double Blind ◽  
Alternative Mode ◽  
Arterial Blood ◽  
Group D

Abstract Background Spinal surgery is associated with high incidence of severe postoperative pain difficult to easy control. Appropriate treatment modalities decreased the postoperative morbidity, increased patient satisfaction, allowed early mobility, and decreased hospital costs. Lidocaine was used as intravenous additives to control intraoperative pain and decrease postoperative pain. As lidocaine, dexmedetomidine infusion associated with lower postoperative pain scores decreased the opioid consumption and its related adverse events. The aim of this double blind randomized prospective comparative study was to compare the efficacy of intraoperative dexmedetomidine versus lidocaine infusion on hemodynamics, fentanyl requirements, and postoperative analgesia among 66 patients subjected to lumbar fixation surgery and randomized into group D which received dexmedetomidine 1 μg/kg infusion over 10 min as a loading dose then 0.3–0.5 μg/kg/h after induction of anesthesia as maintenance dose and group X which received lidocaine 0.3–0.5 mg/kg/h after induction of anesthesia. Results At 10, 15, 30, and 60 min, the mean arterial blood pressure and heart rate significantly decreased in group D compared to group X, and there was significantly higher total dose of intraoperative analgesic for fentanyl in group X than group D. There was significantly higher numeric rating scale in group X compared to group D at 2, 4, 6, 9, 12, 18, and 24 h postoperative with significant early request of the first analgesia, higher incidence of analgesic needs, and higher dose of postoperative analgesia paracetamol, voltaren, or pethidine in group X compared to group D. Conclusions The intraoperative use of dexmedetomidine IV infusion was an alternative mode to decrease the demands of analgesia following spine surgery.

scholarly journals I.V. infusion of magnesium sulphate during spinal anaesthesia improves postoperative analgesia

2010 ◽  
Vol 104 (1) ◽  
pp. 89-93 ◽  
Author(s):  
J.-Y. Hwang ◽  
H.-S. Na ◽  
Y.-T. Jeon ◽  
Y.-J. Ro ◽  
C.-S. Kim ◽  
...  
Keyword(s):  
Spinal Anaesthesia ◽  
Postoperative Analgesia ◽  
Magnesium Sulphate

scholarly journals Comparison of prophylactic dexmedetomidine and ketamine for the control of shivering under spinal anaesthesia

2021 ◽  
Vol 8 (5) ◽  
pp. 685
Author(s):  
Rituparna Murmu ◽  
Amartya Das ◽  
Swarupa Roychoudhury
Keyword(s):  
Side Effects ◽  
Spinal Anaesthesia ◽  
Hemodynamic Parameters ◽  
Neuraxial Block ◽  
The Difference ◽  
Prophylactic Use ◽  
Grade 3 ◽  
To Receive ◽  
Group D ◽  
Single Blind

Background: Shivering is a common problem during neuraxial block. Thermoregulatory control gets compromised by neyraxial block and as a result the incidence of shivering can go up to 56.7%. Aim of the current investigation was to evaluate the effectiveness of prophylactic use of intravenous dexmedetomidine and ketamine for the control of shivering and to note any side-effects of the drugs used during subarachnoid block.Methods: This randomised single blind study was conducted in 151 ASA grade I and II patients. SAB was performed with 3.0mL (15 mg) of 0.5% bupivacaine heavy in all patients. Patients were randomly allocated into two groups of 75 and 76each to receive dexmedetomidine (0.5 µg/kg) in group D and ketamine (0.5 mg/kg) in group K respectively. Temperature and hemodynamic parameters were recorded at every 15mins interval. Shivering was graded from 0 to 4 according to Tsai and Chu and if grade 3 shivering occurred, the study was stopped and pethidine 25 mg was given intravenously as rescue drug.Results: 2.67% of patients in group D had shivering whereas 38.16% patients in group K experienced shivering at the 5th minute after spinal anaesthesia and it was statistically significant. However the difference in the incidence of shivering was not statistically significant between the two groups after the initial 5 minutes till the end of surgery.Conclusions: The prophylactic use of dexmedetomidine reduced incidences of shivering more effectively as compared to prophylactic use of ketamine. None of the drugs caused any untoward side effects.

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