Pradeep R1, Joby Thomas2
Opioids such as fentanyl or buprenorphine are being added as adjuvant to local anaesthetic for spinal anaesthesia. Dexmedetomidine, a new α2 agonist is being tried as an adjuvant in the recent times.
MATERIALS AND METHODS
The patients were randomised into three Groups (n=30 each) by closed envelope technique. Patients in Group 1 received 10 μg fentanyl with 15 mg of 0.5% hyperbaric bupivacaine, Group 2 received 15 mg of 0.5% hyperbaric bupivacaine supplemented with 30 μg of buprenorphine and Group 3 received 15 mg of 0.5% hyperbaric bupivacaine plus 5 μg dexmedetomidine intrathecally. The time to reach maximum sensory and motor level, the regression time of the same, any adverse effects were recorded. Data were analysed using chi-square test or Fisher’s exact test for categorical data and analysis of variance for continuous data. A value of P<0.05 was accepted as statistically significant.
Settings and Design- The study was conducted in a prospective, randomised and double-blind manner. It included ninety American Society of Anaesthesiologists class I and II patients undergoing hemiarthroplasty under spinal anaesthesia.
In this study, the patients in dexmedetomidine group showed significantly longer duration of motor block (240±20 mins.) and sensory blockade (180±22.2 mins.) compared to other groups, which is statistically significant (P=0.0001 and P=0.006, respectively). The time to first request of analgesic postoperatively was also longer (260±30.2) in dexmedetomidine group when compared with other groups (P=0.0001). Haemodynamic parameters were stable and there were no complications in any group.
We concluded that intrathecal dexmedetomidine (5 μg) with bupivacaine provides significantly longer duration of sensory and motor blockade and longer duration for first request of analgesia in the recovery than intrathecal buprenorphine (30 μg) or fentanyl (10 μg) with bupivacaine for spinal anaesthesia for hemiarthroplasty.