The effect of dexmedetomidine on spinal anesthesia quality and hemodynamic changes in patients undergoing inguinal hernia repair surgery: intravenous versus intrathecal

Addition of Dexmedetomidine and Fentanyl to Intrathecal Hyperbaric Bupivacaine for Lower Limb Surgeries: A Randomized, Comparative Study

Background and aim: There is an unmet need to prolong analgesia duration following regional anesthesia; dexmedetomidine as an adjuvant for the intrathecal block has gained popularity over the last few years. The present study compares the onset, duration of sensory and motor block, postoperative analgesia, hemodynamic changes, and adverse effect of dexmedetomidine or fentanyl as an adjuvant to hyperbaric bupivacaine administered intrathecally.

Methods: With approvals, 60 American Society of Anesthesiologists (ASA) physical status I and II adult patients undergoing lower limb surgeries under subarachnoid block were randomized to receive either 5 µg dexmedetomidine (group BD, n=30) or 25 μg fentanyl (group BF, n=30) intrathecally along with 12.5 mg hyperbaric bupivacaine. The time to onset of sensory and motor blockade, time to peak block, intraoperative hemodynamic variations, duration of postoperative analgesia, and associated intraoperative and postoperative complications, if any, were recorded and compared statistically. SPSS v16 (IBM Corp., New York, United States) was used, and P<0.05 was considered significant.

Results: The onset of sensory block in group BD was 1.54 ±0.38 minutes and 3.4 ± 0.40 minutes (P<0.001) in group BF. Time taken for the sensory level to reach T10 in group BD was 3.11± 0.43 minutes and 5.55 ± 0.60 minutes (P<0.001) in group BF. Time taken for two-segment regression in group BD was 160.06 ± 6.85 minutes and 110.4 ± 6.03 minutes (P<0.001) in group BF. The onset of motor block was 2.58 ± 0.437 minutes in group BD and 4.43 ± 0.43 minutes (P<0.001) in group BF. The total duration of analgesia in group BD was 365.8 ± 24.76 minutes and 213.33 ± 20.19 minutes (P<0.001) in group BF. Minimum intraoperative hemodynamic variations were found in group BD, and two groups had comparable side effects.

Conclusion: Dexmedetomidine 5 μg added to intrathecal bupivacaine produced early-onset and prolonged block compared with fentanyl 25 μg. No significant attributable adverse effects were noted for both the drugs except the fall in blood pressure, which was gradual in dexmedetomidine but a steep fall in fentanyl.

Comparative Study of Fentanyl vs Dexmedetomidine as Adjuvants to Intrathecal Bupivacaine in Cesarean Section: A Randomized, Double-Blind Clinical Trial

Purpose

Effective postoperative analgesia is essential in cesarean section. This study aimed to compare postoperative analgesia and hemodynamic changes after intrathecal use of fentanyl or dexmedetomidine combined with bupivacaine.

Patients and Methods

This study involved 110 pregnant women with ASA I and II and gestational age ≥37 weeks who were candidates for elective cesarean section. They were randomly divided into two groups of 55; Group B-D received 10 mg bupivacaine (0.5%) + 5 μg dexmedetomidine and Group B-F received 10 mg bupivacaine (0.5%) + 25 μg fentanyl, intrathecally. The onset of block, duration of analgesia, the score of pain intensity, hemodynamic changes, Apgar scores, and any adverse events were evaluated. P-value <0.05 was considered statistically significant.

Results

Patients in two groups were similar in terms of demographic characteristics and ASA classification. Duration of analgesia in the B-D group was significantly longer than B-F group (428.64±73.39 vs 273.18±61.91 min; P<0.001). The score of pain intensity during recovery time in the B-D group was significantly lower than that of B-F group (0.33±0.84 vs 0.51±0.57 min; P=0.004). The onset of block was also faster in the B-D group than B-F group (98.27±35.95 vs 110.45±37.69 seconds; P=0.036). The two groups did not show significant differences in hemodynamic changes and other variables (P>0.05).

Conclusion

Compared with fentanyl, it seems that adding 5 μg dexmedetomidine to bupivacaine has a better effect on postoperative pain management in cesarean section under spinal anesthesia.

Successful Treatment of Refractory Cancer Pain and Depression with Continuous Intrathecal Administration of Dexmedetomidine and Morphine: A Case Report

Patients who have refractory cancer pain suffer both physically and psychologically. Cancer pain management has improved over the past few decades. However, the treatment of refractory cancer pain is still challenging all over the world. Intraspinal analgesia has become an effective strategy to treat refractory pain in patients with cancer. In this report, we present a patient receiving a large dose of intrathecal opioids for refractory cancer pain, and who is also afflicted with pain-induced depression. Dexmedetomidine (DEX) was used as part of a multimodal analgesic regimen that successfully alleviated both the patient's pain and depression. An intrathecal infusion of DEX may serve as an adjuvant drug in the treatment of cancer pain and pain-related depression.