Karthik Kamal, J S (2011) Effect of Low Dose Dexmedetomidine or Clonidine on the characteristics of Bupivacaine Spinal Block. Masters thesis, Stanley Medical College, Chennai.
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Abstract
INTRODUCTION: Transurethral Resection Of Prostate (TURP) is the surgical procedure done for benign prostatic hypertrophy. The standard anaesthetic technique for TURP is subarachnoid block1. Lignocaine and Bupivacaine are the local anaesthetic drugs used to achieve the subarachnoid block. Adjuvants are a different pharmacological class of drugs, which are used to enhance and prolong analgesia, to lower the dose requirements and to reduce the dose dependent side effects. Many drugs have been tried as spinal adjuvants. They are Opioids, Sodium bicarbonate, Ketamine, Neostigmine, Midazolam, Clonidine and the latest inclusion is Dexmedetomidine. Initially opioids have been the standard choice as spinal adjuvant. But since there were many side effects and complications like early and late depression of ventilation, pruritus, nausea, vomiting, urinary retention, central nervous system excitation, delayed gastric emptying and ocular dysfunction, there is an active search for an alternative ideal adjuvant which is devoid of these side effects and complications. Preservative free Dexmedetomidine when administered into subarachnoid space produce analgesia. Activation of post synaptic alpha 2 receptors in the substantia gelatinosa of the spinal cord is the presumed mechanism by which it produces analgesia. Dexmedetomidine at appropriate doses when used as an adjuvant with Bupivacaine in subarachnoid block seems to prolong the duration of surgical anaesthesia and postoperative analgesia. The side effects like dry mouth, hypotension, bradycardia, are not usual in this dose. The added advantages are sedation and prevent shivering. Both Clonidine and Dexmedetomidine belong to the same group, α2 agonists. They cause sedation and analgesia, in that Dexmedetomidine produces more analgesia and sedation because of its high selectivity to α2A receptor compared to Clonidine. This study has been taken to compare Dexmedetomidine as well as Clonidine as spinal adjuvants with Bupivacaine. AIM OF THE STUDY: The aim of this study is to compare the onset and duration of sensory and motor block, hemodynamic changes and level of sedation following intrathecal Bupivacaine supplemented with either Dexmedetomidine or Clonidine. MATERIALS AND METHODS: After getting the ethical committee approval the study was conducted in 60 patients undergoing elective TURP surgeries. It was a double blinded study in which patients were randomly allocated into three groups A, B and C by using the computer based randomization. After getting informed consent and explaining the procedure details to the patients, the anaesthetic technique was performed. Inclusion Criteria: 1. Grade I prostatic hypertrophy with duration of surgery less than one hour, 2. Age 50 – 70 years, 3. ASA I and II. Exclusion Criteria : 1. Patient refusal, 2. ASA III & IV patients, 3. Known case of diabetics mellitus and hypertension, 4. Spinal deformity, 5. H/o drug allergy. Statistical Tools: The information collected from the study was documented in a Master Chart. Data analysis was done with the help of computer using Epidemiological Information Package (EPI 2008). Using this software range, frequencies, percentages, means, standard deviations and ‘p’ values were calculated. ANNOVA t test was used to test the significance of difference between quantitative variables. A 'p' value of less than 0.05 is taken to denote significant relationship. SUMMARY: This is a randomized double blinded study conducted in 60 patients of ASA I and II undergoing elective transurethral resection of prostate (TURP) surgeries. Patients were allocated in three groups. Group A (Bupivacaine + sterile normal saline as placibo), Group B (Bupivacaine + Clonindine 30Kg), Group C (Bupivacaine + Dexmedetomidine 5Kg). Parameters observed were time of onset of sensory block, time of onset of motor block, two segment regression time, duration of motor blockade, duration of sensory blockade, sedation score, duration of post operative analgesia, haemodynamic changes and side effects. 1. The post operative analgesia was significantly prolonged in Group C and was 364 minutes more than the Group A and 121.5 minutes more than Group B. 2. The systolic blood pressure dropped during the early anaesthetic period but the fall was within the 30 percentage of basal systolic blood pressure. 3. There was no significant fall in pulse rate in all Group A, Group B, and Group C. 4. No Sedation were observed in all three groups, but patient was comfortable, co-operative, oriented and calm. 5. Neither respiratory depression nor decrease in saturation was observed in any of the group. CONCLUSION: (i) Adding 30Kg Clonidine or 5Kg Dexmedetomidine to 10mg of Bupivacaine significantly prolongs the duration of post operative analgesia when compare to Bupivacaine alone in elective transurethral resection of prostate (TURP) surgeries. (ii) Bupivacaine with Dexmedetomidine prolongs significantly the duration of post operative analgesia when compared to Bupivacaine with Clonidine in spinal anaesthesia. (iii) Bupivacaine when used alone or with adjuants like Clonidine (30Kg) or Dexmedetomidine (5Kg) does not produce any appreciable side effects.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Low Dose Dexmedetomidine ; Clonidine ; Bupivacaine Spinal Block. |
| Subjects: | MEDICAL > Anaesthesiology |
| Depositing User: | Subramani R |
| Date Deposited: | 22 Apr 2018 16:20 |
| Last Modified: | 28 Apr 2018 16:58 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/7254 |
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