Karhade Seema Shreepad, Acharya Shilpa Amol, Harnagale Kalpana
Department of Anesthesia, Smt Kashibai Navale Medical College and Hospital, Pune, Maharashtra, India.
Anesth Essays Res. 2015 Sep-Dec;9(3):310-3. doi: 10.4103/0259-1162.158007.
Dexmedetomidine a new drug, which is alpha-two agonist, is recommended by manufacturers as an adjuvant in epidural analgesia and anesthesia.
To study the effects of dexmedetomidine on quality and efficacy of the epidural bupivacaine 0.5% for vaginal hysterectomies, by studying the onset of action, duration of action, highest dermatomal level achieved, degree of motor blockade, intraoperative and postoperative anesthesia and analgesia achieved.
Prospective randomized study.
In this study, 60 American Society of Anesthesiologists I and II patients requiring vaginal hysterectomy were enrolled. Patients were randomly divided into two groups - Group I: Control group receiving epidural bupivacaine 0.5% 15-20 ml only.
Group receiving of epidural bupivacaine 0.5% 15-20 ml with dexmedetomidine 05 mcg/kg. Following parameters were noted: Time to onset of T10 dermatomal level, maximum sensory level achieved, time for complete motor block, time for two segmental dermatomes regression, regression to S1 dermatome, time for first rescue analgesic and total top ups required during study.
Mean and standard deviation was calculated. We used two independent sample t-test to find the P value. Software used STATA 13.0.
The demographic profile was comparable between the groups. There was significant difference between two groups (P < 0.001) regarding onset of analgesia to T10 (17.12 ± 2.44 vs. 10.14 ± 2.94), time to achieve complete motor block (27.16 ± 4.52 vs. 22.98 ± 4.78), which was earlier in dexmedetomidine with bupivacaine group. Prolonged postoperative analgesia, less rescue top ups and adequate sedation score was found with dexmedetomidine group. The intraoperative hemodynamic changes were comparable in both the groups. The incidence of dry mouth, shivering and nausea was more with the dexmedetomidine group.
We conclude that epidural dexmedetomidine 0.5 µg/kg is a good adjuvant providing early onset of sensory and motor block, adequate sedation and prolonged postoperative analgesia with minimal side-effects.
右美托咪定是一种新型药物，为α2肾上腺素能受体激动剂，制造商推荐其作为硬膜外镇痛和麻醉的辅助用药。
通过研究起效时间、作用持续时间、达到的最高皮节水平、运动阻滞程度、术中及术后麻醉和镇痛效果，探讨右美托咪定对0.5%布比卡因用于阴道子宫切除术硬膜外麻醉质量和效果的影响。
前瞻性随机研究。
本研究纳入60例美国麻醉医师协会分级为Ⅰ级和Ⅱ级、需要行阴道子宫切除术的患者。患者随机分为两组——Ⅰ组：对照组仅接受15 - 20 ml 0.5%布比卡因硬膜外注射。
Ⅱ组：接受15 - 20 ml 0.5%布比卡因硬膜外注射加0.5 μg/kg右美托咪定。记录以下参数：达到T10皮节水平的起效时间、达到的最大感觉平面、完全运动阻滞时间、两个节段皮节消退时间、消退至S1皮节时间、首次补救镇痛时间以及研究期间所需追加药物的总量。
计算均值和标准差。采用两独立样本t检验计算P值。使用的软件为STATA 13.0。
两组患者的人口统计学特征具有可比性。两组在镇痛至T10的起效时间（17.12 ± 2.44 vs. 10.14 ± 2.94）、达到完全运动阻滞的时间（27.16 ± 4.52 vs. 22.98 ± 4.78）方面存在显著差异，右美托咪定联合布比卡因组更早出现。右美托咪定组术后镇痛时间延长、补救追加药物次数减少且镇静评分合适。两组术中血流动力学变化具有可比性。右美托咪定组口干、寒战和恶心的发生率更高。
我们得出结论，硬膜外注射0.5 μg/kg右美托咪定是一种良好的辅助用药，能使感觉和运动阻滞起效早、镇静充分、术后镇痛时间延长且副作用最小。
