Mohamed Taznim, Susheela Indu, Balakrishnan Beena P, Kaniyil Suvarna
Department of Anesthesiology, Government Medical College, Kozhikode, Kerala, India.
District Hospital, Thrissur, Kerala, India.
Anesth Essays Res. 2017 Jul-Sep;11(3):681-685. doi: 10.4103/aer.AER_243_16.
Dexmedetomidine, an α adrenergic agonist, has been found to be a useful adjuvant to local anesthetics. It has been found to produce satisfactory block with lower doses of spinal bupivacaine.
The aim of this study is to compare the difference in spinal block characteristics and hemodynamic effects of 7, 8, and 9 mg hyperbaric bupivacaine combined with 5 μg dexmedetomidine and to find out the optimum dose that would provide satisfactory block and hemodynamic stability for lower limb orthopedic surgeries.
This was a prospective, observational study.
Ninety patients undergoing lower limb orthopedic surgeries were allocated to three groups of thirty each. Group A received 7 mg, Group B 8 mg and Group C 9 mg 0.5% hyperbaric bupivacaine along with dexmedetomidine 5 μg. The spinal block characteristics, hemodynamic stability, and side effects were compared.
The quantitative variables were compared using ANOVA test and the qualitative variables using Chi-square test.
All three groups had satisfactory anesthesia and analgesia. The onset of analgesia was slower and peak sensory level lower in Group A. The onset of motor block, time to attain peak sensory levels, duration of analgesia, maximum pain scores, and requirement of rescue analgesics were comparable among groups. Duration of motor block and time of regression of sensory level were more in Group C. Hemodynamics and sedation scores were comparable.
Dexmedetomidine with lower doses of bupivacaine produces satisfactory anesthesia without hemodynamic instability. A dose of 7 mg bupivacaine with 5 μg dexmedetomidine may be sufficient for orthopedic surgeries.
右美托咪定是一种α肾上腺素能激动剂，已被发现是局部麻醉药的有效辅助剂。已发现它能以较低剂量的布比卡因产生满意的阻滞效果。
本研究的目的是比较7mg、8mg和9mg重比重布比卡因联合5μg右美托咪定在脊髓阻滞特征和血流动力学效应方面的差异，并找出能为下肢骨科手术提供满意阻滞和血流动力学稳定性的最佳剂量。
这是一项前瞻性观察性研究。
90例行下肢骨科手术的患者被分为三组，每组30人。A组接受7mg、B组接受8mg、C组接受9mg 0.5%重比重布比卡因以及5μg右美托咪定。比较脊髓阻滞特征、血流动力学稳定性和副作用。
定量变量采用方差分析进行比较，定性变量采用卡方检验进行比较。
所有三组均有满意的麻醉和镇痛效果。A组镇痛起效较慢，感觉峰值水平较低。运动阻滞的起效、达到感觉峰值水平的时间、镇痛持续时间、最大疼痛评分以及急救镇痛药的需求在各组之间相当。C组运动阻滞持续时间和感觉水平消退时间更长。血流动力学和镇静评分相当。
低剂量布比卡因与右美托咪定联合使用可产生满意的麻醉效果且无血流动力学不稳定。7mg布比卡因与5μg右美托咪定的剂量可能足以用于骨科手术。
