Kataria Amar Parkash, Jarewal Vishal, Kumar Rajan, Kashyap Ankush
Department of Anaesthesia, Government Medical College, Amritsar, Punjab, India.
Anesth Essays Res. 2018 Jan-Mar;12(1):251-255. doi: 10.4103/aer.AER_227_17.
Spinal anesthesia is a widely used technique providing faster onset with effective and uniformly distributed sensory and motor block. Due to decreased cardiovascular and central nervous system toxicity, levobupivacaine is a good alternative for spinal anesthesia. Dexmedetomidine when used intrathecally is associated with prolonged motor and sensory block, hemodynamic stability, and less requirement of rescue analgesia in 24 h.
A prospective, randomized study was carried out which included 60 adult patients between the age group of 20 and 65 years of physical status American Society of Anesthesiologists Classes I and II who underwent infraumbilical surgeries. Group L patients received 3 ml (15 mg) of 0.5% isobaric levobupivacaine + 0.3 ml normal saline while Group LD patients received 3 ml (15 mg) of 0.5% isobaric levobupivacaine + 0.3 ml (3 μg) dexmedetomidine. The two groups were compared with respect to the onset and duration of sensory and motor block and hemodynamic stability.
The mean duration of sensory block in Group L was 199.50 ± 7.96 min while in Group LD was 340.20 ± 11.78 min. All the differences were statistically highly significant between the two groups ( < 0.001). Mean duration of motor block in Group L and LD was 150.83 ± 9.17 min and 190.20 ± 9.61 min, respectively. Both the differences were highly significant ( < 0.001).
It is concluded that Group LD has early-onset and prolonged duration of sensory and motor block and longer duration of postoperative analgesia than Group L.
脊髓麻醉是一种广泛应用的技术，起效快，能产生有效且分布均匀的感觉和运动阻滞。由于心血管和中枢神经系统毒性降低，左旋布比卡因是脊髓麻醉的良好替代药物。右美托咪定鞘内注射时，可延长运动和感觉阻滞时间，维持血流动力学稳定，且24小时内所需的补救性镇痛较少。
进行了一项前瞻性随机研究，纳入60例年龄在20至65岁之间、美国麻醉医师协会身体状况分级为I级和II级的成年患者，这些患者接受脐下手术。L组患者接受3毫升（15毫克）0.5%等比重左旋布比卡因+0.3毫升生理盐水，而LD组患者接受3毫升（15毫克）0.5%等比重左旋布比卡因+0.3毫升（3微克）右美托咪定。比较两组感觉和运动阻滞的起效时间和持续时间以及血流动力学稳定性。
L组感觉阻滞的平均持续时间为199.50±7.96分钟，而LD组为340.2±11.78分钟。两组之间所有差异均具有高度统计学意义（<0.001）。L组和LD组运动阻滞的平均持续时间分别为150.83±9.17分钟和190.20±9.61分钟。这两个差异均具有高度统计学意义（<0.001）。
得出的结论是，与L组相比，LD组感觉和运动阻滞起效早、持续时间长，术后镇痛时间也更长。
