Liu Lin, Qian Jing, Shen Bei, Xiao Fei, Shen Huaxiang
Department of Anesthesia.
Department of Obstetrics, Jiaxing University Affiliated Women and Children Hospital, Jiaxing City, China.
Medicine (Baltimore). 2019 Mar;98(9):e14666. doi: 10.1097/MD.0000000000014666.
Dexmedetomidine (Dex), as an adjuvant, has been reported to prolong the duration of spinal analgesia when adding to local anesthetic. We hypothesized that Dex could enhance the efficiency of intrathecal bupivacaine for spinal anesthesia in cesarean section. The aim of his study is to test our hypothesis that 5 μg Dex could enhance the efficiency of intrathecal bupivacaine and reduce the dose requirement of spinal bupivacaine for patients undergoing cesarean section.
Ninety patients with ASA I or II, who underwent cesarean section, were randomized into 2 groups: group D (bupivacaine + 5 μg Dex) and group C (bupivacaine + the same volume of saline). The subsequent dose of spinal bupivacaine was determined by the improved up-down allocation method. The initial dose of bupivacaine in the 2 groups was 4 mg, and the subsequent dose for the following patient was depended on the probability of the current dose. ED95 of spinal bupivacaine was calculated using logistic regression model.
The ED95 and 95% confidence intervals (95% CI) of spinal hyperbaric bupivacaine in group D and group C were 7.4 mg (95% CI, 5.6-12.4 mg) and 11.0 mg (95% CI, 4.4-56.8 mg), respectively. The duration of sensory block was 120.5 ± 37.0 minutes in Dex group and 70.5 ± 34.5 minutes in Control group, respectively (P < .05). The duration of analgesia was 230.5 ± 40.5 minutes in Dex group and 145.1 ± 28.5 minutes in Control group, respectively (P < .001). The consumption of postoperative rescued sufentanil was significantly lower in Dex group than in the Control group (56.3 ± 9.4 vs 65.9 ± 10.7 μg). There was not significantly different in the patient satisfaction of analgesia, incidence of side effects, neonatal outcomes and neurological deficit between the 2 groups.
Intrathecal 5 μg Dex enhances the efficacy of spinal bupivacaine by 24% in patients undergoing cesarean section with spinal anesthesia. No additional side effect was observed by adding spinal Dex.
右美托咪定（Dex）作为一种辅助药物，据报道在加入局部麻醉剂时可延长脊髓镇痛的持续时间。我们假设Dex可以提高剖宫产术中鞘内注射布比卡因用于脊髓麻醉的效果。本研究的目的是验证我们的假设，即5μg Dex可提高鞘内注射布比卡因的效果，并降低剖宫产患者脊髓布比卡因的剂量需求。
90例美国麻醉医师协会（ASA）I或II级行剖宫产的患者被随机分为2组：D组（布比卡因+5μg Dex）和C组（布比卡因+等体积生理盐水）。随后脊髓布比卡因的剂量通过改良的上下分配法确定。两组布比卡因的初始剂量均为4mg，后续患者的剂量取决于当前剂量的概率。使用逻辑回归模型计算脊髓布比卡因的ED95。
D组和C组脊髓高压布比卡因的ED95及95%置信区间（95%CI）分别为7.4mg（95%CI，5.6 - 12.4mg）和11.0mg（95%CI，4.4 - 56.8mg）。Dex组感觉阻滞时间为120.5±37.0分钟，对照组为70.5±34.5分钟（P<0.05）。Dex组镇痛时间为230.5±40.5分钟，对照组为145.1±28.5分钟（P<0.001）。Dex组术后挽救性使用舒芬太尼的量显著低于对照组（56.3±9.4μg vs 65.9±10.7μg）。两组在镇痛患者满意度、副作用发生率、新生儿结局和神经功能缺损方面无显著差异。
鞘内注射5μg Dex可使剖宫产脊髓麻醉患者脊髓布比卡因的疗效提高24%。鞘内添加Dex未观察到额外的副作用。
