Gupta Pranjal, Chouhan Ravindra S, Jangir Krishan G, Rathore Vikram S, Audichya Prakash C, Goyal Sameer
Department of Anaesthesiology and Critical Care, Pacific Medical College and Hospital, Udaipur, IND.
Department of Anaesthesiology and Critical Care, Uttar Pradesh University of Medical Sciences, Etawah, IND.
Cureus. 2024 Dec 23;16(12):e76292. doi: 10.7759/cureus.76292. eCollection 2024 Dec.
Background Due to its affordability and ease of application, the subarachnoid block is the most frequently used method for lower abdominal procedures. Levobupivacaine has an onset of sensory and motor blockade comparable to that of bupivacaine and prolongs the duration of analgesia while facilitating quick recovery from motor block. Fentanyl and dexmedetomidine, when used as additives to intrathecal local anesthetic, can extend the duration of sensory and motor blockade and enhance postoperative analgesia. Aims and objectives The purpose of this study is to examine and compare the effectiveness of fentanyl and dexmedetomidine administered as adjuvants to 0.5% hyperbaric levobupivacaine intrathecally in lower abdominal operations with respect to block characteristics, postoperative analgesia as measured by visual analog scale (VAS) scores, hemodynamic changes, and adverse effects. Materials and methods Seventy patients were randomized into two groups of 36 each. Group LF received 15mg of 0.5% hyperbaric levobupivacaine with 25mcg of fentanyl, and Group LD received 15mg of 0.5% hyperbaric levobupivacaine with 10mcg of dexmedetomidine intrathecally. Results Patients in Group LD had a significantly longer duration of sensory and motor block than those in Group LF. In Group LF, the onset of sensory and motor blockade was faster (6.25 ± 1.89 minutes and 9.00 ± 3.24 minutes) compared to Group LD (8.70 ± 1.93 minutes and 10.95 ± 4.03 minutes). The length of sensory and motor blockade in Group LD was longer than in Group LF (308.28 ± 6.36 minutes vs. 232.28 ± 7.01 minutes and 198.20 ± 6.52 minutes vs. 157.45 ± 6.30 minutes, respectively). The total postoperative requirement for analgesics in the initial 24 hours, and the mean VAS scores were lower in Group LD. Conclusion Patients in Group LD experienced a significantly longer duration of sensory and motor block than those in Group LF. The onset of sensory and motor blockade was significantly faster in Group LF than in Group LD. The total postoperative requirement for analgesics in the initial 24 hours and the mean VAS scores were lower in Group LD. This concludes that the use of dexmedetomidine as an adjuvant to 0.5% hyperbaric levobupivacaine during the subarachnoid block provides prolonged postoperative analgesia, reduces total analgesic requirements, and maintains stable hemodynamics, while the use of fentanyl as an adjuvant to hyperbaric levobupivacaine enhances the onset of both sensory and motor blockade.
由于蛛网膜下腔阻滞价格低廉且操作简便，它是下腹部手术最常用的方法。左旋布比卡因的感觉和运动阻滞起效时间与布比卡因相当，且能延长镇痛时间，同时有助于运动阻滞的快速恢复。芬太尼和右美托咪定作为鞘内局部麻醉药的添加剂使用时，可延长感觉和运动阻滞时间并增强术后镇痛效果。
本研究的目的是研究并比较在蛛网膜下腔阻滞中，芬太尼和右美托咪定作为0.5%重比重左旋布比卡因的佐剂用于下腹部手术时，在阻滞特征、视觉模拟评分（VAS）所测得的术后镇痛、血流动力学变化及不良反应方面的有效性。
70例患者被随机分为两组，每组36例。LF组蛛网膜下腔注射15mg 0.5%重比重左旋布比卡因加25μg芬太尼，LD组蛛网膜下腔注射15mg 0.5%重比重左旋布比卡因加10μg右美托咪定。
LD组患者的感觉和运动阻滞持续时间明显长于LF组。在LF组，感觉和运动阻滞的起效时间比LD组更快（分别为6.25±1.89分钟和9.00±3.24分钟，而LD组为8.70±1.93分钟和10.95±4.03分钟）。LD组的感觉和运动阻滞时间长于LF组（分别为308.28±6.36分钟对232.28±7.01分钟以及198.20±6.52分钟对157.45±6.30分钟）。LD组术后最初24小时镇痛药的总需求量及平均VAS评分更低。
LD组患者的感觉和运动阻滞持续时间明显长于LF组。LF组感觉和运动阻滞的起效时间明显快于LD组。LD组术后最初24小时镇痛药的总需求量及平均VAS评分更低。由此得出结论，在蛛网膜下腔阻滞期间，使用右美托咪定作为0.5%重比重左旋布比卡因的佐剂可提供更长时间的术后镇痛，减少镇痛药总需求量，并维持血流动力学稳定，而使用芬太尼作为重比重左旋布比卡因的佐剂可加快感觉和运动阻滞的起效。
