ABSTRACT
BACKGROUND AND AIMS: The addition of dexmedetomidine to spinal anesthesia decreases the incidence of tourniquet pain but may aggravate hypotension after tourniquet deflation. METHODS: Fifty patients were included in this prospective, double-blinded, randomized study, randomly divided into two equal groups of 25 patients each. Spinal anesthesia was performed using 2.5 mL of 0.5% hyperbaric bupivacaine plus 0.5 mL of normal saline in control group (Group C) or 2.5 mL of 0.5% hyperbaric bupivacaine plus 0.5 mL (5 µg) of dexmedetomidine in (Group D). Tourniquet pain was treated by 50 mg of meperidine and repeated in a dose of 20 mg, and the total meperidine consumption was calculated. After tourniquet deflation, heart rate and mean blood pressure were measured for 15 min in the operating room and at these times: before induction of anesthesia (baseline), after inflating tourniquet (inflation), 1 min before deflating tourniquet (predeflation), after tourniquet deflation (10 min postdeflation), and maximum blood pressure and heart rate changes. Duration of time that started before the minimum blood pressure and maximum heart rate was changed until recovery was recorded. RESULTS: Pain after torniquet inflation was significantly higher in the Group C compared to the Group D. The maximal change of blood pressure was lower in the dexmedetomidine than in the control group. The mean time between the maximal change in blood pressure reached and started to recover was 135 ± 14 s in the dexmedetomidine group and 80 ± 31 s in the control group (P < 0.01) and maximal heart rate change was lower in dexmedetomidine group than the control group. The time between the maximal heart rate changes until recovery was 113.2 ± 19 s in the dexmedetomidine group and 53.2 ± 11 s in the control group P < 0.01. CONCLUSION: Adding dexmedetomidine to spinal anesthesia decreases the incidence of tourniquet pain but aggravates the hemodynamic effect of tourniquet deflation.
ABSTRACT
BACKGROUND AND AIMS: Intrarticular ingection of local anesthetics in the knee joint decreases postoperative pain after knee arthrosopy. Dexmedetomidine an α2 agonist has sedative and analgesic effects and decreases postoperative pain after knee arthroscopy when injected intraarticulary. Levobubivacaine is a long acting local anesthetic with less toxicity than bubivacaine. We compared the analgesic effects of dexmedetomidine when added to intraarticular levobupivacaine in patients posted for knee arthroscopy. METHODS: Data were first tested for normality by Kolmogorov-Smirnov test. Study was done on 90 patients. Patients were divided into 3 groups 30 patients each. Group (C) received 50 ml saline only as a control group. Group (L) received 50 ml 0.25% levobupivacaine. Group (L/D) received 50 ml 0.25% levobupivacaine and dexmedetomidine 1µg.kg-1. (VAS) score was used to assess postoperative pain. Time of first pethidine demand and total dose of pethidine in the first 24 h were recorded, also postoperative complications such as pruritis, nausea and vomiting. SPSS version 16 was used for data analysis. P < 0.05 was considered significant. RESULTS: Postoperative VAS sore at different intervals was less in Group LD than Group L than Group C, time to the first pethedine injection in (min) was longer (39 ± 6, 31 ± 7, 21 ± 6), and total pethedine dose given (mg) was lower (36 ± 9.8, 64 ± 19, 102 ± 24) in Group LD than Group L than Group C respectively. CONCLUSION: Adding dexmedetomidine to intraarticular levobupivacaine in patients undergoing knee arthroscopy provides more analgesic effect with lower pain scores than levobupivacaine alone with less use of postoperative analgesics during the first 24 h.
ABSTRACT
BACKGROUND AND AIMS: Local anesthetic injection in the peritoneal cavity decreases intensity of postoperative pain after laparoscopic surgeries. We compared adding dexmedetomidine to intraperitoneal levobupivacaine in patients undergoing laparoscopic cholecystectomy. METHODS: A total of 105 patients were included in this prospective, double-blinded, randomized study. Patients were randomly divided into three equal sized (n = 35) study groups. Group C patients received intraperitoneal 40 ml normal saline as controlled group. Group L was given 40 ml 0.25% levobupivacaine. Group LD received 40 ml 0.25% levobupivacaine + dexmedetomidine 1 µg/kg. The degree of postoperative pain was measured by visual analog scale (VAS) score. The time of first analgesic demand was recorded and also total dose of painkiller in the first 24 h and postoperative complications were collected. SPSS version 16 was used for statistical analysis. P < 0.05 was considered statistically significant. RESULTS: Postoperative VAS at different time intervals was significantly lower, time to the first demand of painkiller (min) was longer (30.2 ± 14.4, 45.9 ± 20.1, and 56.5 ± 13.2), and total painkiller consumption (mg) was lower (203.5 ± 42.9, 117.8 ± 63.7, and 46.3 ± 41.3) in Group LD than Group L than Group C. CONCLUSION: Adding dexmedetomidine to intraperitoneal levobupivacaine is superior to and gives better results than levobupivacaine alone in patients undergoing laparoscopic cholecystectomy.
