RESUMO
Background Dexmedetomidine is being used as an adjuvant analgesic, both as intravenous (IV) and intrathecal infusion. The role of perineural (P) dexmedetomidine has evoked attention recently. The aim of this study was to compare the effect of IV dexmedetomidine and P dexmedetomidine as an adjunct to supraclavicular brachial plexus block in upper limb orthopaedic surgery. Methods Patients were randomly divided into two equal groups (n=20). Group I (IV dexmedetomidine) received dexmedetomidine 1 mcg/kg IV as loading dose over 10 minutes, followed by continuous infusion of dexmedetomidine 0.4 mcg/kg/hr IV. Group P (P dexmedetomidine) received dexmedetomidine at 1 mcg/kg perineurally. After adequate motor response with the aid of peripheral nerve stimulator a supraclavicular block with 40 ml solution containing 5 mg/kg lignocaine (2%) with adrenaline (1:200,000) and 2 mg/kg of bupivacaine (0.5%) was injected to both the groups. Group P also received dexmedetomidine perineurally with block. Onset and duration of sensory and motor block, Ramsay sedation score, hemodynamic parameters, and postoperative analgesia requirement were assessed along with side effects. The data obtained were recorded as mean ± SD, ranges, numbers, and ratios. Results were analyzed using the chi-square test, the Mann-Whitney test for non-parametric data, and an unpaired 't'-test for parametric data. Statistical analysis was carried out using the SPSS (version 10, 2002; SPSS Inc., Chicago, IL, USA) for Windows statistical package. P value less than 0.05 was considered statistically significant. Results Mean onset of sensory block was earlier in group I than in group P (p<0.05) although mean onset of motor block was not significantly different (p>0.05). Duration of sensory and motor blockade was longer in group I (p<0.05). Patients in group I demonstrated lower pulse rate and lower systolic and diastolic blood pressures throughout the period with comparable SpO2 values. There was no difference in intraoperative Ramsay sedation scores in both groups, but postoperative Ramsay sedation scores at 9, 12, and 15 hours were better in group I (p<0.05). The average time to rescue analgesia (visual analogue scale >4) was higher in group I (p>0.05). Conclusion IV dexmedetomidine produced early onset of sensory block, longer duration of sensory and motor block, and longer duration of analgesia as compared with P dexmedetomidine as an adjuvant to supraclavicular block with 5 mg/kg lignocaine (2%) and 2 mg/kg bupivacaine (0.5%) in upper limb orthopaedic surgeries.
RESUMO
Background This study was undertaken to compare and evaluate the efficacy of 3-ml 0.5% isobaric levobupivacaine versus 3-ml 0.75% isobaric ropivacaine in patients undergoing elective lower abdominal and lower limb surgeries. Methods We allocated 60 patients into two groups (n=30 each) to receive either a spinal block of 3-ml 0.5% isobaric levobupivacaine (group L) or 3-ml 0.75% isobaric ropivacaine (group R). Haemodynamic parameters were measured intraoperatively till the end of surgery and postoperatively for two hours. The onset and duration of sensory block and motor block were recorded. Adverse events were also recorded. The student's unpaired t-test was used for comparing the continuous variables. Results The mean age in group L was 37.83 ±16.51 years and the mean age in group R was 38.50 ±12.97 years. The mean onset of sensory block in group L (6.97 ±1.82 mins) was significantly faster than in group R (8.47 ±2.55 mins), p<0.05. Similarly, so was the mean onset of motor block in group L (10.27 ±1.92 mins) versus group R (12.93 ±2.55 mins), p<0.05. The mean duration of sensory block in group L (147.63 ±27.53 mins) was significantly longer than in group R (97.40 ±12.38 mins), p<0.05, as was the mean duration of motor block in group L (207.33 ±22.27 mins) versus group R (146.60 ±21.22 mins), p<0.05. In group L, 13.3% of patients had complications, with hypotension being the most common (6.7%); in group R, 40% had complications, of which bradycardia was the most common (13.3%). Conclusion There was an earlier onset of sensory and motor block and prolonged duration of sensory and motor block with intrathecal administration of 3-ml 0.5% isobaric levobupivacaine as compared to 3-ml 0.75% isobaric ropivacaine. Haemodynamic parameters were more stable with levobupivacaine than ropivacaine. Adverse effects were more common with ropivacaine.
RESUMO
CONTEXT: Critically ill patients requiring mechanical ventilation frequently need sedatives and analgesics to facilitate their care. Dexmedetomidine, a short-acting alpha-2-agonist, possesses anxiolytic, anesthetic, hypnotic, and analgesic properties. AIMS: The objective of this study was to evaluate the efficacy and safety of dexmedetomidine in comparison to propofol in the management of sedation for post-operative intensive care unit (ICU) patients, as a sedative agent. SETTINGS AND DESIGN: Teaching hospital, A phase III, prospective, open, randomized and comparative. MATERIALS AND METHODS: Thirty patients who were ambulatory and who required the post-operative mechanical ventilation or post-operative sedation were enrolled, in which 15 patients received Dexmedetomidine and remaining 15 patients received propofol. All these patients were treated for the period of 8 to 24 h. STATISTICAL ANALYSIS USED: Data were analyzed using Student's t-test and Chi-square test. The value of P < 0.05 was considered as statistically significant. RESULTS: Demographic data were comparable. Pulse rate, respiratory rate and blood pressure were comparable. Depth of sedation and extubation time were similar. To maintain analgesia throughout the study period, patients receiving propofol infusions required significantly more analgesics than patients receiving Dexmedetomidine. CONCLUSIONS: Dexmedetomidine appears to be a safe and acceptable ICU sedative agent when both the clinician's and patient's perspectives are considered.
