Sidharth B Venu and Venugopalan PG
Objective: It has been demonstrated that dexmedetomidine can extend the time that spinal anaesthesia and postoperative analgesia last. The study's objective was to examine the impact of dexmedetomidine delivery via intrathecal vs intravenous routes on patients posted for lower extremities surgery under spinal anaesthesia with 0.5% hyperbaric bupivacaine.
Methods: A prospective observational study involving 60 ASA PS I & II adults between the ages of 18 & 60 years posted for elective lower extremity surgeries under spinal anaesthesia was conducted from January to June 2022.The participants were randomly assigned to two groups: (1) IT group (n=30) patients received 3 ml of 0.5% hyperbaric bupivacaine and 5 µg of dexmedetomidine intrathecally (100 µg/1 ml ampoule raised in a 40 IU/ml insulin syringe, giving 5 µg=2 IU=0.05 ml) and (2) the IV group (n=30) received 3 ml of 0.5% hyperbaric bupivacaine and 0.05 ml normal saline intrathecally, followed 5 minutes later by IV dexmedetomidine 0.5 µg/kg via infusion pump over 10 minutes as a single dose.
Results: In the IT group, the time from injection to the greatest sensory level was shorter and the sensory beginning occurred statistically substantially sooner at T10 (p 0.001). The IT group had substantially shorter regression times for two dermatomes, to the S1 dermatome, and to the Bromage 3 motor block, however the regression time to the Bromage 0 dermatome was longer (p 0.001). In comparison to the IV group, the IT group demonstrated a considerably longer duration to the need for rescue analgesia and reduced analgesic intake in the first 24 hours (p 0.001). In addition, the IT group experienced much less discomfort than the IV group (p 0.001). The IT group experienced fewer total side effects and a lower sedation score when compared to the IV group, although these differences were not statistically significant (p>0.05).
Conclusion: Dexmedetomidine, when given intrathecally instead of intravenously (IV), had superior analgesic qualities, better hemodynamic stability, and fewer overall adverse effects when used for lower extremities surgeries under bupivacaine spinal anesthesia.
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