Comparison of Intravenous Dexmedetomidine with Midazolam in Prolonging Spinal Anaesthesia with Ropivacaine
Introduction: Midazolam and dexmedetomidine both being sedatives, but the latter with additional analgesic properties is expected to prolong the duration of sensory and motor block obtained with spinal anaesthesia. Aim: To compare intravenous dexmedetomidine with midazolam and placebo with resp...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
| Published: |
JCDR Research and Publications Private Limited
2017-02-01
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| Series: | Journal of Clinical and Diagnostic Research |
| Subjects: | |
| Online Access: | https://jcdr.net/articles/PDF/9344/23874_241216_23874_231216_23874_CE[Ra1]_F(GH)_PF1(NE_RK).pdf |
| Summary: | Introduction: Midazolam and dexmedetomidine both being
sedatives, but the latter with additional analgesic properties is
expected to prolong the duration of sensory and motor block
obtained with spinal anaesthesia.
Aim: To compare intravenous dexmedetomidine with midazolam
and placebo with respect to sensory and motor block duration,
analgesia, and sedation in patients undergoing lower limb
and lower abdominal surgeries with intrathecal ropivacaine
anaesthesia.
Materials and Methods: In this single blind placebo
controlled trial, 60 patients, classified as American Society
of Anaesthesiologists’ (ASA) physical status I–II, were
randomized into three groups (n=20 per group). All patients
were administered ropivacaine (15 mg) for spinal anaesthesia.
Intravenous dexmedetomidine was administered in Group D (1
µg/kg loading dose over 10 minutes, followed by a continuous
infusion (0.5 µg/kg/hr), intravenous midazolam was administered
in Group M (0.05 mg/kg) loading dose, followed by a continuous
infusion (0.02 mg/kg/hr) and normal saline was infused in Group
C. Intraoperative haemodynamic changes, onset, level and
duration of sensory block, onset and duration of motor block,
level of sedation, postoperative analgesia and side effects were
recorded.
Results: Heart rate was seen to fall significantly in Group D
patients for the first 15 minutes. Measurements of mean blood
pressure revealed significant decrease in Group D after 40
minutes, whereas the fall in Group C occurred after 15 minutes.
Duration of sensory block was significantly longer in Group D
patients (208±19.358 mins) as compared to Group M and C
where the duration was (177±15.252 mins) and (177±17.800
mins) respectively. Higher levels of sedation were achieved in
Group D and M where sedation score was 3 (fully asleep but
arousable), 90% cases in Group D and 100% cases in Group
M. The time at which first analgesic was given to patients (VAS
score 4) was (271.50±21.831) in Group D and (202±25.047)
in M and (218.50±38.013) in Group C. Dexmedetomidine
significantly prolongs duration of analgesia providing pain
relief in intraoperative and postoperative period. Injection of
diclofenac sodium 75 mg intramuscular was used as rescue
analgesic. The VAS score reached a value of 4 earlier in the
midazolam and saline group than dexmedetomidine group.
Conclusion: Intravenous dexmedetomidine prolonged spinal
anaesthesia, though midazolam did not. It also provided
sedation and additional analgesia. Therefore, dexmedetomidine
is appropriate during spinal anaesthesia, although heart rate
needs to be monitored cautiously. |
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| ISSN: | 2249-782X 0973-709X |