Compared Dexmedetomidine and Fentanyl on Sensory-Motor Block in Unilateral Intrathecal Anesthesia of Lower-limbs Orthopedic Surgeries: A Randomized Duble-blind Trials
Abstract
Background: One of the alternatives for lower-limb orthopedic surgery is spinal anesthesia. It can affect the hemodynamic status and cause the prolonged motor and sensory blocks, as well as urinary retention, which are less common in the unilateral technique. Different drugs are used to improve the quality of the block and reduce its complications. Dexmedetomidine, a selective alpha-2 adrenergic receptor agonist, and fentanyl, an opioid medication, could administration as an adjuvant to increase the intrathecal block quality. Hence, this study aimed to compare unilateral spinal anesthesia with bupivacaine/dexmedetomidine (BD) and bupivacaine/fentanyl (BF) regimes on the sensory-motor block among patients with lower-limb orthopedic surgeries. Materials and Method: This randomized, double-blind clinical trial was performed on 36 patients who underwent lower-limb orthopedic surgeries in Qaem Hospital, Mashhad, Iran. The patients were randomly divided into two groups. Patients who received 5.7 mg hyperbaric bupivacaine 0.5% plus 10 µg fentanyl (BF group) or 5 µg dexmedetomidine (BD group) were administered for inducing unilateral spinal anesthesia. Patients and investigators responsible for data collection were not awarded from allocation groups. The sensory-motor block level, duration, postoperative analgesia, and complications were recorded and compared between the two groups. Results: No significant difference was observed between the two groups in hemodynamic changes (i.e., systolic and diastolic blood pressure and heart rate) before and after the blockage (P˃0.05). Also, there was no difference in the sensory-motor block level and anesthesia-related complications between BF and BD groups (P˃0.05). Conclusion: In patients for whom the use of opioids for unilateral spinal anesthesia is contraindicated, dexmedetomidine could be considered an appropriate alternative.References
Imbelloni LE, Beato L, Cordeiro JA. Unilateral spinal anesthesia with low 0.5% hyperbaric bupivacaine dose. Rev Bras Anestesiol. 2004;54(5):700-6.
https://doi.org/10.1590/S0034-70942004000500013
PMid:19471781
Kiasari AZ, Babaei A, Alipour A, Motevalli S, Baradari AG. Comparison of hemodynamic changes in unilateral spinal anesthesia versus epidural anesthesia below the T10 sensory level in unilateral surgeries: a double-blind randomized clinical trial. Med Arch. 2017;71(4):274.
https://doi.org/10.5455/medarh.2017.71.274-279
PMid:28974849 PMCid:PMC5585788
Tekye SM, Alipour M. Comparison of the effects and complications of unilateral spinal anesthesia versus standard spinal anesthesia in lower-limb orthopedic surgery. Braz J Anesthesiol. 2014;64:173-6.
https://doi.org/10.1016/j.bjane.2013.06.014
PMid:24907876
Liu SS, Ware PD, Allen HW, Neal JM, Pollock JE. Dose-response characteristics of spinal Bupivacaine in volunteers: clinical implications for ambulatory anesthesia. Anesthesiology. 1996;85(4):729-36.
https://doi.org/10.1097/00000542-199610000-00007
PMid:8873542
Sun S, Wang J, Bao N, Chen Y, Wang J. Comparison of dexmedetomidine and Fentanyl as local anesthetic adjuvants in spinal anesthesia: a systematic review and meta-analysis of randomized controlled trials. Drug Des Devel Ther. 2017;11:3413.
https://doi.org/10.2147/DDDT.S146092
PMid:29238167 PMCid:PMC5716323
Khan AL, Singh RB, Tripathi RK, Choubey S. A comparative study between intrathecal dexmedetomidine and Fentanyl as adjuvant to intrathecal Bupivacaine in lower abdominal surgeries: A randomized trial. Anesth Essays Res. 2015;9(2):139.
https://doi.org/10.4103/0259-1162.156284
PMid:26417118 PMCid:PMC4563960
Mahendru V, Tewari A, Katyal S, Grewal A, Singh MR, Katyal R. A comparison of intrathecal dexmedetomidine, clonidine, and Fentanyl as adjuvants to hyperbaric Bupivacaine for lower limb surgery: A double blind controlled study. J Anaesthesiol Clin Pharmacol. 2013;29(4):496.
https://doi.org/10.4103/0970-9185.119151
PMid:24249987 PMCid:PMC3819844
Li Z, Tian M, Zhang CY, Li AZ, Huang AJ, Shi CX, et al. A randomised controlled trial to evaluate the effectiveness of intrathecal Bupivacaine combined with different adjuvants (Fentanyl, clonidine and dexmedetomidine) in caesarean section. Drug Res. 2015;65(11):581-6.
https://doi.org/10.1055/s-0034-1395614
PMid:25504002
Shah A, Patel I, Gandhi R. Haemodynamic effects of intrathecal dexmedetomidine added to ropivacaine intraoperatively and for postoperative analgesia. Int J Basic Clin Pharmacol. 2013;2:26-9.
https://doi.org/10.5455/2319-2003.ijbcp20130105
Gupta R, Verma R, Bogra J, Kohli M, Raman R, Kushwaha JK. A Comparative study of intrathecal dexmedetomidine and Fentanyl as adjuvants to Bupivacaine. J Anaesthesiol Clin Pharmacol. 2011;27(3):339-43.
https://doi.org/10.4103/0970-9185.83678
PMid:21897504 PMCid:PMC3161458
Nayagam HA, Singh NR, Singh HS. A prospective randomized double blind study of intrathecal Fentanyl and dexmedetomidine added to low dose bupivacaine for spinal anesthesia for lower abdominal surgeries. Indian J Anaesth. 2014;58(4):430-5.
https://doi.org/10.4103/0019-5049.138979
PMid:25197111 PMCid:PMC4155288
Basuni AS, Ahmed Ezz HA. Dexmedetomidine as supplement to low-dose levobupivacaine spinal anesthesia for knee arthroscopy. Egypt J Anaesth. 2014;30(2):149-53.
https://doi.org/10.1016/j.egja.2013.11.003
Taher-Baneh N, Ghadamie N, Sarshivi F, Sahraie R, Nasseri K. Comparação de fentanil e dexmedetomidina como adjuvante à bupivacaína para raquianestesia unilateral em cirurgia de membros inferiores: estudo randômico. Braz J Anesthesiol. 2019;69(4):369-76.
https://doi.org/10.1016/j.bjan.2019.03.005
PMid:31362883 PMCid:PMC9391866
Copyright (c) 2022 Galen Medical Journal
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution 4.0 International License that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
