The effect of intravenous dexmedetomidine to intrathecal bupivacaine on spinal block duration in orthopedic surgery: a double blind controlled study
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Abstract
Background: Spinal anesthesia is a widely used
technique in patients undergoing lower extremity
orthopedic surgery. However, this technique still has
a limitation on the duration of anesthesia that may
not cover the duration of surgery. Objectives: To
investigate the effects of intravenous dexmedetomidine
on the duration of sensory block of spinal anesthesia
in patients undergoing orthopedic surgery. Methods: In
a prospective, double-blind study, ninety ASA I-III
patients undergoing orthopedic surgery under spinal
anesthesia with 0.5% bupivacaine 15 mg were
randomized to 3 groups. Group D (1) received IV
dexmedetomidine 1 mcg/kg over 10 min after spinal
anesthesia, followed by an infusion of 0.4 mcg/kg/hr
for the duration of surgery. Group D (0.5) received IV
dexmedetomidine 0.5 mcg/kg over 10 min, followed
by an infusion of 0.2 mcg/kg/hr. Group C received
normal saline infusion. The duration of motor and
sensory anesthesia, onset time, maximum block
level, time to first request for postoperative analgesia,
postoperative analgesic requirement, and side effects
were assessed. Results: The duration of motor block
in group D (1) was significantly longer than group C
(253.17 ± 57 vs 210.98 ± 67 min, P = 0.007). Duration
of sensory block increased in dexmedetomidine group but not statistical significance. Intraoperative sedation
was greater in dexmedetomidine group. Time to first
request for postoperative analgesia was longer in
group D (1) than in group C (373.5±195 vs 280.8±98 min,
P=0.018). Onset time, maximum block level, incidence
of hypotension, bradycardia, nausea and vomiting,
postoperative analgesic requirement, and patients
satisfaction were similar in all groups. Conclusion: IV
dexmedetomidine 1 mcg/kg over 10 min after spinal
anesthesia, followed by an infusion of 0.4 mcg/kg/hr,
prolonged motor block of bupivacaine spinal
anesthesia without increased significant adverse effects.
It also provided sedation and increased time to first
request for postoperative analgesia.
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