Comparison of fentanyl and dexmedetomidine as an adjuvant to bupivacaine for unilateral spinal anesthesia in lower limb surgery: a randomized trial
Comparação de fentanil e dexmedetomidina como adjuvante à bupivacaína para raquianestesia unilateral em cirurgia de membros inferiores: estudo randômico
Naseh Taher-Baneh, Negin Ghadamie, Farzad Sarshivi, Reza Sahraie, Karim Nasseri
Abstract
Background and objectives: One of the disadvantages of unilateral spinal anesthesia is the short duration of post-operative analgesia, which can be addressed by adding adjuvants to local anesthetics. The aim of current study was to compare the effects of adding dexmedetomidine, fentanyl, or saline to bupivacaine on the properties of unilateral spinal anesthesia in patients undergoing calf surgery. Methods: In this double-blind clinical trial, 90 patients who underwent elective calf surgery were randomly divided into three groups. The spinal anesthetic rate in each of the three groups was 1 mL bupivacaine 0.5% (5 mg). In groups BD, BF and BS, 5 mcg of dexmedetomidine, 25 mcg of fentanyl and 0.5 mL saline were added, respectively. The duration of the motor and sensory blocks in both limbs and the rate of pain during 24 h after surgery were calculated. Hemodynamic changes were also measured during anesthesia for up to 90 min. Results: The duration of both of motor and sensory block was significantly longer in dependent limb in the BF (96 and 169 min) and BD (92 and 166 min) groups than the BS (84 and 157 min) group. Visual Analog Scale was significantly lower in the two groups of BF (1.4) and BD (1.3), within 24 h after surgery, than the BS (1.6) group. Conclusions: The addition of fentanyl and dexmedetomidine to bupivacaine in unilateral spinal anesthesia can increase the duration of the motor and sensory block in dependent limb and prolong the duration of postoperative pain. However, fentanyl is more effective than dexmedetomidine
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Resumo
Justificativa e objetivos: Uma das desvantagens da raquianestesia unilateral é a curta duração da analgesia pós-operatória, que pode ser abordada pela adição de adjuvantes aos anestésicos locais. O objetivo deste estudo foi comparar os efeitos da adição de dexmedetomidina, fentanil ou solução salina à bupivacaína sobre as propriedades da raquianestesia unilateral em pacientes submetidos à cirurgia de panturrilha. Métodos: Neste ensaio clínico duplo-cego, 90 pacientes submetidos à cirurgia eletiva de panturrilha foram randomicamente divididos em três grupos. A quantidade de anestésico para a raquianestesia nos três grupos foi de 1 mL de bupivacaína a 0,5% (5 mg). Nos grupos BD, BF e BS, 5 mcg de dexmedetomidina, 25 mcg de fentanil e 0,5 mL de solução salina foram adicionados, respectivamente. Foram calculados a duração dos bloqueios motor e sensorial em ambos os membros e o escore de dor durante 24 horas após a cirurgia. As alterações hemodinâmicas também foram medidas durante a anestesia por até 90 minutos. Resultados: A duração de ambos os bloqueios, motor e sensorial, foi significativamente maior no membro dependente nos grupos BF (96 e 169 min) e BD (92 e 166 min) que no grupo BS (84 e 157 min). Os escores da escala visual analógica foram significativamente menores nos grupos BF (1,4) e BD (1,3) que no grupo BS (1,6) nas 24 horas após a cirurgia. Conclusões: A adição de fentanil e dexmedetomidina à bupivacaína em raquianestesia unilateral pode aumentar a duração dos bloqueios sensorial e motor no membro dependente e prolongar a duração da dor pós-operatória. Contudo, fentanil é mais eficaz que dexmedetomidina.
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References
1. Henke VG, Bateman BT, Leffert LR. Focused review: spinal anesthesia in severe preeclampsia. Anesth Analg. 2013;117:686---93.
2. Casati A, Moizo E, Marchetti C, et al. A prospective, randomized, double-blind comparison of unilateral spinal anesthesia with hyperbaric bupivacaine, ropivacaine, or levobupivacaine for inguinal herniorrhaphy. Anesth Analg. 2004;99:1387---92.
3. Pöpping DM, Elia N, Marret E, et al. Opioids added to local anaesthetics for single-shot intrathecal anesthesia in patients undergoing minor surgery: a meta-analysis of randomized trials. Pain. 2012;153:784---93.
4. Marhofer P, Brummett CM. Safety and efficiency of dexmedetomidine as adjuvant to local anesthetics. Curr Opin Anaesthesiol. 2016;29:632---7.
5. Sudheesh K, Rao RR, Kavya M, et al. Comparative study of two doses of intrathecal dexmedetomidine as adjuvant with low dose hyperbaric bupivacaine in ambulatory perianal surgeries: a prospective randomised controlled study. Indian J Anaesth. 2015;59:648.
6. Bromage PR. Epidural analgesia. Philadelphia: WB Saunders; 1978. p. 144.
7. Safari F, Aminnejad R, Mohajerani SA, et al. Intrathecal dexmedetomidine and fentanyl as adjuvant to bupivacaine on duration of spinal block in addicted patients. Anesth Pain Med. 2016;6:e26714.
8. Bottros MM, Christo PJ. Current perspectives on intrathecal drug delivery. J Pain Res. 2014;6:615---26.
9. Gupta R, Verma R, Bogra J, et al. A comparative study of intrathecal dexmedetomidine and fentanyl as adjuvants to bupivacaine. J Anaesthesiol Clin Pharmacol. 2011;27:339.
10. Saadalla AET, Khalifa OYA. Influence of addition of dexmedetomidine or fentanyl to bupivacaine lumber spinal subarachnoid anesthesia for inguinal hernioplasty. Anesth Essays Res. 2017;11:554---7.
11. Kanjhan R. Opioids and pain. Clin Exp Pharmacol Physiol. 1995;22:397---403.
12. Sun S, Wang J, Bao N, et al. 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.
13. Kanazi GE, Aouad MT, Jabbour-Khoury SI, et al. Effect of low dose dexmedetomidine or clonidine on the characteristics of bupivacaine spinal block. Acta Anaesthesiol Scand. 2006;50:222---7.
14. Al Ghanem SM, Massad IM, Al-Mustafa MM, et al. Effect of adding dexmedetomidine versus fentanyl to intrathecal bupivacaine on spinal block characteristics in gynecological procedures: a double blind controlled study. Am J Appl Sci. 2009;6:882---7.
15. Nayagam HÁ, Singh NR, Singh HS. A prospective randomised double blind study of intrathecal fentanyl and dexmedetomidine added to low dose bupivacaine for spinal anesthesia for lower abdominal surgeries. Indian J Anaesth. 2014;58:430---5.
16. 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.
17. Kuusniemi KS, Pihlajamaki KK, Pitkanen MT. A low dose of plain or hyperbaric bupivacaine for unilateral spinal anesthesia. Reg Anesth Pain Med. 2000;25:605---10.
18. Van Tuijl I, Giezeman MJ, Braithwaite SA, et al. Intrathecal low-dose hyperbaric bupivacaine clonidine combination in outpatient knee arthroscopy a randomized controlled trial. Acta Anaesthesiol Scand. 2008;52:343---9.
19. Li Z, Tian M, Zhang CY, 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 (Stuttg). 2015;65:5816.
20. Carollo DS, Nossaman BD, Ramadhyani U. Dexmedetomidine: a review of clinical applications. Curr Opin Anesthesiol. 2008;21:457---61.
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