DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20171840

A comparative study of different adjuncts to enhance the effects of intrathecal bupivacaine

Debajyoti Sur, Archana Agarwal, Ajay Kumar Chaudhary, Jaishri Bogra, Prithvi Kumar Singh, Rajni Gupta, Vinod Kumar Bhatia

Abstract


Background: Spinal anaesthesia is the commonly used technique for lower abdominal surgeries. Adjuvants to bupivacaine have been used to provide good quality of perioperative and postoperative analgesia. The aim of the study was to evaluate the effects of subarachnoid administration of bupivacaine with clonidine, magnesium, dexmedetomidine and saline group.

Methods: The prospective, comparative single blind study included 120 patients in American society of anaesthesiologist (ASA) grade I and II, scheduled for lower abdominal surgeries were allocated in four groups. Each group included 15 mg bupivacaine with various adjuvants (30 µg clonidine, 50 mg magnesium sulphate and 3µg dexmedetomidine) were compared with saline group (group S).

Results: Time of onset was earlier in groups D and C but delayed in group M. The total power regains (B0) in group D (250.8±18.87), group M (235.23±24.66) and group C (242.70±25.98) were significantly delayed (p<0.05) as compare with group S (180.07±18.53). Demand of analgesia was significantly earlier in group S as compared with groups C, M and D. Similarly, the time of two segment regression was significantly earlier in group S as compared with groups C, M and D (p<0.001). Patients were hemodynamically stable in groups D, C and M as compared to Group S.

Conclusions: Dexmedetomidine and clonidine were equally effective and better as compared to magnesium as an adjunct to intrathecal bupivacaine.


Keywords


Bupivacaine, Clonidine, Dexmedetomidine, Intrathecal, Magnesium

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References


Meyer RA, Macarthur AJ, Downey K. Study of equivalence: spinal bupivacaine 15 mg versus bupivacaine 12 mg with fentanyl 15 μg for cesarean delivery. Int J Obstet Anesth. 2012;21:17-23.

Sirvinskas E, Laurinaitis R. Use of magnesium sulphate in anesthesiology. Medicine. 2002;38:147-50.

Bischoff P, Kochs E. Alpha 2-agonists in anaesthesia and intensive medicine. Anasthesiol Intensivmed Notfallmed Schmerzther 1993;28:2-12.

Yaksh TL, Reddy SV. Studies in the primate on the analgesic effects association with intrathecal actions of opiates, alpha-adrenergic agonists and baclofen. Anesthesiology. 1981;54:451-67.

Dobrydnjov I, Axelsson K, Thörn S E, Matthiesen P, Klockhoff H, Holmström B, Gupta A. Clonidine Combined with small-dose bupivacaine during spinal anaesthesia for inguinal herniorrhaphy: a randomized double-blinded study. Anesth Analg. 2003;96:1496-503.

Kanazi GE, Aouad MT, Jabbour-Khoury SI. Effect of low-dose dexmedetomidine or clonidine on the characteristics of bupivacaine spinal block. Acta Anaesthesiol Scand. 2006;50:222-7.

Begon S, Pickering G, Dubray C. Magnesium increases morphine analgesic effect in different experimental models of pain. Anesthesiology. 2002;96:627-32.

Lysakowsi C, Dumont L, Czarnetzki C, Trame MR. Magnesium as an adjuvant to postoperative analgesia: A systematic review of randomized trials. Anesth Analg. 2007;104:1532-9.

Arcioni R, Palmisoni S, Tigano S. Combined intrathecal and epidural magnesium sulfate supplementation of spinal anaesthesia to reduce post-operative analgesic requirements: a prospective, randomized, double blind, controlled trial in patients undergoing major orthopedic surgery. Acta Anaesthesiol Scand. 2007;51:482-9.

Chanimov M, Cohen ML, Grinspun Y, Herbert M, Reif R, Kaufman I, et al. Neurotoxicity after spinal anaesthesia induced by serial injections of magnesium sulphate: an experimental study in a rat model. Anaesthesia. 1997;52:223-8.

Mageed Nabil A, El-Ghoniemy Yasser F. Intrathecal fentanyl magnesium for fast-track cardiac anaesthesia. Eg J Anaesth. 2005;21:289-93.

Sabbe MB, Penning JP, Ozaki GT, Yaksh TL. Spinal and systemic action of the alpha 2 receptor agonist dexmedetomidine in dogs. Antinociception and carbon dioxide response. Anesthesiology 1994;80:1057-72.

Virtanen R, Savola JM, Saano V, Nyman L. Characterization of the selectivity, specificity and potency of medetomidine as an alpha 2-adrenoceptor agonist. Eur J Pharmacol 1988;150:9-14.

Buvanendran A, McCarthy RJ, Kroin JS, Leong W, Perry P, Tuman KJ. Intrathecal magnesium prolongs fentanyl analgesia: a prospective, randomized, controlled trial. Anesth Analg. 2002;95:661-6.

Ozalevli M, Cetin TO, Unlugenc H, Guler T, Isik G. The effect of adding intrathecal magnesium sulphate to bupivacaine-fentanyl spinal anaesthesia. Acta Anaesthesiol Scand. 2005;49:1514-9.

Shoebi G, Sadegi M, Firazian A, Tabassomi F. The additional effect of magnesium to lidocaine in spinal anaesthesia for caesarean section. Int J Pharmacol. 2007;3:425-7.

Woolf CJ, Thompson SW. The induction and maintenance of central sensitization is dependent on N-methyl-D-aspartic acid receptor activation; implications for the treatment of post-injury pain hypersensitivity states. Pain. 1991;44:293-9.

Eisenach JC, De Kock M, Klimscha W. Alpha2-adrenergic agonists for regional anaesthesia: A clinical review of clonidine (1984-1995). Anesthesiology. 1996;85:655-74.

Al-Mustafa M, Harawel S, Aloweidi A, Murshidi M, Ammari B, Awwad Z, Al-Edwan G, Ramsay M. Effect of dexmedetomidine added to spinal bupivacaine for urological procedures. Saudi Med J. 2009;30:365-70.

Rochette A, Raux O, Trocin R. Clonidine prolongs spinal anaesthesia in newborns: a prospective dose-ranging study. Anesth Analg. 2004;98:56-9.

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;27:339-43.

Saadawy I, Boker A, Elshahawy MA. Effect of dexmedetomidine on the characteristics of bupivacaine in a caudal block in pediatrics. Acta Anaesthesiol Scand. 2009;53:251-6.

Dayiog˘ Lu H, Baykara N Z, Salbes A, Solak M, Toker K. Effects of adding magnesium to bupivacaine and fentanyl for spinal anaesthesia in knee arthroscopy. J Anesth. 2009;23:19-25.

Shukla D, Verma A, Agarwal A, Pandey HD, Tyagi C. Comparative study of intrathecal dexmedetomidine with intrathecal magnesium sulfate used as adjuvants to bupivacaine. J Anaesthesiol Clin Pharmacol. 2011;27:495-9.

Niemi L. Effects of intrathecal clonidine on duration of bupivacaine spinal anaesthesia, haemodynamics, and postoperative analgesia in patients undergoing knee arthroscopy. Acta Anaesthesiol Scand. 1994;38:724-8.

Larsen B, Dorscheid E, Macher-Hanselmann F, Buch U. Does intrathecal clonidine prolong the effect of spinal anaesthesia with spinal mepivacaine? A randomized double-blind study. Anaesthesist. 1998;47:741-6.

Bahar M, Chanimov M, Grinspun E, Koifman I, Cohen ML. Spinal anaesthesia induced by intrathecal magnesium sulphate: An experimental study in a rat model. Anaesthesia. 1996;51:627-33.

Bouaziz H, Hewitt C, Eisenach JC. Subarachnoid neostigmine potentiation of alpha 2-adrenergic agonist analgesia. Dexmedetomidine versus Clonidine. Reg Anesth. 1995;20:121-7.

Santiveri X, Arxer A , Plaja I, Metje M T, Villalonga A, López M. Anaesthetic and postoperative analgesic effects of spinal clonidine as an additive to prilocaine in the transurethral resection of urinary bladder tumours. Eur J Anaesthesiol. 2002;19:589-93.

Malleeswaran S, Panda N, Mathew P, Bagga R. A randomised study of magnesium sulphate as an adjuvant to intrathecal bupivacaine in patients with mild preeclampsia undergoing caesarean section. Int J Obstet Anesth. 2010;19:161-6.

Nath MP, Garg R, Talukdar T, Choudhary D, Chakrabarty A. To evaluate the efficacy of intrathecal magnesium sulphate for hysterectomy under subarachnoid block with bupivacaine and fentanyl: A prospective randomized double blind clinical trial. Saudi J Anaesth. 2012l;6:254-8.

Saadawy I, Boker A, Elshahawy MA. Effect of dexmedetomidine on the characteristics of bupivacaine in a caudal block in pediatrics. Acta Anaesthesiol Scand. 2009;53:251-6.