Abstract

A COMPARATIVE STUDY TO EVALUATE THREE DIFFERENT DOSES OF DEXMEDETOMEDINE AN ADJUVANT IN SPINAL ANAESTHESIA- A SINGLE INSTITUTIONAL STUDY AT A TERTIARY CARE CENTRE

Dr. Harshavardhan K., Dr. Hilda Shanthini, Dr. Reshmina Chandni Clara Dsouza*, Dr. Paramanand Reddy

Abstract

Back Ground and Objective: Spinal anaesthesia is one of the most common method of regional anaesthesia that is used commonly for lower limb surgeries and for abdominal surgeries. In the past few years the number of surgeries have been increased, as a result of awareness of the people and the increase in the number of modern techniques which are safe along with the other advances that have occurred in the field of medical technology. For providing spinal anaesthesia the most common drug that is used is bupivacaine and the most common adjuvant agent used is dextometiditne. Hyperbaric bupivacaine when used as a spinal anaesthetic agent helps to provide good motor and sensory block that involves most of the lower abdomen and lower limb and hence helps to give a good anaesthesia during the procedure and also provide good for post operative pain relief for a good amount of time. But when bupivacaine is used alone, the duration of sensory motor and post operative analgesia is very limited. Hence in order to enhance the duration of motor and sensory block the postoperative analgesia and the patient compliance adjuvant agents are routinely being used in spinal anaesthesia and dextometiditne is a drug that when added to the primary anaesthetic agent for long duration of anaesthesia and helps in a good sensory and motor blockade. Various studies that have done have shown that when various dosages of the adjuvant agent added to the primary anaesthetic agent in spinal anaesthesia the effect is good with reduction in the number of side effects. Though various studies have been done to compare the various dosages of drugs at present in South India no major study has been undertaken to evaluate the different doses of adjuvant in spinal anaesthesia. In view of all the above said the present study was undertaken to evaluate and find out the best possible optimum dose of dextometiditne in spinal anaesthesia. Methods: A Quasi experimental Study was started after approval from the ethical committee and written informed consent On 60 consenting ASA Grade 1 and 2 patients undergoing lower abdominal or lower limb surgeries between age group of 20 to 60 yrs in Father Muller Medical College Hospital, Mangalore who was admitted during the period of November 2017 to October 2019 for lower abdominal and lower limb surgeries under spinal anesthesia. 3.5ml of 0.5% hyperbaric bupivacaine was used in in spinal anesthesia Then patients were divided into three groups of 20 patients who received varying doses of adjuvant dexmedetomidine as follows Group D5, Group D10 and Group D20. Results In the present study we had the mean age was 35.60 years 33.45 years and 38.10 years in the Group D5 Group D 10 and Group D 20 respectively. there was no significant difference between the groups the p value by ANOVA was more than 0.05 hence the groups are comparable. In the present study we had the 10 females, 11 females 10 females and 10 males 9 males and 10 males in the Group D5Group D10 and Group D20 respectively. there was no significant difference between the groups the p value by ANOVA was more than 0.05 hence the groups are comparable. In the present study we had a mean BMI of 19.3 kg/ m2 19.15 kg/ m2 and 20 kg/ m2 in the Group D5, Group D10 and Group D20 respectively. there was no significant difference between the groups the p value by ANOVA was more than 0.05 hence the groups are comparable. In the present study when we evaluated the heart rate, systolic blood pressure, diastolic blood pressure, and the mean arterial pressure in the various study groups we had at 0 there was no statistical significance between the groups just before laryngoscope with a p value by ANOVA was more than 0.05.but 2 and 1 minutes, 3 minutes and 5 minutes after intubation there was a statistical significance between the groups with the p value by ANOVA was more than 0.05 Highest difference was noted at 2 There was least variation in those Group D5 as those in Group D10 and highest with Group D20. Conclusion: In the study we concluded that the best dose effectively increase the the the duration of motor and sensory block without hemodynamically significant variations. we found that to add to spinal as an adjuvant is 10 microgram of dextometiditne is the best as it is associated with a faster onset and an adequate motor and sensory block for the time required for surgery.

Keywords: But when bupivacaine is used alone, the duration of sensory motor and post operative analgesia is very limited.