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Year : 2017  |  Volume : 31  |  Issue : 1  |  Page : 35-40

Low-dose intravenous alpha-2 agonists as adjuvants to spinal levobupivacaine: A randomized study

Department of Anaesthesiology, SMS Medical College, Jaipur, Rajasthan, India

Correspondence Address:
Pranav Jetley
A-75, Resident Doctor's Hostel, S.M.S Medical College, Jaipur - 302 004, Rajasthan
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijpn.ijpn_59_16

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Background: Alpha-2 agonists have been used with spinal anesthesia for anxiolysis, analgesia, and hypnosis and for postoperative pain relief. These beneficial effects may, however, be offset by their propensity to prolong the duration of motor block and adversely affect hemodynamics when used in higher doses. This study compares the effects of low-dose premedication with intravenous (IV) dexmedetomidine and IV clonidine with placebo, on spinal blockade duration, analgesia, and sedation with intrathecal levobupivacaine. Materials and Methods: In this prospective, randomized, double-blinded, placebo-controlled study, ninety American Society of Anesthesiologists Status I and II patients were randomly allocated into three groups: Group A (control) received 10 ml normal saline IV, Group B received IV dexmedetomidine 0.6 μg/kg, and Group C received IV clonidine 1.2 μg/kg over 10 min, before spinal anesthesia with 0.5% levobupivacaine. Hemodynamics, total duration of analgesia, onset and duration of sensory and motor block, visual analog scale score, and sedation score were assessed. Complications, if any, were noted. Results: The level of sensory block achieved was higher with dexmedetomidine (T4.2 ± 0.8) and clonidine (T4.4 ± 0.7) as compared to control (T5.1 ± 0.7; P< 0.001). Time to two segment regression was greater with dexmedetomidine (146.5 ± 12.5 min) and clonidine (138.9 ± 17.4 min) compared to control (90.1 ± 9.4; P< 0.001). Dexmedetomidine maximally prolonged the duration to first patient request for analgesia (245.2 ± 26.8 min), followed by clonidine (175.3 ± 20.1 min, P< 0.001) and control (121.3 ± 16.1 min, P< 0.001). The duration of motor block was similar in all three groups. Incidence of bradycardia was significantly greater with both dexmedetomidine and clonidine compared to saline (P < 0.05). Conclusion: Premedication with low-dose IV dexmedetomidine and clonidine prolonged sensory blockade and analgesic duration and provided suitable sedation, without prolonging motor blockade.

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