INTRATHECAL DEXMEDETOMIDINE AS AN ADJUVANT TO BUPIVACAINE FOR SPINAL ANAESTHESIA FOR ELECTIVE CESAREAN SECTION: A RANDOMISED DOUBLE-BLIND CONTROLLED STUDY-Upubscience Publisher

INTRATHECAL DEXMEDETOMIDINE AS AN ADJUVANT TO BUPIVACAINE FOR SPINAL ANAESTHESIA FOR ELECTIVE CESAREAN SECTION: A RANDOMISED DOUBLE-BLIND CONTROLLED STUDY

Download as PDF

Volume 3, Issue 1, Pp 24-33, 2020

Author(s)

Yanjun Chen^1#, Zhenyun Yi^1#, Shikai Wu¹, Hongbin Deng¹, Jin Miu², Jia Liu², Hao Wang¹, Yu-yong Liu^1*

Affiliation(s)

¹Department of Anesthesia, the First Affiliated Hospital of Jinan University, Guangzhou 510630, China.

²Department of obstetrics, the First Affiliated Hospital of Jinan University, Guangzhou 510630, China.

Corresponding Author

Yu-yong Liu

ABSTRACT

Objective: This study was designed to evaluate dexmedetomidine (Dex) 5ug as adjuvant combined with 0.5% bupivacaine 10 mg in elective Lower segment cesarean section (LSCS) with respect to the effect on parturients and newborns. Methods: Eighty parturients (ASAⅠ-Ⅱ) undergoing elective LSCS were assigned to 2 groups (n=40) to receive either 0.5% bupivacaine 10 mg with saline (Group C) or 0.5% bupivacaine 10mg with Dex 5ug (Group D). Adverse effects, hemodynamic parameters, Ramsay scores, VAS scores and neonatal Apgar scores were recorded. Umbilical artery blood was collected for blood gas analysis and measuring the levels of umbilical artery blood catecholamine. Data obtained were compiled and analyzed with appropriate tests, p＜0.05 was considered significant. Results: Compared with group C, the VAS score of group D was significant lower at T4（p＜0.05）; The incidence rates of Chill, Nausea, vomit of group D were lower than that in group C（p＜0.05）; This study revealed that the levels of umbilical artery blood lactic acid(Lac) ，Epinephrine (EPI) and Norepinephrine (NA) of group D were obvious lower than that in group C（p＜ 0.05）; MAP, HR, SPO2, Apgar score and Ramsay score did not show statistical difference between the two groups. Conclusions: The addition of 5ug Dex as an intrathecal adjuvant to bupivacaine for elective LSCS provides better analgesia without significant adverse effects, and also reduce the incidence of chill, nausea, vomit during operation.

KEYWORDS

Dexmedetomidine; Bupivacaine; Intrathecal; Lower segment cesarean section

CITE THIS PAPER

Yanjun Chen, Zhenyun Yi, Shikai Wu, Hongbin Deng, Jin Miu, Jia Liu, Hao Wang, Yu-yong Liu. Intrathecal dexmedetomidine as an adjuvant to bupivacaine for spinal anaesthesia for elective cesarean section: a randomised double-blind controlled study. Acta Translational Medicine. 2020, 3(1): 24-33.

REFERENCES

[1] Gizzo S, Noventa M, Fagherazzi S, Lamparelli L, Ancona E, Di Gangi S, et.al.Update on best available options inobstetrics anaesthesia: perinatal outcomes, side effects and maternal satisfaction. Fifteen years systematic literature review. Arch Gynecol Obstet. 2014 Jul; 290(1):21-34. DOI: 10.1007/s00404-014-3212-x.

[2] Chen X, Qian X, Fu F, Lu H, Bein B. Intrathecal sufentanil decreases the median effective dose (ED50) of intrathecal hyperbaric ropivacaine for caesarean delivery. Acta Anaesthesiol Scand. 2010 Mar; 54(3):284-90. doi: 10.1111/j.1399-6576.2009. 02051. x.

[3] Krukowski JA, Hood DD, Eisenach JC, Mallak KA, Parker RL. Intrathecal neostigmine for post-cesarean section analgesia: dose response. Anesth Analg. 1997 Jun; 84(6):1269-75. DOI: 10.1097/00000539-199706000-00018.

[4] Farzi F, Mirmansouri A, Forghanparast K, Heydarzadeh A, Abdollahzadeh M, Jahanyar Moghadam F. Addition of intrathecal fentanyl or meperidine to lidocaine and epinephrine for spinal anesthesia in elective cesarean delivery. Anesth Pain Med. 2014 Feb 7; 4(1):e14081. doi: 10.5812/aapm.14081.

[5] 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 Apr;19(2):161-6. doi: 10.1016/j.ijoa.2009.08.007.

[6] Halder S, Das A, Mandal D, Chandra M, Ray S, Biswas MR,et.al. Effect of different doses of dexmedetomidine as adjuvant in bupivacaine -induced subarachnoid block for traumatized lower limb orthopaedic surgery: a prospective, double-blinded and randomized controlled study [J]. J Clin Diagn Res. 2014 Nov; 8(11):GC01-6.DOI: 10.7860/JCDR/2014/9670.5118.

[7] Marothia KD, Kaur B, Kumar P, Bhupal JPS.A comparative study of 0.5% levobupivacaine alone with 0.5% levo-bupivacaine and dexmedetomidine epidurally for major orthopedic surgeries [J]. Northern Journal of ISA, 2016, 1(1):11-15.

[8] Nayagam HA, 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 [J]. Indian J Anaesth. 2014 Jul; 58(4):430-5. DOI: 10.4103/0019-5049.138979.

[9] Nethra SS, Sathesha M, Dixit A, Dongare PA, Harsoor SS, Devikarani D. Intrathecal dexmedetomidine as adjuvant for spinal anaesthesia for perianal ambulatory surgeries: A randomised double-blind controlled study [J]. Indian J Anaesth. 2015 Mar;59(3):177-81. DOI: 10.4103/0019-5049.153040.

[10] Kanazi GE, Aouad MT, Jabbour-Khoury SI, Al Jazzar MD, Alameddine MM, Al-Yaman R. Effect of low-dose dexmedetomidine or clonidine on the characteristics of bupivacaine spinal block[J]. Acta Anaesthesiol Scand. 2006 Feb;50(2):222-7. DOI: 10.1111/j.1399-6576.2006.00919.x.

[11] Gupta M, Gupta P, Singh DK. Effect of 3 Different Doses of Intrathecal Dexmedetomidine (2.5μg, 5μg, and 10 μg) on Subarachnoid Block Characteristics: A Prospective Randomized Double Blind Dose-Response Trial [J]. Pain Physician. 2016 Mar;19(3):E411-20.

[12] Mohamed SA, El-Rahman AM, Fares KM. Intrathecal Dexmedetomidine, Ketamine, and Their combination added to bupivacaine for postoperative analgesia in major abdominal Cancer surgery. Pain Physician. 2016 Jul; 19(6):E829-39.

[13] Samantaray A, Hemanth N, Gunnampati K, Pasupuleti H, Mukkara M, Rao MH. Comparison of the effects of adding dexmedetomidine versus midazolam to intrathecal bupivacaine on postoperative analgesia. Pain Physician. 2015 Jan-Feb; 8(1):71-7.

[14] Xia F, Chang X, Zhang Y, Wang L, Xiao F. The effect of intrathecal dexmedetomidine on the dose requirement of hyperbaric bupivacaine in spinal anaesthesia for caesarean section: a prospective, doubleblinded, randomized study. BMC Anesthesiol. 2018 Jun 23; 18(1):74. doi: 10.1186/s12871-018-0528-2.

[15] Brummett CM, Padda AK, Amodeo FS, Welch KB, Lydic R.Perineural dexmedetomidine added to ropivacaine causes a dose-dependent increase in the duration of thermal antinociception in sciatic nerve block in rat. Anesthesiology. 2009 Nov; 111(5):1111-9. doi: 10.1097/ALN.0b013e3181bbcc26.

[16] I?güzar O, Bar?? S, Bozkurt A, Can B, Bilge S, Türe H. Evaluation of antinociceptive and neurotoxic effects of intrathecal dexmedetomidine in rats. Balkan Med J. 2012 Dec;29(4):354-7. doi: 10.5152/balkanmedj.2012.034.

[17] Neumann MM1, Davio MB, Macknet MR, Applegate RL 2nd. Dexmedetomidine for awake fiberoptic intubation in a parturient with spinal muscular atrophy type III for cesarean delivery[J]. Int J Obstet Anesth. 2009 Oct;18(4):403-7. DOI: 10.1016/j.ijoa.2009.05.002.

[18] Palanisamy A1, Klickovich RJ, Ramsay M, Ouyang DW, Tsen LC. Intravenous dexmedetomidine as an adjunct for labor analgesia and cesarean delivery anesthesia in a parturient with a tethered spinal cord [J]. Int J Obstet Anesth. 2009 Jul;18(3):258-61. DOI: 10.1016/j.ijoa.2008.10.002.

[19] Li Z, Tian M, Zhang CY, Li AZ, Huang AJ, Shi CX, et al. A Randomised Controlled Trial to Evaluate the Effectiveness of Intrathecal Bupivacaine Combined with Different Adjuvants (Fentanyl, Clonidine and Dexmedetomidine) in Caesarean Section. [J]. Drug Res (Stuttg). 2015 Nov;65(11):581-6. DOI: 10.1055/s-0034-1395614.

[20] Sun Y, Xu Y, Wang GN. Comparative Evaluation of Intrathecal Bupivacaine Alone, Bupivacaine-fentanyl, and Bupivacaine-dexmedetomidine in Caesarean Section. [J]. Drug Res (Stuttg). 2015 Sep;65(9):468-72. DOI: 10.1055/s-0034-1387740.

[21] Gomez T V, Fuenmayor C R. Shivering post epidural anesthesia: different doses of intravenous clonidine [J]. Canadian Journal of Anesthesia, 2002, 49(90001): 54.

[22] Ameta N, Jacob M, Hasnain S, Comparison of prophylactic use of ketamine, tramadol, and dexmedetomidine for prevention of shivering after spinal anesthesia. [J]. J Anaesthesiol Clin Pharmacol. 2018 Jul-Sep;34(3):352-356. DOI: 10.4103/joacp.JOACP_211_16.

[23] Sun L, Guo R, Sun L. Dexmedetomidine for preventing sevoflurane?related emergence agitation in children: A meta?analysis of randomized controlled trials. Acta Anaesthesiol Scand. 2014 Jul;58(6):642-50. doi: 10.1111/aas.12292.

[24] Malin GL, Morris RK, Khan KS. Strength of association between umbilical cord pH and perinatal and long term outcomes: systematic review and meta-analysis. BMJ. 2010 May 13;340:c1471. doi: 10.1136/bmj.c1471.

[25] Leinonen E, Gissler M, Haataja L, Andersson S, Rahkonen P, Rahkonen L.et.al. Umbilical artery pH and base excess at birth are poor predictors of neurodevelopmental morbidity in early childhood. Acta Paediatr. 2019 Oct;108(10):1801-1810. doi: 10.1111/apa.14812.

[26] Einikyte R, Snieckuviene V, Ramasauskaite D, Panaviene J, Paliulyte V, Opolskiene G, et al. The comparison of umbilical cord arterial blood lactate and pH values for predicting short-term neonatal outcomes. [J]. Taiwan J Obstet Gynecol. 2017 Dec;56(6):745-749. DOI: 10.1016/j.tjog.2017.10.007.

[27] Allanson ER, Pattinson RC, Nathan EA, Dickinson JE.The introduction of umbilical cord lactate measurement and associated neonatal outcomes in a South African tertiary hospital labor ward. J Matern Fetal Neonatal Med. 2018 May;31(10):1272-1278. doi: 10.1080/14767058.2017.1315094.

[28] Cahill AG, Macones GA, Smyser CD, López JD, Inder TE, Mathur AM. Umbilical Artery Lactate Correlates with Brain Lactate in Term Infants. Am J Perinatol. 2017 May;34(6):535-540. doi: 10.1055/s-0036-1593844.

[29] Yektas A, Belli E. The effects of 2 μg and 4 μg doses of dexmedetomidine incombination with intrathecal hyperbaric bupivacaine on spinalanesthesia and its postoperative analgesic characteristics [J]. Pain Res Manag. 2014 Mar-Apr; 19(2): 75–81. DOI： 10.1155/2014/956825.

[30] Fairbanks CA, Wilcox GL. Spinal antinociceptive synergism between morphine and clonidine persists in mice made acutely or chronically tolerant to morphine. J Pharmacol Exp Ther. 1999 Mar;288(3):1107-16.

[31] Wang L, Zhang A, Liu W, Liu H, Su F, Qi L. Effects of dexmedetomidine on perioperative stress response, inflammation and immune function in patients with different degrees of liver cirrhosis. Exp Ther Med. 2018 Nov;16(5):3869-3874. doi: 10.3892/etm.2018.6665.

[32] Singla D, Parashar A, Pandey V, Mangla M. Comparative evaluation of dexmedetomidine and labetalol for attenuating hemodynamic stress responses during laparoscopic cholecystectomy in borderline hypertensive patients. Rev Esp Anestesiol Reanim. 2019 Apr;66(4):181-188. doi: 10.1016/j.redar.2018.11.004.

[33] El-Tahan MR, Mowafi HA, Al Sheikh IH, Khidr AM, Al-Juhaiman RA. Efficacy of dexmedetomidine in suppressing cardiovascular and hormonal responses to general anaesthesia for caesarean delivery: A dose–response study. Int J Obstet Anesth. 2012 Jul;21(3):222-9. doi: 10.1016/j.ijoa.2012.04.006.

[34] Khasawinah TA1, Ramirez A, Berkenbosch JW, Tobias JD. Preliminary Experience With Dexmedetomidine in the Treatment of Cyclic Vomiting Syndrome[J]. Am J Ther. 2003 Jul-Aug;10(4):303-7. DOI: 10.1097/00045391-200307000-00012.

[35] Rahimzadeh P, Faiz SHR, Imani F, Derakhshan P, Amniati S. Comparative addition of dexmedetomidine and fentanyl to intrathecal bupivacaine in orthopedic procedure in lower limbs[J]. BMC Anesthesiol. 2018 Jun 6;18(1):62. DOI: 10.1186/s12871-018-0531-7.

[36] Biccard BM, Goga S, de Beurs J. Dexmedetomidine and cardiac protection for non‐cardiac surgery: a meta‐analysis of randomised controlled trials[J]. Anaesthesia. 2008 Jan;63(1):4-14. DOI: 10.1111/j.1365-2044.2007.05306.x.