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ADDING DEXMEDETOMIDINE TO INTRATHECAL LOW DOSE BUPIVACAINE IN VAGINAL HYSTERECTOMY

ADDING DEXMEDETOMIDINE TO INTRATHECAL LOW DOSE BUPIVACAINE IN VAGINAL HYSTERECTOMY. CO-AUTHORS PROF & HEAD .DR. I.CHANDRASEKARAN MD ,DA PROF .DR.S.P.MEENAKSHISUNDARAM MD,DA ASST. PROF . DR.S.SENTHILKUMAR MD.,DA. AUTHOR DR.T.ARUNPRAKASH

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ADDING DEXMEDETOMIDINE TO INTRATHECAL LOW DOSE BUPIVACAINE IN VAGINAL HYSTERECTOMY

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  1. ADDING DEXMEDETOMIDINE TO INTRATHECAL LOW DOSE BUPIVACAINE IN VAGINAL HYSTERECTOMY CO-AUTHORS PROF & HEAD .DR. I.CHANDRASEKARAN MD ,DA PROF .DR.S.P.MEENAKSHISUNDARAM MD,DA ASST. PROF . DR.S.SENTHILKUMAR MD.,DA. AUTHOR DR.T.ARUNPRAKASH INSTITUTE OF ANESTHESIOLOGY MMC , MADURAI

  2. AIM • To study the effect of adding dexmeditomedine with intrathecal low dose bupivacaine for vaginal hysterectomy on • sensory and motor blockade • Postoperative analgesia

  3. STUDY DESIGN • Randomised double blind control study • 60 patients , 30 in each group • Inclusions • ASA I & II • Age 30 to 60 yrs • Vaginal hysterectomy • BMI 18.5 to 25 • Exclusions • Contraindications to spinal anesthesia • Allergy to local anesthetics

  4. METHODS • Patients were divided into two groups • B – inj 0.5 % hyperbaric bupivacaine 2cc +0.05ml of NS • BD – inj 0.5 % hyperbaric bupivacaine 2cc + 0.05 ml of dexmedetomidine (5μg)

  5. 18G iv cannula secured • Monitors • Patient in right lateral position • Under strict aseptic precautions , SAB performed with 25G Quincke spinal needle in the L3- L4 interspace

  6. OBSERVATIONS • Onset of sensory block to pin prick • Onset of motor block ( bromage score) • Time for two segment regression • Sensory recovery time to pin prick • Motor recovery time( bromage score)

  7. PR if less than 60/min inj atropine 0.6 mg iv given • BP if MAP less than 70 mmHg inj ephedrine iv given in titrated doses • SPO2 • RR • SEDATION by Ramsay Score

  8. BROMAGE SCORE FOR MOTOR BLOCKADE

  9. RAMSAY SEDATION SCORE 1- Patient anxious and agitated or restless 2- Patient co-operative, oriented, and tranquil 3- Patient responds to commands only 4- Patient exhibits brisk response to light glabellar tap or loud auditory stimulus 5- Patient exhibits a sluggish response to light glabellar tap or loud auditory stimulus 6- Patient exhibits no response

  10. Postop analgesia assessed by VAS score • If VAS > 4 –study completed,inj diclofenac 75 mg IM given • Side effects • Hypotension • Bradycardia • Nausea , vomiting • Pruritus

  11. ANALYSIS • Demographic datas • Onset of sensory and motor blockade • Maximum level of sensory blockade • Offset time of sensory and motor blockade • Duration of post op analgesia • Side effects

  12. STATISTICAL ANALYSIS Chi-square test If p < 0.05 is significant

  13. DEMOGRAPHIC DATA

  14. AGE & BMI

  15. ASA

  16. ASA

  17. ONSET OF SENSORY BLOCK

  18. ONSET OF SENSORY BLOCK( MIN)

  19. ONSET OF MOTOR BLOCK

  20. ONSET OF MOTOR BLOCK(MIN)

  21. MAXIMUM SENSORY LEVEL

  22. MAXMIMUM SENSORY LEVEL

  23. TIME FOR 2 SEGMENT REGRESSION

  24. TIME FOR 2 SEGMENT REGRESSION(MIN)

  25. SENSORY RECOVERY TIME TO S1

  26. SENSORY RECOVERY TIME TO S1( MIN)

  27. MOTOR RECOVERY TIME

  28. MOTOR RECOVERY TIME (MIN)

  29. MAP AT VARIOUS TIME INTERVALS

  30. MEAN ARTERIAL PRESSURE

  31. PULSE RATE AT VARIOUS TIME INTERVALS

  32. PULSE RATE

  33. SEDATION SCORE

  34. SEDATION SCORE

  35. OBSERVATION Statistical analysis between BD and B GROUP shown that GROUP BD patients have • Early Sensory and motor onset time • delayed Two segment regression • Motor recovery time • prolonged post op analgesia • Good sedation Than GROUP B patients

  36. DEXEMEDETOMIDINE IN SPINAL Intrathecal α2-agonists • Depressing the release of C-fiber transmitters • Hyperpolarization of post-synaptic dorsal horn neurons

  37. The prolongation of the motor block of spinal anesthetics may result from the binding of α2-adrenergic agonists to motor neurons in the dorsal horn cells • Dose related sedation is by acting at locus ceruleus and also by promoting natural sleep pathways

  38. CONCLUSION Dexmedetomidine as an adjuvant to intrathecal low dose Bupivacaine provides • Better quality of analgesia • Delay in two segment regression • Prolonged post op analgesia • Better hemodynamic stability • Good sedation without any side effects

  39. REFERENCES • Effects of adding dexmeditomedine to intrathecal bupivacaine in spinal anesthesia for gynecological procedures - American journal of applied sciences 6(5) : 882 – 887 , 2009 • Dexmedetomidine Enhances the Local Anesthetic Action of Lidocaine via an -2A Adrenoceptor - Anesth Analg 2008;107:96 –101

  40. Effect of low-dose dexmedetomidine or clonidine on the characteristics of bupivacaine spinal block Acta Anaesthesiologica Scandinavica - February 2006 • Effect of dexmedetomidine added to spinal bupivacaine for urological procedures – Saudi med journal 2009 ; vol 30 (3): 365- 370

  41. THANK YOU

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