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International Journal of Recent Trends in Science and Technology, ISSN 2277-2812 E-ISSN: 2249-8109

Volume 9, Issue 1, November 2013 pp 14-19

Research Article

Comparison of Dexmedetomidine, Fentanyl and Magnesium Sulfate as Adjuvants with Hyperbaric Bupivacaine for Spinal Anesthesia: A Double Blind Controlled Study

Sunil B. V.^*, Sahana K. S.^#, Jajee P. R.^†

{^*Associate Professor, ^#Assistant professor, ^†Professor}

Department of Anesthesia, Sapthagiri Institute of Medical Sciences, Bangalore, Karnataka, INDIA.

Academic Editor : Dr. Aher K.R.

Background: Intrathecal adjuvants has gained popularity with the aim of prolonging the duration of block, quality of block and decreased resource utilization compared with general anaesthesia. The purpose of this study was to evaluate the onset and duration of sensory and motor block as well as adverse effects of adding exmedetomidine, fentanyl or magnesium to hyperbaric bupivacaine for spinal anesthesia. Design: randomized double blind trail. Setting:  hospital based study during the period, march-june 2013. Method: 90 Patients  were randomly allocated to three groups of 30 each to receive intrathecally either 15 mg hyperbaric bupivacaine plus 10 µg dexmedetomidine ( group D) or 15 mg hyperbaric bupivacaine plus 25 µg fentanyl (group F) or 15 mg hyperbaric bupivacaine plus 50 mg magnesium  (group M). The onset time to reach T10 sensory and Bromage 3 motor level, the regression time for L1 sensory and Bromage 0 motor block, Sedation scores, hemodynamic changes and side effects were recorded. Statistical analysis:  Performed using computer statistical software system SPSS version 16. Data were expressed as either mean and standard deviation or numbers and percentages. Continuous covariates (age, height, weight and duration of surgery) were compared using analysis of variance (ANOVA). For categorical covariates (gender, ASA class, blood transfusion, nausea/vomiting, hypotension, bradycardia, use of ephedrine, additive analgesia, atropine and type of surgery) a Chi-square test was used, with the p value reported at the 95% confidence interval. For the time to reach T10 dermatome, Bromage 3 scale, and the regression of the sensory block to L1 dermatome and Bromage scale 0, ANOVA test was used to compare the means. The level of significance used was p<0.05. The total sample size was calculated to be 90 (30 patients in each group). Results: Onset of bromage 3 motor block and time to reach T10 sensory dermatome level was statistically significant between group D, group M and group F .onset time for sensory and motor  block was significantly earlier in group D but delayed in group M .(P<0.001, DvsM. P<0.05, DvsF and FvsM). The time for regression of sensory block to L1 dermatome and bromage 0 motor block was significantly prolonged in group D compared to group M, which was greater then group F . (p <0.001, F vs D,M and DvsM). Conclusion: addition of dexmedetomidine prolonged the sensory and motor block significantly when used with hyperbaric bupivacaine for spinal anesthesia. Onset of both sensory and motor block was earlier and significant in Dexmedetomidine group. In magnesium sulfate group although onset of sensory and motor block was delayed, the regression was significantly prolonged then fentanyl group, good haemodynamic stability was observed  and there was no significant side effects in three groups during study period.