Ayush Shah

Abstract

Introduction: The combined spinal epidural anesthesia (CSE) plays a unique role in management of perioperative analgesia. It is associated with early postoperative mobilization and rehabilitation with minimally associated pain and discomfort, which is the most desirable feature in modern surgery.We designed this study for comparative evaluation of dexmedetomidine and ketamine for epidural analgesia in lower limb orthopedic surgeries in patients operated under CSE. Materials and Methods: The study included 50 patients divided into two groups (25 each). Group D: Patient received bolus dose of dexmedetomidine 1 mg/kg after spinal anesthesia followed by bupivacaine 0.125% with dexmedetomidine 1 mg/ml epidurally using 240 ml elastomeric pump at 5ml/ hr till 48 hours. Group K: Patient received bolus dose of ketamine 0.5 mg/kg after spinal anesthesia followed bupivacaine 0.125% with ketamine 0.5mg/ml epidurally using elastomeric pump at 5ml/hr till 48 hours. Results: There was no significant difference between the two groups (p>0.05) in terms of highest sensory level achieved and time for complete motor block. The patients in both the groups were hemodynamicaly stable throughout the study. The duration of analgesia was longer with dexmedetomidine however, none of the patients in both the groups required rescue analgesic. The time to regression of sensory level to L5 in Group D was found to be 594 63.04 minutes as compared to 362.4 45.76 minutes in Group K (p < 0> minutes whereas, in Group K it was 303.6 36.04 minutes (p < 0> vomiting and other side effects were comparable. Conclusion: We conclude that continuous epidural infusion with dexmedetomidine and ketamine effectively reduced the postoperative rescue analgesics requirements and provided good patient satisfaction in patients undergoing lower limb orthopedic surgery. Keywords: Dexmedetomidine, Ketamine, Epidural infusion.

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Abstract

Introduction: Dexmedetomidine, a potent a2-adrenergic agonist with its sedative, anxiolytic, analgesic and sympatholytic property ; is an ideal agent for premedication. The intravenous bolus is associated with bradycardia and hypotension; hence we studied the intramuscular route for hemodynamic stability. Materials and Methods: Sixty adult patients of ASA physical status I and II, aged between 18-60 years, posted for ear surgery received intramuscular dexmedetomidine 2.5mg/kg 60 minutes prior to induction of anesthesia as premedication in recovery room with either injection saline bolus in group D (n=30) or intravenous fentanyl 1.5 mg/kg group DF (n=30) 2 mines before induction in operation theatre. Standard induction technique was used. Sedation score and hemodynamic changes during laryngoscopy were recorded. Results: During laryngoscopy and intubation, transient rise in Heart Rate and Mean arterial pressure seen in Group D as compared to Group DF; (p values within 3 minutes of laryngoscopy. No patient suffered from profound sedation at any point of observation. Conclusion: This study provides evidence that intramuscular dexmedetomidine alone acts as effective premedication agent with attenuation of stress response; and combination of Intramuscular dexmedetomidine and intravenous fentanyl not only attenuate but also prevents stress response to laryngoscopy and tracheal intubation. Keywords: Ear surgery, Tracheal intubation, Fentanyl, Laryngoscopy, Intramuscular dexmedetomidine.

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