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Anesth Essays Res. 2019 Apr-Jun;13(2):330-333. doi: 10.4103/aer.AER_38_19.

Comparison of Prolongation of Spinal Anesthesia Produced by Intravenous Dexmedetomidine and Midazolam: A Randomized Control Trial.

Author information

1
Department of Anaesthesiology and Critical Care, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India.

Abstract

Context:

Various intravenous (i.v.) adjuvants have been used along with spinal anesthesia to delay the onset of postoperative pain.

Aims:

To compare effects of i.v. dexmedetomidine with midazolam on duration of spinal anesthesia.

Settings and Design:

This prospective randomized control trial was conducted in a tertiary care institution.

Subjects and Methods:

Forty-three patients presenting for elective infraumbilical surgery under spinal anesthesia were randomly allocated into two groups. Group A received a loading dose of 0.5 μg/kg followed by 0.5 μg/kg/h of i.v. dexmedetomidine. Group B received a loading dose of 0.03 mg/kg followed by 0.03 mg/kg/h of i.v. midazolam. Two dermatomal regressions, regression to S1 level, and sedation score were noted.

Statistical Analysis Used:

To test the statistical significance of duration of sensory blockade, Mann-Whitney U-test was applied. The incidence of bradycardia and hypotension was analyzed using Pearson's correlation coefficient test.

Results:

The mean time for two dermatomal regressions was significantly prolonged in Group A (2.3 ± 0.4 h) than Group B (1.6 ± 0.5 h, P = 0.001). Mean time for sensory regression to S1 dermatome was also prolonged in Group A (5.2 ± 0.83 h) than in Group B (4.4 ± 0.87 h, P = 0.01). Glycopyrrolate was administered in 45% of patients in Group A and 21% in Group B, which was statistically significant (P = 0.039).

Conclusion:

Conscious sedation with i.v. dexmedetomidine at a loading dose of 0.5 μg/kg followed by 0.5 μg/kg/h prolongs duration of spinal anesthesia than i.v. midazolam at a loading dose of 0.03 mg/kg followed by 0.03 mg/kg/h in patients undergoing infraumbilical surgeries. However, dexmedetomidine is associated with higher incidence of hemodynamic instability.

KEYWORDS:

Adjuvants; dexmedetomidine; midazolam; spinal anesthesia

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