Efficacy of Dexmedetomidine and Ketamine as Adjuvant to Epidural Bupivacaine in Gynaecological Pelvic Surgeries: An Observational Study
Authors/Creators
- 1. Associate Professor, Department of Anaesthesiology, Agartala Government Medical College, Agartala, Tripura, India
- 2. Professor and Head, Department of Anaesthesiology, Agartala Government Medical College, Agartala, Tripura, India
- 3. Associate Professor, Department of Physiology, SRMSIMS, Bareilly, India
- 4. Postgraduate Resident (JR III), Department of Anaesthesiology, Agartala Government Medical College, Agartala, Tripura, India
Description
Background: Epidural anesthesia is commonly used for surgical anesthesia and postoperative analgesia. It provides superior pain relief compared to spinal anesthesia and offers segmental blockade for better hemodynamic stability. However, large volumes of local anesthetic can lead to hemodynamic fluctuations. To address this, adjuvants like dexmedetomidine and preservative-free ketamine are used in epidural anesthesia. This study aims to assess the effects of bupivacaine with dexmedetomidine and bupivacaine with preservative-free ketamine in gynecological surgeries under epidural anesthesia, focusing on stable hemodynamics and prolonged analgesia. Methods: This single-blinded cross-sectional observational study was conducted for one and a half years at Agartala Government Medical College and G.B.P. Hospital. The study included patients undergoing gynecological pelvic surgeries, with ASA physical status I & II, aged 20 to 60 years, and height 145 to 165 centimeters. Exclusion criteria were applied. Ethical approval and written informed consent were obtained. Patients were randomized into two groups: Group BK (Bupivacaine + Ketamine) and Group BD (Bupivacaine + Dexmedetomidine). The technique involved pre-anesthetic check-up, drug administration, hemodynamic monitoring, and assessment of outcomes. Statistical analysis used SPSS software version 19.0. Results: In this study, a total of 60 gynecological cases undergoing pelvic surgeries were included, divided into two groups of 30 each. The mean age of participants was 51.10 ± 6.90 years, with no significant difference between the groups. Baseline characteristics such as religion, ASA grade, and diagnosis were comparable between the groups. The onset of sensory and motor block was faster in the BD group, with significantly longer duration of motor block and analgesia compared to the BK group. Side effects and hemodynamic parameters did not differ significantly between the groups, except for blood pressure, which showed variations at different time intervals. Sedation scores were consistently higher in the BD group. Conclusion: Our study findings support that the addition of epidural dexmedetomidine to bupivacaine as an adjuvant yielded several advantages compared to ketamine. Specifically, dexmedetomidine led to a quicker onset of sensory and motor blockade, as well as a longer duration of both types of blockades.
Abstract (English)
Background: Epidural anesthesia is commonly used for surgical anesthesia and postoperative analgesia. It provides superior pain relief compared to spinal anesthesia and offers segmental blockade for better hemodynamic stability. However, large volumes of local anesthetic can lead to hemodynamic fluctuations. To address this, adjuvants like dexmedetomidine and preservative-free ketamine are used in epidural anesthesia. This study aims to assess the effects of bupivacaine with dexmedetomidine and bupivacaine with preservative-free ketamine in gynecological surgeries under epidural anesthesia, focusing on stable hemodynamics and prolonged analgesia. Methods: This single-blinded cross-sectional observational study was conducted for one and a half years at Agartala Government Medical College and G.B.P. Hospital. The study included patients undergoing gynecological pelvic surgeries, with ASA physical status I & II, aged 20 to 60 years, and height 145 to 165 centimeters. Exclusion criteria were applied. Ethical approval and written informed consent were obtained. Patients were randomized into two groups: Group BK (Bupivacaine + Ketamine) and Group BD (Bupivacaine + Dexmedetomidine). The technique involved pre-anesthetic check-up, drug administration, hemodynamic monitoring, and assessment of outcomes. Statistical analysis used SPSS software version 19.0. Results: In this study, a total of 60 gynecological cases undergoing pelvic surgeries were included, divided into two groups of 30 each. The mean age of participants was 51.10 ± 6.90 years, with no significant difference between the groups. Baseline characteristics such as religion, ASA grade, and diagnosis were comparable between the groups. The onset of sensory and motor block was faster in the BD group, with significantly longer duration of motor block and analgesia compared to the BK group. Side effects and hemodynamic parameters did not differ significantly between the groups, except for blood pressure, which showed variations at different time intervals. Sedation scores were consistently higher in the BD group. Conclusion: Our study findings support that the addition of epidural dexmedetomidine to bupivacaine as an adjuvant yielded several advantages compared to ketamine. Specifically, dexmedetomidine led to a quicker onset of sensory and motor blockade, as well as a longer duration of both types of blockades.
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IJPCR,Vol15,Issue8,Article52.pdf
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Additional details
Dates
- Accepted
-
2023-07-25
Software
- Repository URL
- https://impactfactor.org/PDF/IJPCR/15/IJPCR,Vol15,Issue8,Article52.pdf
- Development Status
- Active
References
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