Comparison of the Effect of Intrathecal Hyperbaric 0.5% Bupivacaine Alone and With Addition of Dexemedetomidine on First Analgesic Request in Post-Operative Care Unit Following Elective Cesarean Section: Bupivacaine alone and with addition of Dexemedetomidine on duration of anesthesia following c-section

Muhammad Shahid; Asiya Sibtain; Mujahid ul Islam; Imtiaz Ahmed; Bahauddin Khan; Rafat Shakil; Faizan Ahmad Ali

doi:10.54393/pbmj.v5i1.260

Authors

Muhammad Shahid Anesthesia Department, Rehman Medical Institute, Peshawar, Pakistan
Asiya Sibtain Rehman Medical Institute, Peshawar, Pakistan
Mujahid ul Islam Anesthesia Department, Rehman Medical Institute, Peshawar, Pakistan
Imtiaz Ahmed Anesthesia Department, Rehman Medical Institute, Peshawar, Pakistan
Bahauddin Khan Rehman Medical Institute of Cardiothoracic Surgery Department, Peshawar, Pakistan
Rafat Shakil Rehman Medical Institute of Cardiothoracic Surgery Department, Peshawar, Pakistan
Faizan Ahmad Ali Anesthesia Department, Rehman Medical Institute, Peshawar, Pakistan

DOI:

https://doi.org/10.54393/pbmj.v5i1.260

Keywords:

Dexmedetomidine, Hyperbaric bupivacaine, Spinal anesthesia

Abstract

Spinal anesthesia has been considered preferred method of anesthesia for patients undergoing elective cesarean sections. Dexmedetomidine (DXM) is relatively a newer drug in Pakistan as compared to conventional used drug i.e. Bupivacaine (BPV) and that’s why the local data regarding its efficacy in cesarean section is lacking. Objective: To compare the mean duration of spinal anasthesia between hyperbaric bupivacaine 0.5% alone versus hyperbaric bupivacaine 0.5% with dexmedetomidine on first analgesic request for women undergoing elective cesarean section under subarachnoid block Methods: Spinal anesthesia was performed in the sitting position under sterile conditions with 25G pencil point needle. After successful intra thecal injection, patient was placed in the supine position with left tilt. The cases in Group A received hyperbaric 0.5% BPV (2.25ml) with 5ug DXM (0.25ml) and those in Group B received only 0.5% BPV (2.25ml) with 0.25ml normal saline under full aseptic measures. These patients underwent cesarean section and were assessed in post-operative time after every 30 minutes to first request of analgesia which were given if there was pain of 4 or more on visual analogue scale. Results: In Group A, mean and SDs for duration of analgesia was 359.73+8.021 minutes. In Group B, mean and SDs for duration of analgesia was 182.30+7.720 minutes Conclusions: In this study, hyperbaric bupivacaine 0.5% with DXM in spinal anesthesia for patients undergoing caesarean section significantly prolonged the duration of analgesia

References

Pogatzki-Zahn E, Segelcke D, Zahn P. Mechanisms of acute and chronic pain after surgery: update from findings in experimental animal models. Curr Opin Anaesthesiol. 2018;31(5):575-585. doi: 10.1097/ACO.0000000000000646.

Reynolds F. General anesthesia is unacceptable for elective cesarean section. Int J Obstet Anesth. 2010;19(2):212–7. doi: 10.1016/j.ijoa.2009.10.003

Heesen M, Stewart A, Fernando R. Vasopressors for the treatment of maternal hypotension following spinal anaesthesia for elective caesarean section: past, present and future. Anaesthesia. 2015;70(3):252–257. doi: 10.1111/anae.13007

Onish E, Murakami M, Hashimoto K, Kaneko M. Optimal intrathecal hyperbaric bupivacaine dose with opioids for cesarean delivery: a prospective double blinded randomized trial. Int J Obstet Anesth. 2017; 31:68-73. doi: 10.1016/j.ijoa.2017.04.001

Sia HAT, Tan KH, Sng BL, Lim Y, Chan E.S.Y, Siddiqui FJ. Hyperbaric versus plain bupivacaine for spinal anesthesia for cesarean delivery. Anesth Analg. 2015;120(1):132–40. doi: 10.1213/ANE.0000000000000443

Furqan A, Mohsin M, Sattar M, Ali A. Intravenous dexmedetomidine has synergistic effect on subarachnoid block with hyperbaric bupivacaine. Cureus. 2019;11(11): e6051. doi: 10.7759/cureus.6051

Kavya UR, Laxmi S, Ramkumar V. Effect of intravenous dexmedetomidine administered as bolus or as bolus-plus-infusion on subarachnoid anesthesia with hyperbaric bupivacaine. J Anaesthesiol Clin Pharmacol. 2018; 34:46-50. doi: 10.4103/joacp.JOACP_132_16

Al-Mustafa MM, Badran IZ, Abu-Ali HM, et al. Intravenous dexmedetomidine prolongs bupivacaine spinal analgesia. Middle East J Anaesthesiol 2009; 20: 225–231.

Kamat SD, Puram NN, Dhumal PR, Agrawal PI, Ramanand JB, Bhosale RR. Comparative study of hyperbaric 0.5% bupivacaine and hyperbaric 0.5% bupivacaine with low dose dexmedetomidine in spinal anaesthesia. Int J Basic Clin Pharmacol 2017; 6:410-3. doi: 10.4103/aer.AER_163_17

Kan RK, Lew E, Yeo SW, Thomas E. General Anaesthesia for cesarean section in a Singapore maternity hospital: a restrospective survey. Int J Obstet Anesth. 2004;13:221–6. doi: 10.1016/j.ijoa.2004.04.007

Sia ATH, Fun WL, Tan TU. The ongoing challenges of regional and general anaesthesia. Best prac Res Clin Obstetrics Gyn. 2009; 24:303–12. doi:10.1016/j.bpobgyn.2009.12.001

Maronge L, Bogod D. Complications in obstetric anaesthesia. Anaesthesia. 2018;73 :61-66. doi: 10.1111/anae.14141.

Bucklin BA, Hawkins JL, Anderson JR, Ullrich FA. Obstetric Anesthesia Workforce Survey. Twenty year update. Anesthesiology. 2005; 103:645–53.

Metodiev Y, Mushambi M. Supraglottic airway devices for Caesarean delivery under general anaesthesia: for all, for none, or for some? Br J Anaesth. 2020;125(1):e7-e11. doi: 10.1016/j.bja.2020.02.012.

Väänänen AJ, Kainu JP, Eriksson H, Lång M, Tekay A, Sarvela J. Does obesity complicate regional anesthesia and result in longer decision to delivery time for emergency cesarean section? Acta Anaesthesiol Scand. 2017 Jul;61(6):609-618. doi: 10.1111/aas.12891.

Birnbach DJ, Bateman BT. Obstetric Anesthesia: Leading the Way in Patient Safety. Obstet Gynecol Clin North Am. 2019;46(2):329-337. doi: 10.1016/j.ogc.2019.01.015.

Weiniger CF. What's new in obstetric anesthesia in 2018? Int J Obstet Anesth. 2020;42:99-108. doi: 10.1016/j.ijoa.2020.03.002.

Practice Guidelines for Obstetric Anesthesia: An Updated Report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia and the Society for Obstetric Anesthesia and Perinatology. Anesthesiology. 2016;124(2):270-300. doi: 10.1097/ALN.0000000000000935

Koridze Sh, Kintraia N, Machavariani P. Cesarian Section-Higher rate and higher challenges. Georgian Med News. 2015;(246):13-7.

Jafarzadeh A, Hadavi M, Hasanshahi G, Rezaeian M, Vazirinejad R, Aminzadeh F, Sarkoohi A. Cesarean or Cesarean Epidemic? Arch Iran Med. 2019;22(11):663-670.

Walsh E, Zhang Y, Madden H, Lehrich J, Leffert L. Pragmatic approach to neuraxial anesthesia in obstetric patients with disorders of the vertebral column, spinal cord and neuromuscular system. Reg Anesth Pain Med. 2021;46(3):258-267. doi: 10.1136/rapm-2020-101792.

ACOG Practice Bulletin No. 205: Vaginal Birth After Cesarean Delivery. Obstet Gynecol. 2019;133(2):e110-e127. doi: 10.1097/AOG.0000000000003078

Kanawati S, Barada MA, Naja Z, Rajab O, Sinno L, El Hasan J. Comparison of clinical effects of meperidine and sufentanil added to 0.5% hyperbaric bupivacaine for spinal anesthesia in patients undergoing cesarean delivery: a randomized controlled trial. J Anesth. 2022, doi: 10.1007/s00540-021-03031-6.

Goffard P, Leloup R, Vercruysse Y, Fils JF, Gautier PE, Kapessidou Y. Comparison of equipotent doses of intrathecal hyperbaric prilocaine 2% and hyperbaric bupivacaine 0.5% for elective caesarean section: A prospective, randomised, controlled, two-centre clinical trial. Eur J Anaesthesiol. 2022;39(3):227-235. doi: 10.1097/EJA.0000000000001548.