Comparison of intravenous dexmedetomidine versus ketamine–dexmedetomidine combination on spinal block characteristics in patients undergoing lower limb orthopaedic surgery – A randomised clinical trial
Background and Aims: One major limitation of the spinal block remains the inability to extend the duration of the block intraoperatively unless planned before with spinal or epidural catheters and/or intrathecal additives. This study was designed to compare the effects of intravenous dexmedetomidine...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2024-09-01
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| Series: | Indian Journal of Anaesthesia |
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| Online Access: | https://journals.lww.com/10.4103/ija.ija_14_24 |
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| author | Annapureddy Sai Krishna Jyotsna Agarwal Samiksha Khanuja Sandeep Kumar Adam Khan Khairat Mohammad Butt |
| author_facet | Annapureddy Sai Krishna Jyotsna Agarwal Samiksha Khanuja Sandeep Kumar Adam Khan Khairat Mohammad Butt |
| author_sort | Annapureddy Sai Krishna |
| collection | DOAJ |
| description | Background and Aims:
One major limitation of the spinal block remains the inability to extend the duration of the block intraoperatively unless planned before with spinal or epidural catheters and/or intrathecal additives. This study was designed to compare the effects of intravenous dexmedetomidine versus low-dose ketamine–dexmedetomidine combination infusion on spinal anaesthesia in lower limb orthopaedic surgeries.
Methods:
This randomised study was conducted in 60 patients scheduled for unilateral lower limb surgeries under spinal anaesthesia. Patients were randomised into Group D (n = 30) (0.5 µg/kg of intravenous (IV) dexmedetomidine bolus followed by maintenance infusion at 0.5 µg/kg/h) and Group LKD (n = 30) (IV bolus of 0.5 µg/kg of dexmedetomidine and 0.2 mg/kg of ketamine, followed by maintenance infusions of dexmedetomidine and ketamine at 0.5 µg/kg/h and 0.2 mg/kg/h, respectively). Ramsay Sedation Scale score of 3–4 was maintained. The t-test or the Wilcoxon–Mann–Whitney U test was used to compare the parameters between groups.
Results:
The mean sacral segment 1 (S1) regression time was 390.3 [standard deviation (SD):84.38] [95% confidence interval (CI): 360.13, 420.53] versus 393.23 (SD: 93.01) (95% CI: 363.04, 423.43) min in Group D versus Group LKD respectively ((P = 0.701). The number of episodes of hypotension was significantly higher in Group D (19 patients) compared to Group LKD (nine patients) (P = 0.001). Pre- and postoperative stress markers (24 h) and the incidence of postoperative nausea and shivering were comparable between the two groups (P > 0.05). Tramadol requirement in the postoperative period was significantly less in Group LKD compared to Group D (P = 0.003).
Conclusion:
The duration of S1 regression was similar between group dexmedetomidine (Group D) and group low-dose ketamine and dexmedetomidine (Group LKD). |
| format | Article |
| id | doaj-art-acb7f4f093ee4d57a5ed8b74c0f7a51d |
| institution | Kabale University |
| issn | 0019-5049 0976-2817 |
| language | English |
| publishDate | 2024-09-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Indian Journal of Anaesthesia |
| spelling | doaj-art-acb7f4f093ee4d57a5ed8b74c0f7a51d2025-01-23T09:22:54ZengWolters Kluwer Medknow PublicationsIndian Journal of Anaesthesia0019-50490976-28172024-09-0168979580010.4103/ija.ija_14_24Comparison of intravenous dexmedetomidine versus ketamine–dexmedetomidine combination on spinal block characteristics in patients undergoing lower limb orthopaedic surgery – A randomised clinical trialAnnapureddy Sai KrishnaJyotsna AgarwalSamiksha KhanujaSandeep KumarAdam KhanKhairat Mohammad ButtBackground and Aims: One major limitation of the spinal block remains the inability to extend the duration of the block intraoperatively unless planned before with spinal or epidural catheters and/or intrathecal additives. This study was designed to compare the effects of intravenous dexmedetomidine versus low-dose ketamine–dexmedetomidine combination infusion on spinal anaesthesia in lower limb orthopaedic surgeries. Methods: This randomised study was conducted in 60 patients scheduled for unilateral lower limb surgeries under spinal anaesthesia. Patients were randomised into Group D (n = 30) (0.5 µg/kg of intravenous (IV) dexmedetomidine bolus followed by maintenance infusion at 0.5 µg/kg/h) and Group LKD (n = 30) (IV bolus of 0.5 µg/kg of dexmedetomidine and 0.2 mg/kg of ketamine, followed by maintenance infusions of dexmedetomidine and ketamine at 0.5 µg/kg/h and 0.2 mg/kg/h, respectively). Ramsay Sedation Scale score of 3–4 was maintained. The t-test or the Wilcoxon–Mann–Whitney U test was used to compare the parameters between groups. Results: The mean sacral segment 1 (S1) regression time was 390.3 [standard deviation (SD):84.38] [95% confidence interval (CI): 360.13, 420.53] versus 393.23 (SD: 93.01) (95% CI: 363.04, 423.43) min in Group D versus Group LKD respectively ((P = 0.701). The number of episodes of hypotension was significantly higher in Group D (19 patients) compared to Group LKD (nine patients) (P = 0.001). Pre- and postoperative stress markers (24 h) and the incidence of postoperative nausea and shivering were comparable between the two groups (P > 0.05). Tramadol requirement in the postoperative period was significantly less in Group LKD compared to Group D (P = 0.003). Conclusion: The duration of S1 regression was similar between group dexmedetomidine (Group D) and group low-dose ketamine and dexmedetomidine (Group LKD).https://journals.lww.com/10.4103/ija.ija_14_24dexmedetomidinehaemodynamichypotensionketaminemotor regressionpostoperative periodsensory blockadespinal anaesthesia |
| spellingShingle | Annapureddy Sai Krishna Jyotsna Agarwal Samiksha Khanuja Sandeep Kumar Adam Khan Khairat Mohammad Butt Comparison of intravenous dexmedetomidine versus ketamine–dexmedetomidine combination on spinal block characteristics in patients undergoing lower limb orthopaedic surgery – A randomised clinical trial Indian Journal of Anaesthesia dexmedetomidine haemodynamic hypotension ketamine motor regression postoperative period sensory blockade spinal anaesthesia |
| title | Comparison of intravenous dexmedetomidine versus ketamine–dexmedetomidine combination on spinal block characteristics in patients undergoing lower limb orthopaedic surgery – A randomised clinical trial |
| title_full | Comparison of intravenous dexmedetomidine versus ketamine–dexmedetomidine combination on spinal block characteristics in patients undergoing lower limb orthopaedic surgery – A randomised clinical trial |
| title_fullStr | Comparison of intravenous dexmedetomidine versus ketamine–dexmedetomidine combination on spinal block characteristics in patients undergoing lower limb orthopaedic surgery – A randomised clinical trial |
| title_full_unstemmed | Comparison of intravenous dexmedetomidine versus ketamine–dexmedetomidine combination on spinal block characteristics in patients undergoing lower limb orthopaedic surgery – A randomised clinical trial |
| title_short | Comparison of intravenous dexmedetomidine versus ketamine–dexmedetomidine combination on spinal block characteristics in patients undergoing lower limb orthopaedic surgery – A randomised clinical trial |
| title_sort | comparison of intravenous dexmedetomidine versus ketamine dexmedetomidine combination on spinal block characteristics in patients undergoing lower limb orthopaedic surgery a randomised clinical trial |
| topic | dexmedetomidine haemodynamic hypotension ketamine motor regression postoperative period sensory blockade spinal anaesthesia |
| url | https://journals.lww.com/10.4103/ija.ija_14_24 |
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