Comparative Study Between Dexmedetomidine And Magnesium sulfate Added to Bupivacaine In Spinal Anesthesia For Postoperative Analgesia In Patients Undergoing Perianal Surgeries

Abd El Rahman, Ahemed; Hassan, Khaled; Mohamed, Mohamed

doi:10.21608/smj.2017.40543

Comparative Study Between Dexmedetomidine And Magnesium sulfate Added to Bupivacaine In Spinal Anesthesia For Postoperative Analgesia In Patients Undergoing Perianal Surgeries

Document Type : Original Article

Authors

Department of Anesthesiology and Critical Care Surgery Faculty of Medicine, University of Sohag

10.21608/smj.2017.40543

Abstract

Spinal anesthesia is the most commonly used technique for lower abdominal surgeries as it is very economical and easy to administer. A number of adjutants, such as Opioids , Clonidine, and Midazolam have been studied to prolong the effect of spinal anesthesia (ELIA , et al 2008).
      Dexmedetomidine a new highly selective a2- agonist is under evaluation as a neuraxial adjuvant as it provides stable hemodynamic conditions, good quality of intraoperative and postoperative analgesia with minimal side effects(Kanazi and Al-Ghanem 2009).
     Magnesium sulfate (Mg) is an antagonist of N-methyl D Aspartate receptor (NMDA) improves postoperative analgesia after intrathecal administration as an effective adjuvant to bupivacaine (Soave and Arcangeli 2009).
Aim of the work
      To compare the postoperative analgesic effects and any side effects ofdexmedetomidine and magnesium sulfate (Mg) when added to bupivacaine in spinal anesthesia in patientsundergoing perianal surgeries.
Patients and methods
     Ninty ASA physical status I and II patients aged 18-70 years, of either sex, scheduled for perianal surgeries under spinal anesthesia in this prospective randomized, double-blinded study.
Results
       All the Mg cases needed analgesia within 4 hours postoperative, while for all the Dex cases needed analgesia within5 hours postoperative. The difference between the two groups was highly significant.

Keywords

References

1- Elia N., Culibras X., Mazaa C., Schiffer E. and Tramer M.R.: Clonidine as an adjuvant to intrathecal local anesthetics for surgery: Systematic review of randomized trials. Reg. Anesth. Pain Med.2008, 33: 159-67

2- KanaziG.E., AouadM.T., Jabbour-Khoury S.I., AL Jazzar M.D.,ALAMEDDINE M.M., AL-YAMAN R., et al.: Effect of low-dose dexmedetomidine or clonidine on the characteristics of bupivacaine spinal block. Acta. AnesthesiolScand,2006, 50: 222-7

3- Soave PM, Conti G, Costa R, Arcangeli A.: Magnesium anaesthesia. Curr Drug Targets;(2009), 10:734–43.

4- Merskey H &Bogduk N Classification of Chronic Pain, IASP Task Force on Taxonomy. Seattle, IASP Press(1994).

5- Portenoy RK, Kanner RM: Definition and assessment of pain. In: Portenoy RK, Kanner RM, eds. Pain Management: Theory and Practice. Philadelphia, PA: FA Davis; (1996):7

6- Jensen MP, McFarlandCA: Increasing the reliability and validity of pain intensity measurement in chronic pain patients. Pain. (1993);55:195-203

7- Bieri D, Reeve RA, Champion GD, et al: The Faces Pain Scale for the self-assessment of the severity of pain experienced by children: development, initial validation, and preliminary investigation for ratio scale properties. Pain.(1990); 41:139-150.

8- Carollo DS, Nossaman BD, Ramadhyani U – Dexmedetomidine: a review ofclinical applications. CurrOpinAnaesthesiol 2008;21:457-461.

9- Khan ZP, Ferguson CN, Jones RM – Alpha-2 and imidazoline receptor agonists:their pharmacology and therapeutic role. Anaesthesia 1999;54:146-165.

10- Haselman MA – Dexmedetomidine: a useful adjunct to consider in some high-risk situation. AANA J 2008;76:335-339

11- Lazard EM. An analysis of 575 cases of eclamptic and pre eclamptictoxaemias treated by IV injections of magnesium sulphate. Am J ObstetGynecol1933; 26: 647-656.

12- Scardo JA, Hogg BB, Newman RB. Favourable hemodynamic effects of magnesium sulphate in pre eclampsia. Am J ObstetGynecol 1995 173: 1249-1253.

13- Winkler AW, Smith PK, Hoff HE. Intravenous magnesium sulphate in the treatment of nephritic convulsions in adults. J Clin Invest 1942 21: 207-216.

14- Sibai BM. Eclampsia VI .Maternal-perinatal outcome in 254 consecutive cases. Am JObstetGynecoll990; 163: 1049-1055.

15- Bromage P.R.: An evaluation of bupivacaine in epidural analgesia for obstetrics. Can. Anesth. Soc. J.1969, 16: 46-56,.

16- AL-Ghanem S.M., Massad I.M., AL-Mustafa M.M., AL-Zaben K.R.,QUDAISAT I.Y., QATAWNEH A.M. and ABU-ALI H.M.: Effect of addingdexmedetomidine versus fentanyl to intrathecal bupivacaine on spinal blockcharacteristics in gynecological procedures: A double blind controlled study. Am. J.Appl. Sci.2009, 6: 882- 7,.

17- Gupta R., Reetu V., Bogra J., Kohli M., Raman R. and Kushwaha J.K.: Acomparative study of in-trathecaldexmedetomidine and fentanyl as adjuvant to bupivacaine, J. AnesthesiolClin. Pharmacol. Jul-Sep., 27 (3), 2011: 339-343.

18- Arcioni R, Palmisani S, Tigano S, et al. Combined intrathecal andepidural magnesi‐um sulfate supplementation of spinal anesthesia to reduce post-operative analgesic requirements: a prospective, randomized, double-blind, controlled trial in patients undergoing major orthopedic surgery. ActaAnaesthesiol Scand. 2007;51:482-9.

19- Ozalevli M, Cetin TO, Unlugenc H, Guler T, Isik G. The effect of adding intrathecal magnesium sulphate to bupivacaine-fentanyl spinal anaesthesia. ActaAnaesthesiol Scand. 2005;49:1514-9.

20- Malleeswaran S, Panda N, Mathew P, Bagga R. A randomised study of magnesium sulphate as an adjuvant to intrathecal bupivacaine in patients with mild preeclamp‐sia undergoing caesarean section. Int J ObstetAnesth. 2010;19:161-6.

21- Khezri MB, Rezaei M, DelkhoshReihany M, Haji SeidJavadi E. Comparison of post‐operative analgesic effect of intrathecal clonidine and fentanyl added to bupivacaine in patients undergoing cesarean section: a prospective randomized double-blind study. Pain Res Treat. 2014;2014:513628.

22- Singh R, Gupta D, Jain A. The effect of addition of intrathecal clonidine to hyperbaric bupivacaine on postoperative pain after lower segment caesarean section: A random‐ized control trial. Saudi J Anaesth. 2013;7:283-290.