title: Effect of different doses of dexmedetomidine as adjuvant in bupivacaine -induced subarachnoid block for traumatized lower limb orthopaedic surgery: a prospective, double-blinded and randomized controlled study.
abstract: OBJECTIVE
  Improved pain management for blunt trauma to the lower extremity has shown to reduce morbidity, induce early ambulation and improve long-term outcomes. Dexmedetomidine; a selective α-2 agonist; has recently been used intrathecally in different doses to prolong spinal anaesthesia. We evaluated the effect of adding two different doses of dexmedetomidine to hyperbaric bupivacaine for spinal anaesthesia. The primary endpoints were the onset and duration of sensory, motor block and duration of analgesia.
  
  
  METHODS
  Eighty patients, (20-60yrs) posted for elective lower limb orthopedic surgery of traumatic origin under spinal anaesthesia were divided into 2 equal groups (Group D5&D10) in a randomized, double-blind fashion. In this prospective parallel group study, group D5(n=40) 3ml 0.5% hyperbaric bupivacaine+5μg dexmedetomidine in 0.5 ml of normal saline and group D10 (n=40) 3ml 0.5% bupivacaine+10μg dexmedetomidine in 0.5 ml of normal saline were administered intrathecally. Sensory and motor block onset times and block durations, time to first analgesic use, total analgesic need, postoperative VAS, hemodynamics and side effects were recorded for each patient.
  
  
  RESULTS
  Though with similar demographic profile in both groups, sensory and motor block in group D10(p<0.05) was earlier than group D5. Sensory, motor block duration and time to first analgesic use were significantly longer and the need for rescue analgesics was lower in group D10(p<0.05) than D5. 24 h VAS score was significantly lower in group D10(p<0.05). Intergroup hemodynamics was comparable (p>0.05) without any appreciable side effects.
  
  
  CONCLUSIONS
  Spinal dexmedetomidine increases the sensory, motor block duration and time to first analgesic use, and decreases analgesic consumption in a dose-dependent manner.
authors.affiliation: Senior Resident, Department of Anaesthesiology, R.G Kar Medical College , Kolkata, India .
authors.forename: Susanta
authors.initials: S
authors.lastname: Halder
authors.affiliation: Assistant Professor, Department of Anaesthesiology, College of Medicine & Sagore Dutta Hospital , Kolkata, India .
authors.forename: Anjan
authors.initials: A
authors.lastname: Das
authors.affiliation: Assistant Professor, Department of Oral & Maxillofacial Surgery, R Ahmed Dental College , Kolkata, India .
authors.forename: Debabrata
authors.initials: D
authors.lastname: Mandal
authors.affiliation: R.M.O Cum CT, Department of Orthopedics, R.G Kar Medical college , Kolkata, India .
authors.forename: Mainak
authors.initials: M
authors.lastname: Chandra
authors.affiliation: R.M.O Cum CT, Department of ENT, College of Medicine & Sagore Dutta Hospital , Kolkata, India .
authors.forename: Souradeep
authors.initials: S
authors.lastname: Ray
authors.affiliation: Associate Professor, Department of Anaesthesiology, College of Medicine & Sagore Dutta Hospital , Kolkata, India .
authors.forename: Madhuri Ranjana
authors.initials: MR
authors.lastname: Biswas
authors.affiliation: Assistant Professor, Department of Gyanecology and Obstetrics, College of Medicine & Sagore Dutta Hospital , Kolkata, India .
authors.forename: Parthojit
authors.initials: P
authors.lastname: Mandal
authors.affiliation: R.M.O Cum CT, Department of Gyanecology and Obstetrics, College of Medicine & Sagore Dutta Hospital , Kolkata, India .
authors.forename: Tanuka
authors.initials: T
authors.lastname: Das
keywords: Dexmedetomidine; Hyperbaric bupivacaine; Spinal anaesthesia (intrathecal, subarachnoid)