title: Comparative analysis of epidural bupivacaine versus bupivacaine with dexmedetomidine for vaginal hysterectomy.
abstract: BACKGROUND
  Dexmedetomidine a new drug, which is alpha-two agonist, is recommended by manufacturers as an adjuvant in epidural analgesia and anesthesia.
  
  
  OBJECTIVE
  To study the effects of dexmedetomidine on quality and efficacy of the epidural bupivacaine 0.5% for vaginal hysterectomies, by studying the onset of action, duration of action, highest dermatomal level achieved, degree of motor blockade, intraoperative and postoperative anesthesia and analgesia achieved.
  
  
  METHODS
  Prospective randomized study.
  
  
  METHODS
  In this study, 60 American Society of Anesthesiologists I and II patients requiring vaginal hysterectomy were enrolled. Patients were randomly divided into two groups - Group I: Control group receiving epidural bupivacaine 0.5% 15-20 ml only.
  Group receiving of epidural bupivacaine 0.5% 15-20 ml with dexmedetomidine 05 mcg/kg. Following parameters were noted: Time to onset of T10 dermatomal level, maximum sensory level achieved, time for complete motor block, time for two segmental dermatomes regression, regression to S1 dermatome, time for first rescue analgesic and total top ups required during study.
  
  
  METHODS
  Mean and standard deviation was calculated. We used two independent sample t-test to find the P value. Software used STATA 13.0.
  
  
  RESULTS
  The demographic profile was comparable between the groups. There was significant difference between two groups (P < 0.001) regarding onset of analgesia to T10 (17.12 ± 2.44 vs. 10.14 ± 2.94), time to achieve complete motor block (27.16 ± 4.52 vs. 22.98 ± 4.78), which was earlier in dexmedetomidine with bupivacaine group. Prolonged postoperative analgesia, less rescue top ups and adequate sedation score was found with dexmedetomidine group. The intraoperative hemodynamic changes were comparable in both the groups. The incidence of dry mouth, shivering and nausea was more with the dexmedetomidine group.
  
  
  CONCLUSIONS
  We conclude that epidural dexmedetomidine 0.5 µg/kg is a good adjuvant providing early onset of sensory and motor block, adequate sedation and prolonged postoperative analgesia with minimal side-effects.
authors.affiliation: Department of Anesthesia, Smt Kashibai Navale Medical College and Hospital, Pune, Maharashtra, India.
authors.forename: Seema Shreepad
authors.initials: SS
authors.lastname: Karhade
authors.affiliation: Department of Anesthesia, Smt Kashibai Navale Medical College and Hospital, Pune, Maharashtra, India.
authors.forename: Shilpa Amol
authors.initials: SA
authors.lastname: Acharya
authors.affiliation: Department of Anesthesia, Smt Kashibai Navale Medical College and Hospital, Pune, Maharashtra, India.
authors.forename: Kalpana
authors.initials: K
authors.lastname: Harnagale
keywords: Bupivacaine; dexmedetomidine; epidural anesthesia; vaginal hysterectomy