Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 287114

AbstractMaterial and MethodsResultsDiscussionConclusionReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2021 | Month : August | Volume : 15 | Issue : 8 | Page : UC16 - UC19 Full Version

Comparison of Intrathecal Dexmedetomidine and Fentanyl as Adjuvants to Hyperbaric Bupivacaine: A Randomised Controlled Trial


Published: August 1, 2021 | DOI: https://doi.org/10.7860/JCDR/2021/47662.15296
Anuradha Deotale, Sandeep S Kadam

1. Junior Consultant, Department of Cardiac Anaesthetic, Narayana Hrudralaya, Bengaluru; Dr. D Y Patil Medical College Hospital and Research Centre, Kolhapur, Bengaluru, Karnataka, India. 2. Associate Professor, Department of Anaesthesiology, Dr. D Y Patil Medical College Hospital and Research Centre, Kolhapur, Maharashtra, India.

Correspondence Address :
Dr. Sandeep S Kadam,
Associate Professor, Department of Anaesthesiology, Dr. D Y Patil Medical College Hospital and Research Centre, Kolhapur, Maharashtra, India,
E-mail: kadamsandeeps@gmail.com

Abstract

Introduction: Subarachnoid block using bupivacaine along with fentanyl is routinely used in regional anaesthesia technique in lower limb and lower abdominal surgeries. However, fentanyl is often associated with various side effects. The use of dexmedetomidine as an alternative to fentanyl in regional blocks is emerging due to minimal adverse effects and prolonged duration of action.

Aim: To compare intrathecal dexmedetomidine and fentanyl as adjuvants to hyperbaric bupivacaine.

Materials and Methods: The prospective, randomised study was performed on 100 patients, divided into two groups. Group I patients were administered with bupivacaine 12.5 mg (2.5 mL)+
fentanyl 25 μg (0.5 mL) whereas group II patients received bupivacaine 12.5 mg (2.5 mL) + dexmedetomidine 5 μg (0.5 mL). Post anaesthesia Heart Rate (HR) and Blood Pressure (BP) were recorded. The onset of sensory and motor block, level of sensory block, time for two segment regression, motor and sensor recovery, duration, quality of analgesia and Visual Analog Scale (VAS) score were recorded. Data were analysed using R Studio V 1.2.5001 software. Wilcoxon signed rank test and independent sample t-test were used to find the difference between mean. The p<0.05 was considered statistically significant.

Results: Time for onset of sensory block (p=0.0027), motor block (p<0.001) and peak sensory block (p<0.001) was significantly high in group I patients. Most of the patients of group I had a T8 level of sensory block (38%) while in group II around 36% of patients had T6 level of sensory block. Time for full motor recovery (p=0.0015) and sensor recovery (p<0.001) was high in group II patients.

Conclusion: Dexmedetomidine is associated with long term motor and sensory block, excellent analgesia and there was less demand for rescue analgesics as compared to fentanyl.

Keywords

Analgesia, Blood pressure, Heart rate, Local analgesia, Spinal anaesthesia

In various regional techniques of anaesthesia, the subarachnoid block is commonly used for lower limb and abdominal surgeries with bupivacaine being a local anaesthetic are commonly performed (1),(2). Various opioid adjuncts are used with bupivacaine for long-lasting intra and postoperative analgesia (2). Fentanyl is a highly lipophilic short-acting opioid when combined with local anaesthetics, which leads to improved quality and duration of anaesthesia (1). However, the use of intrathecal fentanyl is associated with unreliable postoperative analgesia or adverse effects such as pruritus, nausea/vomiting and respiratory depression (2),(3). Dexmedetomidine is a selective α2 adrenergic receptor agonist, used for various applications and procedures in the preoperative and critical care setting (4). The use of dexmedetomidine as an adjunct to regional anaesthesia and analgesia is emerging as it produces fewer side effects (1),(5). Previous studies have shown that intrathecal 5 μg dexmedetomidine with hyperbaric bupivacaine can produce more optimal postoperative analgesia with fewer adverse effects (2),(6),(7),(8),(9).

Despite few evidences of efficacy of dexmedetomidine as an adjuvant to bupivacaine in spinal anaesthesia, the primary objective of this study was to explore the usefulness of dexmedetomidine as an adjuvant. However, the secondary objective was to compare this α2 adrenergic agonist with the previously established and widely used adjuvant- fentanyl on the spinal block characteristics in patients scheduled for surgery.

Material and Methods

This prospective randomised trial was performed between November 2018-October 2020, Dr. D Y Patil Medical College Hospital and Research centre, Kolhapur, Maharashtra, India following approval by the Institutional Ethics Committee (IEC) (DYPMCK/PG-14/1721/17-18).

Inclusion criteria: Following written informed consent, 100 patients with an age range from 18-60 years of American Society of Anesthesiologists (ASA) grade I and II scheduled to undergo either lower limb, abdominal, gynaecological and/or urological surgeries were included in the study.

Exclusion criteria: Patients with allergy to the anaesthetics, dependent on narcotics, spinal abnormality, skin infection, bleeding disorder, cardiopulmonary manifestations, peripheral neuropathy, and obstetric cases were excluded from the study.

Sample size calculation: Sample size was calculated using R Studio V 1.2.5001 software. The calculated sample size for each group was n=42 and the power of the study was 90%.

Patients were divided into two groups by sealed envelope simple random sampling procedure, each group consisted of 50 patients. Group I patients were anaesthetised with bupivacaine 12.5 mg (2.5 mL)+fentanyl 25 μg (0.5 mL) and group II patients with bupivacaine 12.5 mg (2.5 mL)+dexmedetomidine 5 μg (0.5 mL) (Table/Fig 1).

Study Procedure

Patients of both the groups were advised to remain nil per oral for six hours and received diazepam 10 mg and ranitidine 150 mg orally as premedication the night before and in the morning on the day of the surgery. In the operation theatre, electrocardiogram, pulse oximetry and non invasive BP monitors were attached and baseline parameters such as Pulse Rate (PR), BP, were recorded, and monitoring was initiated. Intravenous (i.v.) access was secured, and all the cases were preloaded with 500 mL ringer lactate solution. At the L3-L4 intervertebral space subarachnoid block was administered using a 23-gauge Quincke spinal needle with patients in the sitting or left lateral position under all aseptic precautions. Postanaesthesia vital parameters such as HR, BP and VAS were recorded at different time interval.

Sensory block was tested by the pin-prick method using a hypodermic needle. The onset and duration of sensory block, the highest level of sensory block and the time for two dermatomal segment regression of sensory level were recorded. The onset of sensory block is defined as the time of injection of the drug into subarachnoid space to loss of pin-prick sensation. The duration of sensory block is defined as the time from onset to time of pin-prick sensation to the S1 dermatomal area. The motor block was assessed by the modified Bromage score, which consists of grades such as grade 0 for full flexion of knee and feet, grade 1- just able to flex knees, full flexion of feet, grade 2- unable to flex knee, but some flexion of feet possible and grade 3- unable to move legs or feet (10). Intra and postoperative pain were assessed by VAS scale and categorised into no pain to slight pain (0-2), mild pain (2-5), moderate (5-7), severe pain (7-9), and worst possible pain (10). Analgesics were given on patient demand and time taken at analgesia required was noted. Postoperative VAS was recorded at 3, 6, and 12 hours. Four point modified Belzarena scale was used to assess the quality of intraoperative analgesia which is characterised as 1- unable to tolerate pain, 2- able to tolerate discomfort with additional analgesia, 3- some discomfort but no additional analgesics required and 4- completely satisfied (11). Postoperative complications such as hypotension, bradycardia, sedation, nausea, vomiting, and urinary retention were recorded.

Statistical Analysis

Data were analysed using R Studio V 1.2.5001 software. Continuous variables were expressed in mean±standard deviation (Mean±SD) whereas categorical variables were expressed in percentage and frequency. Wilcoxon signed rank test and independent sample t-test were used to find the difference between mean. The p<0.05 was considered statistically significant.

Results

The mean age of the patients (N=100) was 41.32±11.48 years. Baseline characteristics of the two groups were well matched as illustrated in (Table/Fig 2).

The time taken for the onset of sensory and motor block was significantly high in group I patients when compared with group II patients (Table/Fig 3). Similarly, time for peak sensory block in group I was significantly higher than group II (p<0.001).

Group, I patients had the highest level of sensory block as compared with group II (Table/Fig 4).

The time for two-segment regression was significantly slower in group II (139.22±7.45 min) when compared with group I (83.32±8.71 min) (p<0.001). Significantly higher time for full motor recovery (p=0.0015) and sensory recovery (p<0.001) was observed in group II patients. Duration of analgesia, quality of intraoperative analgesia and VAS score is shown in (Table/Fig 5).

The groups were not differing significantly with respect to HR at any interval except at 60 min (p=0.0025) (Table/Fig 6). No significant difference was observed in diastolic BP in both groups. Significant reduction in systolic BP was observed in group II patients compared with group I at 0 minute (p=0.03), 10 minutes (p=0.02), 20 minutes (p=0.009), 30 minutes (p=0.003), and 60 minutes (p=0.004) (Table/Fig 7).

Discussion

Subarachnoid block is one of the commonly used regional technique of anaesthesia using bupivacaine and fentanyl (1),(2). However, dexmedetomidine is emerging as adjuvant alternative to fentanyl due to its less adverse effect and prolonged duration of action (1),(5). This study was conducted to assess the efficacy of the intrathecal dexmedetomidine bupivacaine in regional anaesthesia compared to a conventional drug such as fentanyl and bupivacaine.

The demographical characteristics (age and height) of the patients was similar in both the groups and were comparable with previous reports (2),(12). The dexmedetomidine as an adjuvant to bupivacaine is an attractive alternative to fentanyl + bupivacaine for long duration surgical procedures as it is associated with various factors such as- early onset and long term motor and sensory block, long duration of analgesia, low VAS score and higher time for peak sensory block. Study conducted by Paul A et al., also revealed the similar findings (13). In contrast with these findings, the study of Mahendru V et al., and Rahimzadeh P et al., suggests an insignificant difference in the onset of sensory and motor block (2),(14). The variance in the result was may be due to the use of isobaric bupivacaine (in their studies), the difference in the definition of onset time and differences in patient positioning as in sitting position increased gravity-induced peripheral blood pooling causes hypotension and may influence onset of blocks (2),(15).

The highest levels of sensory block in group I and II were T6 (8%) and T4 (6%), respectively. Similar results were observed in previous studies (2),(14),(16). Significantly prolonged two sensory segment regression in group II was observed which was similar to the previous reports (2),(6),(7),(9). Moreover, higher time for full motor recovery (p=0.0015) and sensor recovery (p<0.001) was observed in group II patients which was comparable with the study of Mahendru V et al., and Thada B et al., (2),(17). The prolonged duration of sensory and motor block could be due to the synergistic action of bupivacaine in the presence of dexmedetomidine which produces action by binding with motor neurons in the dorsal horn (2),(16).

Previous studies suggested that bupivacaine and dexmedetomidine treated patients showed delayed requirement of rescue analgesia, improved analgesic efficacy as well as dose-dependent prolongation of motor and sensory block with the decreased analgesic requirement (2),(7),(9),(13). Similarly, in the current study, duration of complete analgesia, duration of effective analgesia and time for first medication was significantly high in group II. Here, four-point modified Belzarena scale was used to assess the quality of intraoperative analgesia (1- unable to tolerate pain; 2- able to tolerate discomfort with additional analgesia; 3- some discomfort but no additional analgesics required, and 4- completely satisfied) (11). Authors noted high quality of analgesia in 94% of patients of group II and 66% in group I as they were completely satisfied. These findings were unique points noted in this study. Pain was assessed by VAS, it consist of line anchored at one end by a label such as ‘no pain’ and at other end ‘worst pain imaginable’ or pain as bad as can be’ (18). Intraoperative VAS score in group I was significantly higher than group II which was similar to previous reports (19). These findings suggest that dexmedetomidine adjuvant to bupivacaine produces excellent and long-lasting analgesic action. The most common adverse effect associated with the use of α2 adrenergic receptor agonist is bradycardia and hypotension (20). Similarly, in this study decreased diastolic BP was observed in group II at a different time interval. A level of or higher level of anaesthesia is the reason for the hypotension and bradycardia. The cause of hypotension during high level of anaesthesia is the blockade of the cardiac sympathetic nerve (21).

Limitation(s)

The study limits due to lack of control group to study systemic effect of dexmedetomidine and fentanyl. Moreover, this study contributes to the information on dexmedetomidine as an attractive adjuvant bupivacaine. Hence, further studies that compare the i.v. and intrathecal effect of dexmedetomidine considering a control group is recommended.

Conclusion

Dexmedetomidine 5 μg provides rapid onset and high duration of sensory and motor block and can provide excellent and long lasting analgesic action. Intrathecal dexmedetomidine can be considered as an alternative to fentanyl in surgical procedures as it produces profound intrathecal anaesthesia and analgesia with minimal adverse effects.

References

1.
Verghese T, Dixit N, John L, George R, Gopal S. Effect of intravenous dexmedetomidine on duration of spinal anaesthesia with hyperbaric bupivacaine-A comparative study. Indian J Clin Anaesth. 2019;6:97-01. [crossref]
2.
Mahendru V, Tewari A, Katyal S, Grewal A, Singh MR, Katyal R. A comparison of intrathecal dexmedetomidine, clonidine, and fentanyl as adjuvants to hyperbaric bupivacaine for lower limb surgery: A double blind controlled study. J Anaesthesiol Clin Pharmacol. 2013;29:496-02. [crossref] [PubMed]
3.
Cowan CM, Kendall JB, Barclay PM, Wilkes RG. Comparison of intrathecal fentanyl and diamorphine in addition to bupivacaine for caesarean section under spinal anaesthesia. Br J Anaesth. 2002;89:452-58. [crossref] [PubMed]
4.
Grewal A. Dexmedetomidine: New avenues. J Anaesthesiol Clin Pharmacol. 2011;27:297-02. [crossref] [PubMed]
5.
Mantz J, Josserand J, Hamada S. Dexmedetomidine: New insights. Eur J Anaesthesiol. 2011;8:03-06. [crossref] [PubMed]
6.
Kanazi GE, Aouad MT, Jabbour-Khoury SI, Al Jazzar MD, Alameddine MM, Al-Yaman, et al. Effect of low-dose dexmedetomidine or clonidine on the characteristics of bupivacaine spinal block. Acta Anaesthesiol Scand. 2006;50:222-27. [crossref] [PubMed]
7.
Al-Mustafa MM, Abu-Halaweh SA, Aloweidi AS, Murshidi MM, Ammari BA, Awwad ZM, et al. Effect of dexmedetomidine added to spinal bupivacaine for urological procedures. Saudi Med J. 2009;30:365-70.
8.
Al Ghanem SM, Massad IM, Al-Mustafa MM, Al-Zaben KR, Qudaisat IY, Qatawneh AM, et al. Effect of adding dexmedetomidine versus fentanyl to intrathecal bupivacaine on spinal block characteristics in gynaecological procedures: A double blind controlled study. Am J Appl Sci. 2009;6:882-87. [crossref]
9.
Gupta R, Verma R, Bogra J, Kohli M, Raman R, Kushwaha JK. A Comparative study of intrathecal dexmedetomidine and fentanyl as adjuvants to Bupivacaine. J Anaesthesiol Clin Pharmacol. 2011;27:339-43. [crossref] [PubMed]
10.
Bromage PR. A comparison of the hydrochloride and carbon dioxide salts of lidocaine and prilocaine in epidural analgesia. Acta Anaesthesiol Scand Suppl. 1965;16:55-59. [crossref] [PubMed]
11.
Shilpashri AM, Roychoudhury P, Girish KM. Comparative study of 0.5% bupivacaine and 0.5% bupivacaine with clonidine (30 μg) for spinal anaesthesia. J Evol Med Dent Sci. 2015;4(71):12385-97. [crossref]
12.
Kamal MH, Ibrahim JH, Saaed AA, Zayed MS, Magdy M. Comparison of intrathecal dexmedetomidine and fentanyl as adjuvants to levobupivacaine in parturients undergoing elective cesarean sections. Med J Cairo Univ. 2017;85:593-600.
13.
Paul A, Nathroy A, Paul T. A comparative study of dexmedetomidine and fentanyl as an adjuvant to epidural bupivacaine in lower limb surgeries. J Med Sci. 2017;37(6):221. [crossref]
14.
Rahimzadeh P, Faiz SH, Imani F, Derakhshan P, Amniati S. Comparative addition of dexmedetomidine and fentanyl to intrathecal bupivacaine in orthopedic procedure in lower limbs. BMC Anaesthesio. 2018;18:62. [crossref] [PubMed]
15.
Shahzad K, Afshan G. Induction position for spinal anaesthesia: Sitting versus lateral position. J Pak Med Assoc. 2013;63:43409.
16.
Ravipati P, Isaac GA, Reddy PN, Krishna L, Supritha T. A comparative study between intrathecal isobaric Ropivacaine 0.75% plus Dexmedetomidine and isobaric Ropivacaine 0.75% plus fentanyl for lower limb surgeries. Anaesth Essays Res. 2017;11:621-26. [crossref] [PubMed]
17.
Thada B, Khare A, Sethi SK, Meena S, Verma M. Comparison of dexmedetomidine and fentanyl as intrathecal adjuvants to 0.5% hyperbaric bupivacaine for total abdominal hysterectomy under subarachnoid block: A prospective randomised double-blind study. Anaesthesia, Pain & Intensive Care. 2017;21:65-72.
18.
Hala EA, Shafie MA, Youssef H. Dose-related prolongation of hyperbaric bupivacaine spinal anaesthesia by dexmedetomidine. Ain-Shams J Anaesthesiol. 2011;4:83-95.
19.
Jain N, Mathur PR, Soni P, Patodi V, Sethi SK, Mathur V. A comparative clinical study of intrathecal bupivacaine 2.5 mg with dexmedetomidine 5 μg versus intrathecal bupivacaine 2.5 mg with fentanyl 25 μg on the duration of labor analgesia using combined spinal epidural technique. J Obse Anaesth Crit Care. 2019;9:24. [crossref]
20.
Eisenach JC, De Kock M, Klimscha W. α2-Adrenergic agonists for regional anaesthesia: A clinical review of clonidine (1984-1995). Anaesthesiology: The Journal of the American Society of Anaesthesiologists. 1996;85:655-74. [crossref] [PubMed]
21.
Maruyama K, Nishikawa Y, Nakagawa H, Ariyama J, Kitamura A, Hayashida M. Can intravenous atropine prevent bradycardia and hypotension during induction of total intravenous anaesthesia with propofol and remifentanil? J Anaesth. 2010;24:293-96. [crossref] [PubMed]

DOI and Others

10.7860/JCDR/2021/47662.15296

Date of Submission: Nov 05, 2020
Date of Peer Review: Jan 02, 2021
Date of Acceptance: Feb 01, 2021
Date of Publishing: Aug 01, 2021

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Nov 06, 2020
• Manual Googling: Jan 30, 2021
• iThenticate Software: Jul 31, 2021 (23%)

ETYMOLOGY: Author Origin

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)
  • www.omnimedicalsearch.com