Background and Objectives: Ropivacaine has reduced risk of cardiotoxicity, neurotoxicity with rapid recovery of motor function. We have conducted an observational study on effect of intrathecal 0.75% isobaric ropivacaine and combination of 0.75% isobaric ropivacaine with dexmedetomidine in spinal anesthesia for below umbilical surgeries, based on duration of analgesia, duration of motor blockade, hemodynamic profile and side effects.

Methods: After ethical committee approval and informed consent from patients, a prospective observational study was performed on 34 patients scheduled for below umbilical surgeries under subarachnoid block (SAB). This study was done among two group of patients belonging to ASA 1 and 2. Both the groups of patients were comparable with respect to sex, height and weight. Patients were divided into 2 groups according to the drugs they received, Group R: Received 2.5ml volume of 0.75% isobaric ropivacaine and 0.5ml normal saline(n=17). Group D: Received 2.5ml volume of 0.75% isobaric ropivacaine and 5µg dexmedetomidine in 0.5ml normal saline (n=17). Computer software SPSS version‑22 (IBM SPSS Statistics, Somers NY, USA) was used for statistical analysis. Independent t test and chi‑square test were used and p <0.05 was considered as significant. 

Results and Discussion: The mean onset of Analgesia in Group R was 2.8 ± 1.0 min and in Group D was 6.6 ± 3.4 min (P <0.001).Mean Duration of Analgesia in Group R was 201.6 ± 16.0 min and in Group D was 263.6 ± 12.7 min12.7 min (P <0.001). Mean Onset of motor block in Group R was 9.2 ± 2.5 min and in Group D was 11.8 ± 4.4 min (P = 0.05).Mean Duration of motor block in Group R was 104 ± 12.1 min and in Group D was 182.9 ± 18.4 min (P <0.001). Incidence of hypotension (P = 0.037 < 0.05) were more in patients who received dexmedetomidine

Conclusion: Intrathecal administration of dexmedetomidine with ropivacaine prolongs duration of analgesia and duration of motor blockade and associated with increased incidence of hypotension.

Keywords: ropivacaine. dexmedetomidine. isobaric.

1. Miller R. Miller's anesthesia. 8th ed. Elsevier; 2015:368,369,1684-1716.
2. Broadbent CR, Maxwell WB, Ferrie R, et al. Ability of anaesthetists to identify a marked lumbar interspace. Anaesthesia 2000;55(11):1122–1126.
3. Thomas E J Healy. Wylie and Churchill-Davidson's A Practice of Anesthesia. (7th ed.).; 2003.
4. Kannabiran Vijayanand P. Comparison of the Duration of Analgesia, Duration of Sensory and Motor Blockade and Incidence of Side Effects of Intrathecal 0.75% Isobaric Ropivacaine with Combination of 0.75% Isobaric Ropivacaine and Dexmedetomidine. Indian Journal of Clinical Anaesthesia. 2016;3(1):85.
5. Palmer CM, Emerson S, Volgoropolous D, et al. Dose-response relationship of intrathecal morphine for post-cesarean analgesia. Anesthesiology 1999;90(2): 437–444.
6. Abboud TK, Dror A, Mosaad P, et al. Mini-dose intrathecal morphine for the relief of post-cesarean section pain: Safety, efficacy, and ventilatory responses to carbon dioxide. Anesth Analg 1988;67(2):137–143.
7. Dahl JB, Jeppesen IS, Jørgensen H, et al. Intraoperative and postoperative analgesic efficacy and adverse effects of intrathecal opioids in patients undergoing cesarean section with spinal anesthesia: A qualitative and quantitative systematic review of randomized controlled trials. Anesthesiology 1999;91(6):1919–1927.
8. Hunt CO, Naulty JS, Bader AM, et al. Perioperative analgesia with subarachnoid fentanyl-bupivacaine for cesarean delivery. Anesthesiology 1989;71(4):535–450.
9. Maze M, Tranquilli W: Alpha-2 adrenoceptor agonists: defining the role in clinical anesthesia, Anesthesiology 74:581-605,1991.
10. Qin XP, Xie HG, Wang W, et al: Effect of the gene dosage of CgammaP2C19 on diazepam metabolism in Chinese subjects, Clin Pharmacol Ther 66:642-646, 1999.
11. Aitkenhead AR, Rowbotham DJ, Smith G, eds (2001) Textbook of anaesthesia. Fourth edition. Churchill Livingstone, Edinburgh.
12. Elia N, Culebras X, Mazza C, et al: Clonidine as an adjuvant to intrathecal local anesthetics for surgery: systematic review of randomized trials, Reg Anesth Pain Med 33(2):159-167, 2008.
13. Maya S. Suresh, Scott Segal, Roanne L. Preston,Roshan Fernando,C. LaToya Mason. Shnider and Levinson’s Anesthesia for Obstetrics , 5th ed. :171-173 ; 2013.
14. Stoelting R, Hillier S, Stoelting R. Handbook of pharmacology & physiology in anesthetic practice. 6th ed. 2012:349-352.
15. Goerig M, Agarwal K, Schulte am Esch J: The versatile August Bier (1861–1949), father of spinal anesthesia. J Clin Anesth 12:561, 2000
16. Marx G: The first spinal anesthesia: Who deserves the laurels? Reg Anesth 19:429,1994
17. Barash, Paul G.; Cullen, Bruce F.; Stoelting, Robert K.. Clinical anesthesia. (5th ed.).: 9-11; 2006.
18. Harold Ellis, Stanley Feldman, William Harrop Griffiths. Anatomy for Anaesthetists. (8th ed.): 97-135; 2004.
19. Andreas G Erdmann. Concise Anatomy for Anaesthesia. (1st ed.). USA:42-100; 2001.
20. Ramaiah, Y., Manduri, S., B, S. and Lalitha, P. (2015). To evaluate the efficacy of undergoing urological surgeries : a prospective, randomised, controlled, double - blind study. Journal of Evolution of Medical and Dental Sciences, 4(03), pp.329-341.
21. Virtanen R, Savola intrathecal isobaric 0.75% ropivacaine with the combination of isobaric 0.75% ropivacaine and dexmedetomidine in geriatric hypertensive patients
22. Aantaa R, Kanto J, Scheinin M, Kallio A, Scheinin H. Dexmedetomidine, an alpha 2-adrenoceptor agonist, reduces anesthetic requirements for patients undergoing minor gynecologic surgery. Anesthesiology. 1990 Aug;73(2):230-5. PubMed PMID: 1974394.
23. 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 Jul;27(3):339-43. doi: 10.4103/0970-9185.83678. PubMed PMID: 21897504; PubMed Central PMCID: PMC3161458.
24. Kanazi GE, Aouad MT, Jabbour-Khoury SI, Al Jazzar MD, Alameddine MM, Al-Yaman R, Bulbul M, Baraka AS. Effect of low-dose dexmedetomidine or clonidine on the characteristics of bupivacaine spinal block. Acta Anaesthesiol Scand. 2006 Feb; 50(2):222-7.

Dr Anzer Shah. M

Assistant Professor, Dept. of Anaesthesiology, Govt. TD Medical College, Alappuzha, India