The Effects of Dexmedetomidine Added to Spinal Levobupivacaine for Transurethral Endoscopic Surgery

摘要

Background: Intrathecal α2 agonists prolong the duration of action of local anesthetics and reduce the required dose. Dexmedetomidine is an α2 receptor agonist and its α2/α1 selectivity is 8 times higher than that of clonidine. Aims: In this study, we aimed to investigate the effect of adding dexmedetomidine to intrathecal levobupivacaine on the onset time and duration of motor and sensory blocks. Study Design: Randomized controlled study. Methods: Patients were randomly assigned into two groups. Group L (n= 30) patients received 3 mL (15 mg) of 0.5% levobupivacaine +0.3 mL normal saline and Group LD (n= 30) patients received 3 mL (15 mg) of 0.5% levobupivacaine + 0.3 mL (3 μg) dexmedetomidine. Sensory block onset time, block reaching time to T10 dermatome, the most elevated dermatome level, two dermatome regression time, sensory block complete regression time as well as motor block onset time, reaching Bromage 3 and regressing to Bromage 0 were recorded. Results: Sensory and motor block onset times were shorter in Group LD than in Group L (p<0.001). The regression of the sensory block to S1 dermatome and Bromage 0 were longer in Group LD than Group L (p<0.001). The two dermatome regression time was longer in Group LD than Group L (p< 0.001). There were no statistically significant differences between groups in blood pressure and heart rate. There was no statistically significant difference between groups when adverse effects were compared. Conclusion: We conclude that intrathecal dexmedetomidine addition to levobupivacaine for spinal anaesthesia shortens sensory and motor block onset time and prolongs block duration without any significant adverse effects. Turkish Ba?l?k: Transuretral Endoskopik Cerrahide Spinal Levobupivacaine Eklenen Deksmedetomidinin Etkileri Anahtar Kelimeler: Deksmedetomidin, levobupivakain, spinal blok. Arka Plan: ?ntratekal uygulanan α2 agonistler lokal anestezi etki süresini uzat?r ve gerekli doz ihtiyac?n? azalt?r. Deksmedetomidin bir α2 resept?r agonistidir ve α2/ α1 selektivitesi klonidinden 8 kat daha yüksektir. Ama?: Bu ?al??mada spinal anestezide levobupivakaine eklenen deksmedetomidinin duyusal ve motor blok ba?lama zaman?na ve blok süresine etkisini ara?t?rmay? ama?lad?k. ?al??ma Tasar?m?: Randomize kontrollü ?al??ma Y?ntemler: Bu ?al??maya spinal anestezi alt?nda transuretral prostat ya da mesane tüm?rü rezeksiyonu planlanan 60 hasta al?nd? Hastalar rastgele iki gruba ayr?ld?. Grup L (n=30) i?in % 0.5 lik levobupivakainden 3mL (15mg) + 0.3 ml normal salin, Grup LD (n=30) i?in % 0.5 lik levobupivakainden 3ml (15mg) + 3μg deksmedetomidin (0.3ml) uyguland?. Duyusal blok ba?lama zaman?, T10 dermatomuna ula?ma zaman?, en yüksek dermatom seviyesi, iki dermatom gerileme zaman? ve duyusal blo?un tam geri d?nme zaman? kaydedildi. Motor blok ba?lama zaman?, Bromage 3'e ula?ma zaman? ve Bromage 0 a gerileme zaman? kaydedildi. Bulgular: Duyusal ve motor blok ba?lama süresi Grup LD de Grup L den daha k?sa idi (p<0.001). Duyusal blo?un S1 dermatomuna ve Bromage skorunun 0 a geri d?nme süresi Grup LD de Grup L den daha uzundu (p<0.001). Duyusal blo?un iki dermatom gerileme süresi de Grup LD de Grup L den daha uzundu. Gruplar?n kan bas?nc? ve kalp h?z? de?erleri aras?nda istatistiksel olarak anlaml? fark yoktu. Gruplar aras?nda yan etki g?rülme s?kl??? a??s?ndan istatistiksel olarak anlaml? fark yoktu. Sonu?: Spinal anestezide levobupivakaine eklenen intratekal deksmedetomidinin, belirgin bir yan etkiye neden olmadan duyusal ve motor blok ba?lama süresini k?saltt??? ve blok süresini uzatt??? sonucuna vard?k.