الفهرس 
ANATOMY OF THE SPINAL CORD AND THE VERTEBRAL COLUMNOnly 14 pages are availabe for public view
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Abstract
O
ne of the main objectives of anesthesia is to alleviate the patient’s pain and agony, by ensuring the performance of surgical procedures without any discomfort. Elimination of postoperative pain is indispensable due to the central, peripheral and immunological stress response to tissue injury. So there is a need for extended analgesia without any side effects to achieve this goal.
The use of opioids in intrathecal or epidural anesthesia has become common to increase postoperative analgesia. However, opioid-induced side effects, such as respiratory depression, nausea, vomiting, urinary retention and pruritus, limit their use.
The purpose of this study was to evaluate the effect of intravenous versus intravenous dexmedetomidine with subarachnoid anaesthesia in patients undergoing elective infra-umbilical surgery. The duration of analgesia and effect on haemodynamic parameters were evaluated. Moreover, undesirable side effects along with the effect on Ramsay sedation score were studied. Hundred patients were randomly allocated into two equal groups (50 patients): group (A) and group (B).
• group (A) received 3 ml of bupivacaine 0.5% plus 0.5 ml of normal saline (Total volume: 3.5 ml) along with 1µg/kg intravenous dexmedetomidine 10 minutes before the blockade.
• group (B) received 3 ml of bupivacaine 0.5% plus intrathecal 5 µg dexmedetomidine (Precedex ©) diluted in normal saline up to the volume of 0.5 ml (Total volume: 3.5 ml).
All patients were clinically assessed and routine preoperative investigations will be done: CBC, Coagulation profile, liver function tests, kidney function tests, fasting blood sugar and ECG.
The initial vital data were measured after applying the standard monitoring including pulse oximetry, non-invasive blood pressure and ECG. All patients received a pre-load of 10 ml/kg of plain Ringer’s solution before the blockade. 150 mg Ranitidine was administered IV before surgery.
Results of this study:
Intrathecal dexmedetomidine prolonged postoperative analgesia, duration of sensory and motor blockade compared to IV dexmedetomidine without any significant adverse effects and haemodynamic perturbation. So, we concluded that the addition of 5 µg dexmedetomidine as an adjuvant to 0.5% hyperbaric bupivacaine intrathecally can be a better alternative to provide a satisfactory and longer duration of analgesia as compared to IV dexmedetomidine.
CONCLUSION
T
his study revealed that the duration of analgesia and the duration of the sensory and motor blockade in group (B) were significantly longer than those of the group (A). Besides, the findings of the present study revealed some interesting results regarding the effect of intrathecal vs. intravenous dexmedetomidine administration on the Ramsay sedation score. In this study, sedation was acceptable in both groups and Ramsay sedation score was higher in group (A) during the surgery but it was higher in group (B) during the recovery room period.
Moreover, the intensity of pain score was significantly lower in group (B). Therefore, according to the mentioned findings, it can be concluded that the use of intrathecal dexmedetomidine, compared to intravenous dexmedetomidine, reached better outcome. Hence, intrathecal dexmedetomidine administration can be recommended in this regard.