Prajwal Kumar Jayaramu1 , Thippeswamy H.G.2
BACKGROUND In developed and developing countries, the elderly patients, because of associated co-morbidities, due to physiological changes of aging, are at risk of hemodynamic changes after spinal anaesthesia with conventional dose of local anaesthetics. Therefore, lower doses of local anaesthetics along with an adjuvant are preferred for spinal anaesthesia in elderly patients. Intrathecal a2- adrenoceptor agonists as adjuvant drugs have been shown to decrease the required doses of local anaesthetics and are devoid of major side effects. METHODS A prospective, interventional study was done after obtaining ethical committee clearance and written informed consent. Patients undergoing Infraumbilical surgeries under spinal anaesthesia were selected and divided into 2 groups of 60 patients. Group BN received bupivacaine 2 mL with Normal saline 0.1 mL and Group BD, bupivacaine 2 mL with dexmedetomidine 0.1 mL. Hemodynamic parameters, sensory and motor blocks were assessed periodically. RESULTS There were no clinically and statistically significant changes in heart rate and blood pressure. We found statistically significant decrease in the time to onset of sensory and motor block (min) in Group BD (1.68 ± 0.96 and 2.42 ± 1.12) compared to Group BN (2.24 ± 0.81 and 3.33 ± 1.06). Duration (min) of analgesia and the time for first rescue analgesia were prolonged in Group BD (457.23 ± 77.31 and 520.85 ± 87.93) in comparison to Group BN (323.61 ± 59.87 and 377.6 ± 56.37) respectively. There were no side effects except for mild sedation in Group BD. CONCLUSIONS Addition of dexmedetomidine 5 mcg to intrathecal bupivacaine in elderly patients causes minimum haemodynamic changes, prolongs sensory and motor block and delays the time for the first rescue analgesia. In the said dose, it is safe without severe adverse effects.
