الفهرس 
Spinal anaesthesiaOnly 14 pages are availabe for public view
 |  | from | 107 |  |  |
| | | from | 107 | | |
Abstract
Background: Lower limb surgeries are mostly performed under spinal anaesthesia. It has the advantage of being free from the risks of intubation but its duration of action is limited, so early analgesic intervention is needed in the postoperative period.
Aim: The aim of this study is to compare the effect of addition of dexmedetomidine or dexamethasone to bupivacaine on the onset time and duration of spinal anaesthesia, quality of block, intraoperative and postoperative complications and postoperative analgesia in patients undergoing lower limb surgeries. Patients and methods: This prospective randomized blind controlled clinical trial was carried out in Ain-Shams University Hospitals (from April 2014 till February 2016). It included 54 ASA I and II physical status adult patients who underwent elective orthopaedic lower limb surgeries that didn’t exceed 3 hours. The patients were divided into 3 groups. Each patient received total volume of 5ml prepared drug intrathecally. Patients allocated to group A received intrathecal injection of 3ml (15mg) of 0.5% hyperbaric bupivacaine + 2ml of normal saline containing 5μg preservative free dexmedetomidine. Patients allocated to group B received intrathecal injection of 3ml (15mg) of 0.5% hyperbaric bupivacaine + 2ml (8mg) preservative free dexamethasone. Patients allocated to group C received intrathecal injection of 3ml (15mg) of 0.5% hyperbaric bupivacaine + 2ml normal saline. Results: The current study revealed that the onset of sensory block was significantly faster in group A (2.64 ± 0.34) compared with B and C groups (3 ± 0.124) and (4.72± 0.31) respectively (P <0.001) and in group B compared with group C (P <0.001).The three groups were comparable in terms of the onset of motor block with no significant statistical difference (P= 0.083). The time to two-segment regression was significantly longer in A and B groups (153.1 ± 5.72) and (136.11 ±5.3) respectively compared with group C (105.8± 6.9) (P < 0.001) and significantly longer in group A compared with group B with P-value < 0.001. Time to motor block regression to Bromage 0 was significantly longer in A and B groups compared with group C (P <0.001), but it was longer in group A (234.3± 15.4) compared with group B (202.5 ± 18.78) with P-value < 0.001. Conclusion: This study showed that the addition of dexmedetomidine or dexamethasone to bupivacaine in spinal anaesthesia for lower limb surgeries significantly speeded the onset of the sensory blockade and prolonged both sensory and motor blockades duration with prolonged time of postoperative analgesia compared with bupivacaine alone. However, dexmedetomidine caused faster onset and more prolongation of the duration in both the spinal block and the time of postoperative analgesia than dexamethasone.