COMPARATIVE EVALUATION OF THREE DEXMEDETOMIDINE DOSES COMBINED WITH LOW-DOSE 0.5% HYPERBARIC BUPIVACAINE FOR SPINAL ANESTHESIA DURING TURP: A RANDOMIZED, DOUBLE-BLIND CLINICAL STUDY
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Keywords
Dexmedetomidine, Hyperbaric Bupivacaine. Spinal Anesthesia, TURP
Abstract
Background: The talking anesthesia technique has been the choice of conducting transurethral resection of the prostate (TURP), partly because it is safe and effective. Hyperbaric bupivacaine has slowly assumed the role of preference since older agents such as cinchocaine, despite their usefulness, are not as long-lasting as their counterparts, and highly expensive and restricted to a patient position.
Study design: Randomized double-blind
Duration and place of study: this study was conducted in Liaquat National Hospital and Medical College Karachi from January 2024 to January 2025
Objectives: This study aims at the evaluation as well as the comparison of the clinical effects of three different doses of intrathecal dexmedetomidine when combined with 0.5% hyperbaric bupivacaine in patients undergoing TURP.
Methods: This study is a randomised, double-blind clinical trial involving 120 male subjects of age 55-70 years who were about to undergo elective TURP. Random selection of three equal groups was received by the participants. Group A was given 0.5% hyperbaric bupivacaine 1.5 ml (7.5 mg) and dexmedetomidine 6 mcg. Group C was given 10 mcg dexmedetomidine along with bupivacaine and Group B was given 8 mcg dexmedetomidine with the same amount of bupivacaine. Researchers observed the time and duration to occurrence of sensory and motor block. Pain relief after operations involved morphine. The Numeric Rating Scale (NRS) of pain, total morphine use, and time until first rescue analgesia were recorded at 6, 8, and 12 hours.
Results: There is no statistically significant difference between the sensory and motor block length and onset of Groups A and B. In comparison with A and B, the Group C showed a significantly faster onset of block (P < 0.05). Also, the time whose first analgesic need occurred was considerably longer in Group C in comparison with Groups A and B, and it was longer in Group B in comparison with the group A (P < 0.05). Also, the total consumption of morphine during the study, as well as the NRS scores, were the lowest in the Group C at every registered point subsequent to the Group B and the highest in the Group A (P < 0.05).
Conclusion: The addition of 10 mcg of dexmedetomidine to 0.5 percent hyperbaric bupivacaine mixture has a drastic effect on the quality and the duration of spinal anesthesia used in TURP surgery with a high degree of analgesia and low opioid demand. In increasing the doses, the efficacy rises but the incidence of adverse effects does not improve with high doses in comparison with low ones.
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Aqil Qayoom
Aqil Qayoom, Assistant Professor Anesthesia, Liaquat National Hospital and Medical College Karachi, Pakistan
Khawar Aziz Siddiqui
Khawar Aziz Siddiqui, Consultant Anesthesia, Mediclinic Airport Road Hospital Abu Dhabi, United Arab Emirates
Ahmed Uddin Soomro
Ahmed Uddin Soomro, Associate Professor Anesthesia and ICU, Chandka Medical College Hospital @ SMBBMU Larkana, Pakistan
Muneeba Arshad
Muneeba Arshad, Assistant Professor Anesthesia, Dow International Medical College, Dow University Hospital Ojha Karachi, Pakistan
Imran Hafeez
Imran Hafeez, Consultant Anesthesia, King Abdullah Medical City Makkah, Saudi Arabia
Ravi Kumar
Ravi Kumar, Registrar Anaesthesia, Prince Sultan Military Medical City Riyadh, Saudi Arabia