Skip to main content
SpringerLink
Log in

The effect of dexmedetomidine on spinal anesthesia quality and hemodynamic changes in patients undergoing inguinal hernia repair surgery: intravenous versus intrathecal

  • Clinical Trial
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to evaluate the quality of spinal anesthesia and hemodynamic parameters of intravenous versus intrathecal dexmedetomidine in patients undergoing inguinal hernia repair surgery under spinal anesthesia.

Methods

Fifty male patients aged 18–70 years with ASA I and II were randomly divided into two groups of 25 patients receiving either intravenous (1 μg/kg infused during 10 min before blockade) or intrathecal (5 μg, added to local anesthetics) dexmedetomidine. The duration of analgesia, sensory and motor blockade levels, the score of pain intensity, post-operative analgesic usage and the level of sedation as well as hemodynamic changes, and complications were recorded.

Results

The duration of analgesia in the intrathecal group was significantly longer than intravenous group (403.588 ± 93.706 vs. 274.048 ± 47.266 min; P < 0.001). Duration of the sensory and motor blockade were significantly longer in intrathecal than intravenous group (230.440 ± 26.494 vs. 181.400 ± 28.850 min; P < 0.001 for sensory block, and 253.800 ± 32.637 vs. 205.400 ± 30.921 min; P < 0.001 for motor block). The score of pain intensity was lower in the intrathecal group in the post-operative period (3.680 ± 1.680 vs. 5.520 ± 1.901; P = 0.001 and 2.360 ± 1.320 vs. 3.24 ± 1.69; P = 0.041, respectively, for the time 6 and 12). Ramsay sedation score was higher in the intravenous group during surgery but it was higher in intrathecal group during recovery room period (P < 0.05). Moreover, the incidence of bradycardia was significantly lower in the intrathecal group (0% vs. 36% respectively; P = 0.002).

Conclusion

Administration of intrathecal dexmedetomidine along with local anesthetics can be recommended to increase the quality of spinal anesthesia with minimal complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Petersen L, Millikan KW (2015) Inguinal hernia. In: Saclarides TJ, Myers JA, Millikan KW (eds) Common surgical diseases: an algorithmic approach to problem solving. Springer New York, New York, pp 229–231

    Chapter  Google Scholar 

  2. Khosravi F, Alishahi M, Khanchemehr Y, Jarineshin H (2019) A comparison between the effects of preloading with Ringer’s solution and Voluven on hemodynamic changes in patients undergoing elective cesarean section under spinal anesthesia. Med Arch 73:44–48

    Article  Google Scholar 

  3. Farzi F, Mirmansouri A, Naderi Nabi B et al (2017) Comparing the effect of adding fentanyl, Sufentanil, and placebo with Intrathecal bupivacaine on duration of analgesia and complications of spinal anesthesia in patients undergoing cesarean section. Anesth Pain Med 7(5):e12738

    Article  Google Scholar 

  4. Amer MM, Rashwan DA, Shaker MA (2015) Comparative study of two doses of Intrathecal Dexmedetomidine versus fentanyl as adjuvant to hyperbaric bupivacaine spinal anesthesia. Med Sci 3:2450–2464

    Article  Google Scholar 

  5. Niu X-Y, Ding X-B, Guo T, Chen MH, Fu SK, Li Q (2013) Effects of intravenous and Intrathecal Dexmedetomidine in spinal anesthesia: a meta-analysis. CNS Neurosci Ther 19:897–904. https://doi.org/10.1111/cns.12172

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Jarineshin H, Abdolahzade Baghaei A, Fekrat F, Kargar A, Abdi N, Navabipour S, Zare A, Akhlaghi H (2015) Comparison of two different doses of dexmedetomidine in attenuating cardiovascular responses during laryngoscopy and endotracheal intubation: a double blind, randomized, clinical trial study. J Med Life 8:45–51

    CAS  PubMed  PubMed Central  Google Scholar 

  7. Khan ZP, Munday IT, Jones RM, Thornton C, Mant TG, Amin D (1999) Effects of dexmedetomidine on isoflurane requirements in healthy volunteers. 1: pharmacodynamic and pharmacokinetic interactions. Br J Anaesth 83:372–380. https://doi.org/10.1093/bja/83.3.372

    Article  CAS  PubMed  Google Scholar 

  8. Manne GR, Upadhyay MR, Swadia VN (2014) Effects of low dose dexmedetomidine infusion on haemodynamic stress response, sedation and post-operative analgesia requirement in patients undergoing laparoscopic cholecystectomy. Indian J Anaesth 58:726

    Article  CAS  Google Scholar 

  9. Kim JE, Kim NY, Lee HS, Kil HK (2013) Effects of intrathecal dexmedetomidine on low-dose bupivacaine spinal anesthesia in elderly patients undergoing transurethral prostatectomy. Biol Pharm Bull 36:959–965. https://doi.org/10.1248/bpb.b12-01067

    Article  CAS  PubMed  Google Scholar 

  10. Al-Mustafa MM, Abu-Halaweh SA, Aloweidi AS et al (2009) Effect of dexmedetomidine added to spinal bupivacaine for urological procedures. Saudi Med J 30:365–370

    PubMed  Google Scholar 

  11. Afifi MH, Mohammed AM, Abdullah SI, Ellisy KE (2016) Intrathecal versus intravenous dexmedetomidine in characteristics of bupivacaine spinal block in lower abdominal surgery. Menoufia Med J 29:523–529

    Article  Google Scholar 

  12. Jarineshin H, Fekrat F, Kermanshah AK (2016) Treatment of postoperative pain in pediatric operations: comparing the efficiency of bupivacaine, bupivacaine-dexmedetomidine and bupivacaine-fentanyl for caudal block. Anesthesiol Pain Med 6:5e39495. https://doi.org/10.5812/aapm.39495

    Article  Google Scholar 

  13. Elgebaly AS (2018) Evaluation the effects of intravenous vs. spinal dexmedetomidine during anesthesia for cesarean sections with severe pre-eclampsia. J Anesth Clin Res 9:801. https://doi.org/10.4172/2155-6148.1000801

    Article  Google Scholar 

  14. Kaya FN, Yavascaoglu B, Turker G, Yildirim A, Gurbet A, Mogol EB, Ozcan B (2010) Intravenous dexmedetomidine, but not midazolam, prolongs bupivacaine spinal anesthesia. Can J Anesth 57:39–45

    Article  Google Scholar 

  15. Ashour FH, Abdellah AS, El Sayed RM (2018) Intrathecal versus intravenous infusion of dexmedetomidine during subarachnoid block in lower abdominal surgeries. Sci J Al-Azhar Med Fac Girls 2:237

    Google Scholar 

  16. Tarıkçı Kılıç E, Aydın G (2018) Effects of dexmedetomidine infusion during spinal anesthesia on hemodynamics and sedation. Libyan Med 13(1):1436845. https://doi.org/10.1080/19932820.2018.1436845

    Article  Google Scholar 

  17. Park SH, Shin YD, Yu HJ et al (2014) Comparison of two dosing schedules of intravenous dexmedetomidine in elderly patients during spinal anesthesia. Korean J Anesthesiol 66:371

    Article  CAS  Google Scholar 

  18. Gupta R, Bogra J, Verma R, Kohli M, Kushwaha JK, Kumar S (2011) Dexmedetomidine as an intrathecal adjuvant for postoperative analgesia. Indian J Anaesth 55:347–351

    Article  CAS  Google Scholar 

  19. Magdy H, Mohsen M, Saleh M (2015) The effect of intrathecal compared with intravenous dexmedetomidine as an adjuvant to spinal bupivacaine anesthesia for cesarean section. Ain Shams J Anaesthesiol 8:93–99

    Article  Google Scholar 

  20. Elcıcek K, Tekın M, Katı I (2010) The effects of intravenous dexmedetomidine on spinal hyperbaric ropivacaine anesthesia. J Anesth 24:544–548

    Article  Google Scholar 

  21. Gertler R, Brown HC, Mitchell DH, Silvius EN (2001) Dexmedetomidine: a novel sedative-analgesic agent. Proc (Bayl Univ Med Cen) 14:13–21. https://doi.org/10.1080/08998280.2001.11927725

    Article  CAS  Google Scholar 

  22. Miller RD, Pardo M (2011) Basics of anesthesia e-book. Elsevier Health Sciences

Download references

Acknowledgments

We would like to thank Hormozgan anesthesiology, critical care, and pain management research center staff, Farnoosh Tofighi and Nina Heydari for writing assistance and Esmaeel Alimolaee who contributed to the editing of the manuscript.

Contributions of authors statement

Hashem Jarineshin: Conceived and designed the study, analyzed the data, wrote the manuscript, read and revised the manuscript and final editing of the manuscript.Fatemeh Khosravi: Performed research, analyzed the data, wrote the manuscript and read and final editing of the article.Niloofar Sadeghi: Performed research, analyzed the data, wrote the manuscript and revised the paper.All authors reviewed and approved the final version of the manuscript.

Author information

Authors and Affiliations

  1. Anesthesiology, Critical Care and Pain Management Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran

    Fatemeh Khosravi, Niloofar Sadeghi & Hashem Jarineshin

  2. Department of Physiology, Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran

    Fatemeh Khosravi

Authors
  1. Fatemeh Khosravi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Niloofar Sadeghi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hashem Jarineshin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hashem Jarineshin.

Ethics declarations

Conflict of interest

The authors declare that there are no conflicts of interest.

Informed consent

Informed consent to participate was obtained from all participants.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards and the study was done after obtaining the Ethics Committee approval with the following Code of Ethics HUMS.REC.1396.37 and IRCT code IRCT20171030037093N23. Implementation of the research project and possible complications were explained to the patients and they were included in the study after obtaining written informed consent from each patient in accordance with the Helsinki declaration.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Khosravi, F., Sadeghi, N. & Jarineshin, H. The effect of dexmedetomidine on spinal anesthesia quality and hemodynamic changes in patients undergoing inguinal hernia repair surgery: intravenous versus intrathecal. Eur J Clin Pharmacol 76, 923–928 (2020). https://doi.org/10.1007/s00228-020-02870-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00228-020-02870-8

Keywords

Search

Navigation