COMPARATIVE EFFECTS OF BUPRENORPHINE AND DEXMEDETOMIDINE AS ADJUVANTS TO BUPIVACAINE SPINAL ANAESTHESIA IN ELDERLY MALE PATIENTS UNDERGOING TRANSURETHRAL RESECTION OF PROSTRATE (TURP) AND TRANSURETHRAL RESECTION OF BLADDER TUMOR (TURBT): A RANDOMIZED PROS
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Keywords
Spinal anaesthesia, Buprenorphine, Dexmedetomidine, Bupivacaine, Lower abdominal surgery, Analgesia
Abstract
Background: Transurethral resection of the prostate (TURP) or transurethral resection of bladder tumor (TURBT) is a commonly performed urological procedure in elderly men with spinal anaesthesia being the technique of choice. Use of low-dose spinal anesthetic drug with adjuvants is desirable. The present study was undertaken to evaluate and compare the characteristics of subarachnoid blockade, hemodynamic stability, time of first analgesia request and adverse effects of intrathecal buprenorphine and dexmedetomidine as an adjuvant to 0.5% hyperbaric bupivacaine for lower abdominal surgeries.
Methods: A total 60 elderly male patients of ASA status I/II, aged 60 years and above, scheduled for elective TURP and TURBT were enrolled and divided into two groups namely Group B and Group D of 30 each. Patients in Group B received 60μg of buprenorphine with 0.5% bupivacaine 14 mg intrathecally whereas patients in Group D received 5μg of dexmedetomidine with 0.5% bupivacaine 14 mg intrathecally. The onset time to peak sensory level, motor block, haemodynamic variables, duration of motor block, analgesia and any adverse effects were noted.
Results: There was no significant difference between groups regarding demographic characteristics and type of surgery. The motor, sensory blockade and time of rescue analgesia were significantly prolonged in Group D compared to Group B. There was no significant difference in haemodynamic variables although Group D had lower Heart Rate (HR) than Group B.
Conclusion: Dexmedetomidine as an intrathecal adjuvant with 0.5% hyperbaric bupivacaine prolonged anaesthesia, analgesia with better degree of sedation and reduced need of rescue analgesics with fewer side effects when compared to intrathecal buprenorphine
References
2. Kirson LE, Goldman JM, Slover RB. Low-dose intrathecal morphine for postoperative pain control in patients undergoing transurethral resection of the prostate. Anesthesiology 1989;71:192-5.
3. Nott MR, Jameson PM, Julious SA. Diazepam for relief of irrigation pain after transurethral resection of the prostate. Eur J Anaesthesiol 1997;14:197-200.
4. Kaseb H, Aeddula NR. Bladder Cancer. [Updated 2022 Oct 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK536923/
5. Kaur N, Goneppanavar U, Venkateswaran R, Iyer SS. Comparative effects of buprenorphine and dexmedetomidine as adjuvants to bupivacaine spinal anaesthesia in elderly male patients undergoing transurethral resection of prostrate: a randomized prospective study. Anesthesia, Essays and Researches. 2017 Oct;11(4):886.
6. Bhattacharyya S, Bisai S, Biswas H, Tiwary MK, Mallik S, Saha SM. Regional anesthesia in transurethral resection of prostate (TURP) surgery: A comparative study between saddle block and subarachnoid block. Saudi J Anaesth. 2015 Jul-Sep;9(3):268-71.
7. Gupta M, Shailaja S, Hegde KS. Comparison of intrathecal dexmedetomidine with buprenorphine as adjuvant to bupivacaine in spinal asnaesthesia. J Clin Diagn Res. 2014 Feb;8(2):114-7.
8. Al-Mustafa MM, Abu-Halaweh SA, Aloweidi AS, Murshidi MM, Ammari BA, Awwad ZM, Al-Edwan GM, Ramsay MA. Effect of dexmedetomidine added to spinal bupivacaine for urological procedures. Saudi Med J. 2009 Mar 1;30(3):365-70.
9. Gupta R, Verma R, Bogra J, Kohli M, Raman R, Kushwaha JK. A comparative study of intrathecal dexmedetomidine and fentanyl as adjuvants to bupivacaine. Journal of anaesthesiology clinical pharmacology. 2011 Jul 1;27(3):339-43.
10. Gandhi R, Shah A, Patel I. Use of dexmedetomidine along with bupivacaine for brachial plexus block. National journal of medical research. 2012 Mar 31;2(01):67-9.
11. Eisenach JC, De Kock M, Klimscha W. α2-Adrenergic agonists for regional anesthesia: a clinical review of clonidine (1984-1995). The Journal of the American Society of Anesthesiologists. 1996 Sep 1;85(3):655-74.
12. Lirola T,Aantaa R,Laitio R, Kentala E,Lahtinen M,Wighton A,et al.Pharmcokinectics of prolonged infusion of high dose dexmedetomidine in critically ill patients.Critical care 2011;15:R257.
13. Al-Mustafa MM, Badran IZ, Abu-Ali HM, Al-Barazangi BA, Massad IM, Al-Ghanem SM. Intravenous dexmedetomidine prolongs bupivacaine spinal analgesia. Middle East J Anesthesiol. 2009 Jun 1;20(2):225-31.
14. Talke P, Tayefeh F, Sessler DI, Jeffrey R, Noursalehi M, Richardson C. Dexmedetomidine does not alter the sweating threshold, but comparably and linearly decreases the vasoconstriction and shivering thresholds. The Journal of the American Society of Anesthesiologists. 1997 Oct 1;87(4):835-41.
15. Capogna G, Celleno D, Tagariello V, Loffreda‐Mancinelli C. Intrathecal buprenorphine for postoperative analgesia in the elderly patient. Anaesthesia. 1988 Feb;43(2):128-30
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Dr Aman Kujur
Junior resident, Department of Anaesthesiology, Government Medical College, Nagpur,Mob. No-7987400809
Dr Afrin Khoja
Junior resident, Department of Anaesthesiology, Government Medical College, Nagpur, Mob-9028535716