Key result
Dexmedetomidine added to ropivacaine significantly shortened the mean time to reach T10 sensory block (5.7 min) compared to clonidine (9.6 min) and ropivacaine alone (15.6 min).
Why the study?
Does the addition of dexmedetomidine or clonidine to ropivacaine improve the onset and duration of epidural anesthesia in adults undergoing lower abdominal and lower limb surgeries?
RCT (n=60)
Double-blind
Randomized into three groups
No
Does the addition of dexmedetomidine or clonidine to ropivacaine improve the onset and duration of epidural anesthesia in adults undergoing lower abdominal and lower limb surgeries?
Absolute Event Rate: 5.7% vs 15.6%
p-value: p=<0.0001
Dexmedetomidine is a more effective adjuvant than clonidine when added to ropivacaine for epidural anesthesia, providing faster onset and longer duration of sensory and motor blockade with acceptable hemodynamic stability.
Supports preferring dexmedetomidine over clonidine for faster ropivacaine epidural onset; extends RCT comparisons of alpha-2 agonists.
BACKGROUND: Better adjuvants for epidural analgesia are still evolving. Dexmedetomidine that is alpha-2 agonist can be used as an adjuvant in epidural analgesia and anesthesia. AIMS: The aim of this study was to compare the effect of dexmedetomidine versus clonidine in combination with ropivacaine in epidural anesthesia on intraoperative and postoperative analgesia, to find out the better adjuvant for regional anesthesia. SETTINGS AND DESIGN: Randomized control trial. MATERIALS AND METHODS: Sixty adult patients (18-60 years) with American Society of Anesthesiologists (ASA) 1/ASA 2 grade and undergoing lower abdominal and lower limbs surgeries were included and randomized into three groups of 20 patients each. Group 1 - received ropivacaine with normal saline. Group 2 - received ropivacaine with dexmedetomidine. Group 3 - received ropivacaine with clonidine. STATISTICAL ANALYSIS: Mean and Standard deviation were calculated. All the data were analyzed using analysis of variance and Chi-square test. The value of P< 0.05 was considered significant. RESULTS: All the three groups were comparable with respect to age, sex, and ASA grade. There was statistically significant mean time to reach T10 sensory block level (15.8, 5.7, 9.6 min in Groups 1, 2, and 3, respectively). The maximum duration of analgesia was statistically higher in Group 2 patients (383.7 vs. 365.3 and 280.5 min in Group 3 and Group 1, respectively). The mean time to reach motor block was significantly shorter in Group 2. Side effects were comparable in all groups with statistically insignificant fall in mean arterial pressure and hypotension was noted with Group 2. CONCLUSION: We concluded that the patients receiving the addition of dexmedetomidine to ropivacaine in epidural anesthesia had a faster onset and longer duration of sensory and motor blockade. Dexmedetomidine in comparison to clonidine had acceptable sedation and hemodynamic stability and minimal dose requirement make very effective adjuvant in epidural anesthesia with comparable side effects.
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A 2016 study conducted an RCT in Patients undergoing lower abdominal and lower limbs surgeries (n=60). Dexmedetomidine vs. Clonidine (2 µg/kg) or Normal Saline with ropivacaine was evaluated on Mean time to reach T10 sensory block level (p=<0.0001). Dexmedetomidine added to ropivacaine significantly shortened the mean time to reach T10 sensory block (5.7 min) compared to clonidine (9.6 min) and ropivacaine alone (15.6 min).
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