Comparing the effect of adding intrathecal morphine versus dexmedetomidine as adjuvant to bupivacaine in spinal anaesthesia for lower limb orthopaedic surgery
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Date
2018
Authors
Noordin, Mohammad Faiz Mohammad
Journal Title
Journal ISSN
Volume Title
Publisher
Pusat Pengajian Sains Perubatan, Universiti Sains Malaysia
Abstract
Background: We studied the effect of adding intrathecal morphine versus
dexmedetomidine as adjuvant to bupivacaine in lower limb orthopaedic surgery. The onset
and the duration of spinal anaesthesia were assessed using clinical examination.
Methods: Thirty-six patients, aged 18-60 year old, classified under ASA 1-2, who
underwent elective lower limbs orthopaedic surgery under spinal anaesthesia, were
randomised into two groups: group morphine (n=18) and group dexmedetomidine (n=18).
Spinal anaesthesia was performed and in group morphine 2.5 ml of 0.5% hyperbaric
bupivacaine and 0.2 mg morphine in 0.5 ml of normal saline were administered
intrathecally. In group dexmedetomidine, 2.5 ml of 0.5% hyperbaric bupivacaine and 5 μg
dexmedetomidine in 0.5 ml normal saline. Measurement of sensory block according to
dermatome level, Bromage scale for motor assessment and post operative pain score were
recorded for statistical analysis. Data were tested by independent t-test and repeated
measure ANOVA analysis.
Results: There was no significant difference with regard to the duration to reach T10
between morphine and dexmedetomidine (p>0.05). There was a significant difference with
regard to time (mean) to reach Bromage 3 between morphine and dexmedetomidine
(p<0.05). The time [mean (SD)] to reach Bromage 3 for morphine was 4.56 (0.78) minutes
and for dexmedetomidine was 3.83 (0.79) minutes indicating that the time to reach
Bromage 3 was lower in dexmedetomidine. There was a significant difference with regard
to time taken to reach Bromage 0 between morphine and dexmedetomidine (p<0.05). The
[mean (SD)] to reach Bromage 0 for morphine was 134.44 (20.64) minutes and for
dexmedetomidine was 276.67(54.02) minutes indicating that the time to reach Bromage 0
was higher in dexmedetomidine. For time-treatment interaction results in repeated measure
ANOVA analysis, we found that there was a significant difference between pain score of
groups based on time (F= 2.54, p= 0.031). The mean pain score was higher for those who
took dexmedetomidine compared to morphine.
Conclusions: Intrathecal dexmedetomidine significantly cause prolonged in sensory and
motor block in comparison with intrathecal morphine. However for post-operative pain
control, intrathecal morphine gave better pain control post-operatively
Description
Keywords
Anesthesia , Spinal