Analgesia, Dexmedetomidine, Transurethral Resection of Prostate
Conditions
Brief summary
This study was conducted to compare the effects of intrathecal versus intravenous dexmedetomidine administration in patients undergoing Transurethral resection of the prostate under spinal anesthesia.
Detailed description
Multiple prostatic pathologies become evident in the elderly males. Of them, benign prostatic hyperplasia is one of the most prevalent issues in aging men and transurethral resection of the prostate (TURP) still represents the standard surgical treatment. Most transurethral resection of the prostate (TURP) procedures are performed under spinal anesthesia. Spinal anesthesia has many advantages including, easy application, low cost, decreasing the risk of aspiration, decreasing intraoperative bleeding, eliminating the need for mechanical ventilation together with the decreased risk of intraoperative cardiac events or post-operative hypoxic episode. The management of post-operative pain following spinal anesthesia using a short-acting anesthetic still constitutes a major problem for anesthesiologists and pain physicians. However, the duration and efficacy of spinal anesthesia could be improved by adjuvants. Dexmedetomidine is an alpha 2 receptor agonist that have antinociceptive action for both visceral and somatic pain. At low doses, it has sedative and hypnotic effects without having a negative impact on respiration. Multiple studies have reported that intrathecal and intravenous administration of this drug could prolong the duration of spinal anesthesia and post-operative analgesia.
Interventions
DRUGControl group
The cases will be subjected to spinal anesthesia with a 3 ml volume (2.5 ml of hyperbaric bupivacaine 10 mg in addition to 0.5 normal saline). 50 ml of normal saline was infused over a ten-minute period, followed by 200 ml infusion till the end of operation.
DRUGIntrathecal group
The cases will be subjected to the same anesthetic mixture as controls with adding dexmedetomidine 5 μg in the saline component. 50 ml of normal saline was infused over a ten-minute period, followed by 200 ml infusion till the end of operation.
DRUGIntravenous group
The intravenous group will receive 2.5 ml of hyperbaric bupivacaine (10 mg), in addition to intravenous dexmedetomidine, which will be started at 1 μg/kg loading dose diluted in 50 ml saline administered within 10 min, followed by maintenance at a 0.4 μg/kg/h dose diluted in 200 ml saline till the end of the procedure.
Sponsors
Tanta University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Investigator)
Eligibility
Sex/Gender
MALE
Age
50 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
* Cases aged between 50 and 70 years * Having class I or II according to the American society of anesthesiologists (ASA)
Exclusion criteria
* Cases with heart block * Dysrhythmia * Contraindications for spinal anesthesia * Known allergy to the study medications * Classified as ASA class \> II * Alpha 2 agonist or antagonist therapy.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Time to first analgesic request | 24 hours postoperatively | Time to first analgesic request will be recorded |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| The onset of sensory | 24 hours Postoperatively | Time to reach T7 sensory block will be recorded |
| The degree of motor block | 24 hours Postoperatively | The degree of motor block will be assessed using the modified Bromage Score. Grade 0 No motor block Grade 1 Inability to raise extended leg, able to move knees and feet Grade 2 Inability to raise extended leg and move knee, able to move feet Grade 3 Complete motor block of the lower limbs. |
| Sedation level | Intraoperativley | Patients level of sedation will be assessed via Ramsay sedation score. This score is numbered from 1 to 6, based on patient responsiveness. |
| Total analgesic requirements | 48 hours Postoperatively | Total analgesic requirements will be recorded |
| The incidence of side effects | 48 hours Postoperatively | The incidence of side effects including (bradycardia, hypotension, nausea, vomiting, and pruritis) will be recorded.. |
Countries
Egypt
Contacts
Primary ContactLaila Elahwal, MD
Outcome results
None listed