Regional Anaesthesia
Condition: Anesthesia, Obstetric
Study type: Interventional

Summary: 
      Spinal anesthesia is an established technique used in obstetric surgeries, It provides
      adequate analgesia both intra and post-operative and also avoids complications associated
      with general anesthesia for mother and fetus. The quality of spinal anesthesia has been
      reported to be improved by using additives Dexmedetomidine is a highly selective
      α2-adrenoreceptor agonist that has been introduced to anesthesia. It produces dose-dependent
      sedation, anxiolysis, and analgesia without respiratory depression. Neostigmine is an
      anticholinesterase agent, which inhibits the hydrolysis of acetylcholine by competing with
      acetylcholine for attachment to acetyl cholinesterase; administration of Neostigmine through
      intrathecal route apparently activates the descending pain inhibitory system that relies on
      spinal cholinergic interneuron. Study conducted to evaluate whether neostigmine given by
      intrathecal route with 0.5% hyperbaric bupivacaine for spinal anesthesia can provide
      prolongation of sensory blockade duration as effective as dexmedetomidine given by the same
      route and in compination with same drug with lower cost, more stable hemodynamics and
      comparable side effects. After obtaining Institutional Ethics Committee approval and written
      informed consent,54 patients American Society of Anesthesiologist (ASA) physical status I and
      II were enrolled into the study and were randomlyassigned into 3 groups. Group 1were received
      10 mg (2ml) hyperbaric bupivacaine and 0.1 ml (10 μg) DXM and 0.1 ml normal saline, Group 2
      were received 10 mg (2ml) hyperbaric bupivacaine and 0.1 ml (50 μg) neostigmine and 0.1 ml
      normal saline and Group 3were received 10 mg (2ml) hyperbaric bupivacaine and 0.2 ml normal
      saline as control.

      The investigators measured the time to reach T4 dermatome sensory block, peak sensory level,
      Time to reach Bromage 3 motor block, the regression time for sensory and motor block, also
      the investigators measured hemodynamic, sedation score, visual analogue score, any
      complications occurred and Apgar score for fetus during blockade and the investigators
      assessed the duration of pain relief .
    


Intervention name(s): DEXMEDETOMIDINE; Neostigmine; Bupivacaine
Intervention type(s): Drug; Drug; Drug
Intervention description(s): DXM is a nonselective α2 agonist. Alpha2 adrenoreceptors, the overall response to α2 adrenoreceptors agonists is related to the stimulation of α2 adrenoreceptors located in the CNS and spinal cord. These receptors are involved in the sympatholysis, sedation, and antinociception effects of α2 adrenoreceptors.
DEXMEDETOMIDINE (DXM) DXM shows a high ratio of specificity for the α2 receptor (α2/α11600: 1) compared with clonidine (α2/α1 200: 1), making it a complete α2 agonist. (76) DXM belongs to the imidazole subclass of α2 receptor agonists, similar to clonidine. It is freely soluble in water.; Neostigmine is an indirect cholinomimetic agent. It produces its primary effects by inhibiting the action of AChe, which hydrolyzes acetylcholine (ACh) to choline and acetic acid. By inhibiting AChe, the indirect-acting drug increases the concentration of spinal endogenous ACh. This drug is, in effect, amplifiers of endogenous ACh and act primarily where ACh is physiologically release. It combines reversibly with AChe by the formation of an ester linkage, which lasts about 30 minutes. The pharmacokinetic of neostigmine administered by bolus injection is linear with respect to bolus injection.; The onset of sensory blockade following spinal block with bupivacaine is very rapid (within one minute); maximum motor blockade and maximum dermatome level are achieved within 15 minutes in most cases.
The conduction of nerve impulses along nerve fibers is related to changes in the electrical gradient across the nerve membrane and movement of predominantly sodium ions (but also potassium ions) from intracellular to extracellular fluid and vice versa. Bupivacaine work by reversibly blocking specific areas of the nerve cell membrane, known as sodium channels. It contains a mixture of ionized and un-ionized particles which, when injected into body tissues, make more un-ionized particles available, which are lipid soluble and able to penetrate the nerve cell membrane.
Intervention MeSH terms: Dexmedetomidine; Bupivacaine; Neostigmine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Supportive Care