Lower Limb Surgery Clinical Trial
Official title:
Optimal Single-dose Intrathecal Dexmedetomidine for Postoperative Analgesia After Lower Limb Surgery
Spinal anesthesia is a commonly used technique for lower limb surgeries offering better
quality of postoperative analgesia, lower incidence of side effects, and shorter
post-anesthesia care unit stay than general anesthesia. However, the relatively short
duration of action of the currently available local anesthetics (LAs) make these advantages
short-lived.
The risk for local anesthetic toxicity (LAST) increases with the trials to use higher
concentrations or volumes of intrathecal local anesthetics to increase the duration of
analgesia.
Dexmedetomidine has the potential to prolong the duration of perioperative analgesia without
the need for using high doses of local anesthetics and hence with decreasing the potential
risk of local anesthetic, but the increased likelihood adverse effects such as short term
bradycardia and prolonged duration of motor block may offset these benefits.
The aim of this study is to determine the optimal single-dose of intrathecal dexmedetomidine
that prolongs the analgesic duration with the least possible side effects.
With the patients in the sitting position and the use of complete aseptic technique, 25G
Whitacre spinal needles will be introduced through L2-L4 interspaces and after observing
free flow of the CSF, a 3ml volume including bupivacaine 12.5mg in conjunction with
dexmedetomidine (3 µg) will be injected in the first case, then the patient will be turned
supine.
The dose of intrathecal DEX given to the next patient will be guided by modified Dixon's
up-and-down method using 1.5 mg as a step size, which assumed to be of clinical importance.
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