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İntravenöz Deksmedetomidin Premedikasyonunun Bupivakain ile Uygulanan Spinal Anestezide Duyusal Blok Süresine Etkisi

The Effects of Intravenous Dexmedetomidine Premedication on Sensory Block of Bupivacaine Induced Spinal Anesthesia

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Abstract (2. Language): 
In this double blind, randomized and placebo-controlled study, we aimed to compare the effects of dexmedetomidine and midazolam on the sensory or motor blockage, following a single dose administration, before spinal anesthesia. Seventy-five ASA I-II patients undergoing transurethral resection of the prostate (TUR-P) either received intravenous dexmedetomidine 0.5 µg kg -1 (Group D, n = 25) or midazolam 0.05 mg kg -1 (Group M, n = 25) or saline (Group K, n = 25) 5 minutes prior to spinal anesthesia were enrolled.Level of sedation, upper level of sensory blockage and the time of sensory and motor blockage regression were then recorded. The Ramsay sedation scores were detected to be similar in Group D and Group M both of which were higher than those in the Group K (p<0.001 for two groups). The upper sensory blockage level was revealed to be higher in Group D compared to Group M or Group K (p<0.001 for two groups). The duration of the sensory blockage in the dexmedetomidine group was detected to be longer than the midazolam or saline group, but not the duration of motor block (p<0.05 for two groups). It was found in Group D that the postoperative first analgesic necessity time was longer than Group M or Group K (p<0.01 for two groups). Postoperative analgesic consumption were less in the group D compared with groups M and P (p<0.05 for two groups). Premedication with intravenous dexmedetomidine provided equal levels of sedation and more evident analgesia compared with midazolam. In addition, dexmedetomidine prolonged sensory blockage of bupivacaine-induced spinal anesthesia
Abstract (Original Language): 
Çift kör, randomize ve plasebo kontrollü olarak planlanan çalışmada spinal anestezi öncesi intravenöz tek doz uygulanan deksmedetomidin ve midazolamın, duyusal ve motor blok süresi üzerine etkisinin karşılaştırılması amaçlanmıştır. Transüretral prostat rezeksiyonu (TUR-P) operasyonu planlanan ASA I-II, 75 olguda spinal anesteziden 5 dakika önce intravenöz deksmedetomidin 0.5 µg kg -1 (Grup D, n=25), midazolam 0.05 mg kg -1 (Grup M, n=25) veya serum fizyolojik (Grup K, n=25) uygulamasından sonra, sedasyon seviyesi, duyusal blok üst seviyesi, duyusal ve motor blok gerileme zamanı kaydedildi. Ramsay sedasyon skoru, Grup D ve Grup M’de benzer ve Grup K’den daha yüksek bulundu (her iki grup için p<0.001). Duyusal blok üst seviyesi, Grup D’de, Grup M ve Grup K’ye göre daha yüksek olarak saptandı (her iki grup için p<0.001). Deksmedetomidin grubunda duyusal blok süresinin, midazolam ve kontrol grubundan daha uzun olduğu, ancak motor blok süresini uzatmadığı belirlendi (her iki grup için p<0.05). Postoperatif ilk analjezik gereksinim zamanı, Grup D’de Grup M ve K’ye göre daha uzun bulundu (her iki grup için p<0.01). Postoperatif analjezik tüketimi Grup D’de, Grup M ve Grup K’ye göre daha azdı (her iki grup için p<0.05). Deksmedetomidin ile premedikasyon midazolama benzer sedasyon ve daha belirgin analjezi sağlar. Ek olarak, deksmedetomidin bupivakain ile uygulanan spinal anestezinin duyusal blok süresini uzatır.
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REFERENCES

References: 

1. Hu P, Harmon D, Frizelle H. Patient comfort during regional
anesthesia. J Clin Anesth 2007;19:67-74.
2. Wu CL, Naqibuddin M, Fleisher LA. Measurement of patient
satisfaction as an outcome of regional anesthesia and analgesia:
a systematic review. Reg Anesth Pain Med 2001;26:196-208.
3. Weinbroum AA, Szold O, Ogorek D, Flaishon R. The
midazolam-induced paradox phenomenon is reversible by
flumazenil. Epidemiology, patient characteristics and review of
the literature. Eur J Anaesthesiol 2001;18:789-97.
4. Hall JE, Uhrich TD, Barney JA, Arain SR, Ebert TJ. Sedative,
amnestic, and analgesic properties of small-dose
dexmedetomidine infusions. Anesth Analg 2000;90:699-705.
5. Karaaslan D, Peker TT, Alaca A et al. Comparison of buccal
and intramuscular dexmedetomidine premedication for
arthroscopic knee surgery. Clin Anesth 2006;18:589-93.
6. Jaakola ML. Dexmedetomidine premedication before
intravenous regional anesthesia in minor outpatient hand
surgery. J Clin Anesth 1994;6:204-11.
7. Kanazi GE, Aouad MT, Jabbour-Khoury SI, et al. Effect of
low-dose dexmedetomidine or clonidine on the characteristics
of bupivacaine spinal block. Acta Anaesthesiol Scand
2006;50:222-7.
8. Liu S, Chiu AA, Neal JM, Carpenter RL, Bainton BG,
Gerancher JC. Oral clonidine prolongs lidocaine spinal
anesthesia in human volunteers. Anesthesiology. 1995;82:1353-
9.
9. Rhee K, Kang K, Kim J, Jeon Y. Intravenous clonidine
prolongs bupivacaine spinal anesthesia. Acta Anaesthesiol
Scand 2003;47:1001-5. F.N. Kaya, ark.
92
10. Ramsay MA, Savege TM, Simpson BR, Goodwin R.
Controlled sedation with alphaxalone-alphadolone. Br Med J
1974;2:656-9.
11. Coskuner I, Tekin M, Kati I, Yagmur C, Elcicek K. Effects of
dexmedetomidine on the duration of anaesthesia and
wakefulness in bupivacaine epidural block. Eur J Anaesthesiol
2007;24:535-40.
12. Wahlander S, Frumento RJ, Wagener G, et al. A prospective,
double-blind, randomized, placebo-controlled study of
dexmedetomidine as an adjunct to epidural analgesia after
thoracic surgery. J Cardiothorac Vasc Anesth 2005;19:630-5.
13. Arain SR, Ebert TJ. The efficacy, side effects, and recovery
characteristics of dexmedetomidine versus propofol when used
for intraoperative sedation. Anesth Analg 2002;95:461-6.
14. Ebert TJ, Hall JE, Barney JA, Uhrich TD, Colinco MD. The
effects of increasing plasma concentrations of
dexmedetomidine in humans. Anesthesiology 2000;93:382-94.
15. Williams JT, Henderson G, North RA. Characterization of
alpha 2-adrenoceptors which increase potassium conductance in
rat locus coeruleus neurones. Neuroscience 1985;14:95-101.
16. Guo TZ, Jiang JY, Buttermann AE, Maze M.
Dexmedetomidine injection into the locus ceruleus produces
antinociception. Anesthesiology 1996;84:873-81.
17. Butterworth JF 5th, Strichartz GR. The alpha 2-adrenergic
agonists clonidine and guanfacine produce tonic and phasic
block of conduction in rat sciatic nerve fibers. Anesth Analg
1993;76:295-301.
18. Memiş D, Turan A, Karamanlioğlu B, Pamukçu Z, Kurt I.
Adding dexmedetomidine to lidocaine for intravenous regional
anesthesia. Anesth Analg 2004;98:835-40.
19. Fisher B, Zornow MH, Yaksh TL, Peterson BM.
Antinociceptive properties of intrathecal in rats. Eur J
Pharmacol 1991;192:221-5.
20. Xu M, Wei H, Kontinen VK, Kalso E, Pertovaara A. The
dissociation of sedative from spinal antinociceptive effects
following administration of a novel alpha-2-adrenoceptor
agonist, MPV-2426, in the locus coeruleus in the rat. Acta
Anaesthesiol Scand 2000;44:648-55.
21. Calasans-Maia JA, Zapata-Sudo G, Sudo RT.
Dexmedetomidine prolongs spinal anaesthesia induced by
levobupivacaine 0.5% in guinea-pigs. J Pharm Pharmacol
2005;57:1415-20.
22. Weinbroum AA, Ben-Abraham R. Dextromethorphan and
dexmedetomidine: new agents for the control of perioperative
pain. Eur J Surg 2001;167:563-9.

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