The dose-effect relationship of intrathecal bupivacaine co-administered with dexmedetomidine for total knee arthroplasty

Abstract

Abstract: AIM: To determine the dose-effect relationship of intrathecal bupivacaine (Bup) co-administered with dexmedetomidine (Dex) for total knee arthroplasty (TKA). METHODS: One hundred Sixty-two ASAⅠ-Ⅱ patients undergoing TKA with use of CSEA were enrolled in this study. Patients were randomely assigned into three groups: Group B (Bup), Group BD1 (Bup plus 2 μg Dex) and Group BD2 (Bup plus 4 μg Dex). Each group was further divided by Bup doses of 6-11 mg. Successful anesthesia and successful tourniquet pain blockade were defined. The ED₅₀ and ED₉₅ values for successful anesthesia and successful tourniquet pain blockade were determined separately by Probit regression analysis. RESULTS:The rate of successful anesthesia was not different among three groups. The time of start postoperative analgesia in Group BD1, Group BD2 was later than that in Group B (P=0.036), respectively. The rate of successful tourniquet pain blockade was different among three groups. The ED₅₀ and ED₉₅ values for successful tourniquet pain blockade were significantly smaller in Group BD1 and BD2 than that in Group B (P<0.05). CONCLUSION: Intrathecal Dex did not decrease the dose of intrathecal Bup required for successful anesthesia for patients undergoing TKA. However, it reduced the dose required for tourniquet pain blockade.

Key words: bupivacaine, dexmedetomidine, spinal anesthesia, tourniquet, pain, dose-effect relationship

CLC Number:

R733

XU Yan, YUAN Li-yong. The dose-effect relationship of intrathecal bupivacaine co-administered with dexmedetomidine for total knee arthroplasty[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2014, 19(7): 789-794.

References

[1] 赵刚,蔡建明,路牧,等.右美托咪定复合丙泊酚在无痛肠镜检查中的应用[J]. 中国临床药理学与治疗学,2013,18(1):95-99.
[2] 仲俊峰,胡双燕,李玉红,等.右美托咪啶复合丙泊酚靶控输注对喉罩置入条件的影响[J].中国临床药理学与治疗学,2013,18(2):186-189.
[3] 蔡畅,郭建荣.右美托咪啶在临床应用中的研究进展[J].中国临床药理学与治疗学,2011,16(3):349-353.
[4] 赵刚,俞米林,蔡建明,等.布比卡因复合小剂量右美托咪定行蛛网膜下腔阻滞的疗效观察[J].中国中西医结合外科杂志,2013,19(1):74-76.
[5] Kim JE,Kim NY,Lee HS,et al.Effects of Intrathecal Dexmedetomidine on Low-Dose Bupivacaine Spinal Anesthesia in Elderly Patients Undergoing Transurethral Prostatectomy[J].Biol Pharm Bull,2013,36(6):959-965.
[6] Erdivanli B,Altun M,Sezen OK,et al.Anti-nociceptive, analgesic and pathohistological effects of intrathecal dexmedetomidine and bupivacaine in rats[J].Rev Bras Anestesiol,2013,63(2):183-187.
[7] 卫琰,朱刚,周晓鸣,等.帕瑞昔布钠超前镇痛对下肢骨科手术止血带疼痛控制的影响[J].中国疼痛医学杂志,2012,18(1):59-60.
[8] Jung JY,Han JH,Yi JW,et al.Remifentanil prevents tourniquet-induced arterial pressure increase in elderly orthopedic patients under sevoflurane/N2O general anesthesia[J].Int J Med Sci,2012,9(4):311-315.
[9] Fettes PD,Hocking G,Peterson MK,et al.Comparison of plain and hyperbaric solutions of ropivacaine for spinal anaesthesia[J].Br J Anaesth,2005,94(1):107-111.
[10] 裘福荣,黄晓晖,李娟.药物效应动力学及受体动力学[M].孙瑞元,郑青山,主编.数学药理学新论.1版.北京:人民卫生出版社,2004:205-206.
[11] 李伟,夏仁云.止血带疼痛机制[J].中国矫形外科杂志,2000,7(1):59-61.
[12] Satsumae T, Yamaguchi H, Inomata S, et al.Magnesium sulfate attenuates tourniquet pain in healthy volunteers[J].J Anesth,2013,27(2):231-235.
[13] Cherng CH,Wong CS,Wu CT,et al.Intrathecal glutamate release during hindlimb tourniquet inflation and femoral artery occlusion in rats[J].J Formos Med Assoc,2013,112(5):259-262.
[14] Nazarian A,Christianson CA,Hua XY,et al.Dexmedetomidine and ST-91 analgesia in the formalin model is mediated by alpha2A-adrenoceptors: a mechanism of action distinct from morphine[J].Br J Pharmacol,2008 ,155(7):1117-1126.
[15] Zhang H,Zhou F,Li C,et al.Molecular mechanisms underlying the analgesic property of intrathecal dexmedetomidine and its neurotoxicity evaluation: an in vivo and in vitro experimental study[J].PLoS One,2013,8(2):e55556.
[16] Chen SR,Pan HM,Richardson TE,et al.Potentiation of spinal alpha(2)-adrenoceptor analgesia in rats deficient in TRPV1-expressing afferent neurons[J].Neuropharmacology,2007,52(8):1624-1630.
[17] Gurbet A,Turker G,Kose DO,et al.Intrathecal epinephrine in combined spinal-epidural analgesia for labor: dose-response relationship for epinephrine added to a local anesthetic-opioid combination[J].Int J Obstet Anesth,2005,14(2):121-125.
[18] Solanki SL,Bharti N,Batra YK,et al.The analgesic effect of intrathecal dexmedetomidine or clonidine, with bupivacaine, in trauma patients undergoing lower limb surgery:a randomised, double-blind study[J].Anaesth Intensive Care,2013,41(1):51-56.
[19] Shukla D,Verma A,Agarwal A,et al.Comparative study of intrathecal dexmedetomidine with intrathecal magnesium sulfate used as adjuvants to bupivacaine[J]. J Anaesthesiol Clin Pharmacol,2011,27(4):495-499.