Study of additive effect of Dexmedetomidine added to epidural Ropivacaine for orthopedic lower limb procedures

  • Mathews Jacob Command Hospital,Lucknow,Army Medical Corps
  • Nitesh Agrawal Commmand Hospital, Lucknow,Army Medical Corps
  • Debashish Paul Armed Forces Medical College pune
Keywords: Dexmedetomidine, adjuvant, hemodynamic stability.


Background: The incidence of RTA is ever increasing has been associated with wide range of injuries. The present study aims to provide better anesthetic options for lower limb surgeries in order to improve intra as well as post- operative outcomes.

Methodology: Total of 100 Patients of ASA Grade I and II between the age of 18 and 60 years, undergoing lower limb orthopedic surgeries, were randomly allocated to one of the two treatment group. Patients in study group A receive 17 ml of 0.75% ropivacaine and 0.5mcg per kg of Dexmedetomidine (DXM), while study group B receives 17 ml solution of 0.75% ropivacaine and 1.5mcg per kg of DXM. Bromage scale was used to measure motor blocked and grades of sedation were evaluated using Ramsay sedation score. Peri and post block characteristics as well as hemodynamic parameters were recorded.

Results: The demographic profiles and the post op block characteristics of the patients in the two groups were comparable. The results of the study has shown that the addition of 0.5 mcg per kg of DXM to 17 ml solution of 0.75% ropivacaine not only prolongs the duration of analgesia but also provides desired sedation levels with peri and post-operative period hemodynamic stability during the surgical procedure.

Conclusion: Titrating optimum dose of DXM as epidural adjuvant with desired duration of sensory and motor block; peri and post operative analgesia; level & duration of sedation and hemodynamic stability, it is concluded by the study that 1.5 mcg dose of DXM gives no additional benefit over 0.5 mcg/kg dose, neither to the patients nor to the surgical team.


Download data is not yet available.


. Nalini Vadivelu, Arsenio Bustos and Raymond Sinatra. Pain Management for Orthopedic Procedures. Pain Management. Buisness briefing: US Orthopedic Review 2006: 57-9.

. Hala El-Kerdawy. Analgesic requirements for patients undergoing lower extremity orthopedic surgery; The Effect of Combined Spinal and Epidural Magnesium. MEJ Anesth 2008; 19(5); 1013-25.

. Edmundas Sirvinskas, Rokas Laurinaitis: Use of magnesium sulphate in anesthesiology. Medicina. 2002; 38:696-8.

. Campora E, Merlini L, Pace M, et al: The incidence of narcotic-induced emesis. J Pain Symptom Manage.1991; 6:428-30.

. Brockway MS, Noble DW, Sharwood-Smith GH, et al: Profound respiratory depression after extradural fentanyl. Br J Anaesth. 1990; 64:243-5.

. Ashburn MA, Love G, Pace NL: Respiratory-related critical events with intravenous patient controlled analgesia. Clin J Pain. 1994,10:52-6.

. Mahoney O M, Noble P C, Davidson J, Tullos H S, The effect of continuous epidural analgesia on postoperative pain, rehabilitation, and duration of hospitalization in total knee arthroplasty, Clin. Orthop. Relat. Res. 1990; 260:307.

. Wulf H, Biscoping J, Beland B, Bachmann-Mennenga B, Motsch J, Ropivacaine epidural anesthesia and analgesia versus general anesthesia and intravenous patient-controlled analgesia with morphine in the perioperative management of hip replacement. Ropivacaine Hip Replacement Multicenter Study Group, Anesth. Analg. 1999; 89(1): 111116.

. Bajwa SJ, Bajwa SK, Kaur J, Singh G, Arora V, Gupta S et al. Dexmedetomidine and clonidine in epidural anaesthesia: A comparative evaluation. Indian J Anaest 2011; 55:116-21.

. Bucklin B, Eisenach JC, Tucker B. Pharmacokinetics and dynamic studies of intrathecal, epidural and intravenous dexmedetomidine. Anesthesiology. 1991; 75 (3): 662.

. Hall JE, Uhrich TD, Barney JA, Arain SR, Ebert TJ: Sedative, amnestic, and analgesic properties of small-dose dexmedetomidine infusions. Anesth Analg 2000; 90(3): 699-705.

. Bellevile JP, Ward DS, Bloor BC, Maze M: Effects of Intravenous Dexmedetomidine in human sedation, ventilation, and metabolic rate. Anesthesiology. 1992; 77:1134-42.

. Ebert TJ, Hall JE, Barney JA, Ulrich TD, Colin T. The effects of increasing plasma concentrations of dexmedetomidine in humans. Anesthesiology. 2000; 93:382-94.

. 14. Lawrence CJ, Delange S: Effect of a single pre-operative dexmedetomidine dose on isoflurane requirements and peri-operative haemodynamic stability. Anaesthesia. 1997; 52:736-44.

. Aantaa RE, Kanto JH, Scheinin M, Kallio AM, Scheinin HL. Dexmedetomidine premedication for minor gynecologic surgery. Anesth Analg. 1990; 70:407-13.

. Bohrer M, Mappes A, Lauber R, Stanski DR, Maitre PO. Dexmedetomidine decreases thiopental dose requirement and alters distribution pharmacokinetics. Anesthesiology. 1994; 80:1216-27.

Original Research Articles