A randomized comparative study to evaluate the efficacy of dexmedetomidine used as an adjuvant to isobaric 1% 2-chloroprocaine in parturients undergoing elective lower segment cesarean section under subarachnoid block

Abstract

Background and Aims: Preservative-free 1% 2-chloroprocaine (2-CP) is an amino-ester local anesthetic (LA), suitable for short duration daycare or ambulatory surgeries. Dexmedetomidine as an adjuvant may enhance the efficacy of LA. Our study aimed to evaluate the analgesic efficacy and safety of intrathecal dexmedetomidine as an adjuvant to 1% 2-CP in parturients undergoing elective lower segment cesarean section (LSCS). Material and Methods: After obtaining approval from the Institutional Ethics Committee and informed written consent, 100 term parturients aged 18–35 years, belonging to American Society of Anesthesiologists (ASA) physical status II, undergoing elective LSCS were randomly allocated into two groups. Group CD received 1% preservative-free 2-CP 3 ml (30 mg) +0.5 ml dexmedetomidine (5 μg) diluted in (normal saline) NS, while Group C (n = 50) received 1% preservative-free 2-CP 3 ml (30 mg) +0.5 ml NS. Among the various parameters noted, duration of sensory block was the primary outcome measure while the onset of sensory block, highest dermatomal level achieved, time to achieve highest dermatomal level, time to two-segment regression, onset and duration of motor block, duration of analgesia, Visual Analog Scale (VAS) score, Apgar score, hemodynamic changes, and side effects were secondary outcome measures. Results: Both groups were comparable with respect to demographic profile, onset of sensory block, onset and duration of motor block. The duration of sensory block (100.12 ± 15.41 versus 71.68 ± 4.68 min) (<0.0001) as well as the duration of analgesia (113.08 ± 13.74 versus 81.60 ± 8.28 min) (<0.0001) were significantly prolonged in Group CD compared to Group C. Apgar score of newborns, hemodynamic parameters, and adverse effects were comparable in two groups. Conclusion: Intrathecal dexmedetomidine (5 μg) as an adjuvant to preservative-free 1% 2-CP results in a prolonged duration of both sensory block and analgesia for LSCS without affecting motor block characteristics.

Keywords

• 2-chloroprocaine
• dexmedetomidine
• lower segment cesarean section
• subarachnoid block