Study of effect of nebulised Dexmedetomidine on onset and duration of Spinal Anaesthesia- a one year hospital based randomised clinical trial

After obtaining approval from the Ethical Committee, and applying inclusion and exclusion criteria, subjects undergoing infra-umbilical surgery in supine position under Spinal anaesthesia will be included in the study.Data collection procedure:

In the Pre-operative area

 After obtaining approval and consent for the study, patient’s details are elicited, and NBM status is confirmed.

Pulse Oximeter, NIBP, ECG leads are attached and baseline reading is taken in the Preoperative room.

Patient will be shifted into the OT. Baseline pulse,NIBP and SpO2 will be recorded.

Patient will then receive Spinal anaesthesia in L3-L4 space with 3.2ml of 0.5% Hyperbaric Bupivacaine. Intraoperative Pulse, SpO2, NIBP will be monitored every 5 minutes upto 30 minutes and then every 10 minutes till the end of surgery.

After the action of spinal anaesthesia, patient will receive nebulisaion.

Group I will receive dexmedetomidine nebulisation with maximum of 1mcg/kg diluted with Normal Saline upto 5 ml.

 Patients in Group II will receive nebulisation with 5 ml of saline.

Onset of Sensory and Motor blockade is noted. Onset and duration of Sensory blockade is noted with cold swab.

Motor blockade is assessed with Bromage Scale with the following score:-

0-   No paralysis

1-      Unable to flex hip, but able to flex knees and ankle

2-      Unable to flex hips and knees, but able to flex ankles

3-      Unable to flex ankles, only able to move toes.

4-      Total paralysis

Time for regression of sensory block by 2 segments is noted as duration of Sensory Blockade.

Duration of time taken for Bromage score 0 to return is noted as duration of Motor blockade.

Intraoperative fall in HR over 15% of baseline will be treated with Inj. Atropine 0.6mg IV while fall in BP>20% will be treated with 3 mg of Mephentermine IV if required.

Intraoperatively sedation will be assessed using Ramsay sedation score every half hourly till the duration of surgery or for 3 hours whichever is longer.

Post Operatively- Pain will be evaluated using the VAS Scale. When VAS>3, patient will receive Inj. Paracetamol 15mg/Kg BW. The time at which patient asks for analgesic is noted and the total analgesic consumption in the First 24 hours is noted.