Effect of dexmedetomidine and fentanyl on hemodynamic changes and block profile following spinal anesthesia with ropivacaine among patients with femoral fractures undergoing lower limb surgery.

The aim of this study was to compare the effect of dexmedetomidine and fentanyl on hemodynamic changes and block characteristics following spinal anesthesia with ropivacaine among patients with femoral fractures undergoing lower limb surgery. In this double-blind clinical trial, 64 patients who were candidates for lower limb surgery. Patients were divided into two groups based on the block pattern. In the first group, dexmedetomidine was prescribed. In the second group, fentanyl with ropivacaine was prescribed. Sensory and motor blocks at or above the T8 dermatome in each group were measured. Furthermore, the sensory block was evaluated every 1 minute after anesthesia with a needle (pin prick method) and also the motor block was evaluated every 5 minutes by the bromage scale. There was a statistically significant difference between the two groups in terms of the time for achieving sensory block to T8 or higher dermatome (p = 0.0001). The time elapsed until the onset of motor block was shorter in the dexmedetomidine group, and dexmedetomidine had a shorter time for achieving sensory block to T8 or higher dermatome than fentanyl. A statistically significant difference was found in terms of the time elapsed until the motor block and the time for achieving sensory block to the T8 dermatome or higher (p <0.05). The time elapsed until the onset of motor block was shorter in the dexmedetomidine group, and dexmedetomidine had a shorter time for achieving sensory block to T8 or higher dermatome than fentanyl. Our findings revealed a statistically significant difference in terms of the duration of sensory block for reaching the T12 to L1 dermatome and the duration of obtaining bromide scores 0 and 1 (p = 0.0001). The time for achieving sensory block to dermatome T12 to L1 and the time of obtaining bromage scales of 0 and 1 were longer in dexmedetomidine group (p = 0.0001). Pain in dexmedetomidine group was less than fentanyl group in 2 to 8 hours after surgery (p <0.05). The duration of analgesia was longer in the dexmedetomidine group (p = 0.001). In summary, it can be suggested that adding dexmedetomidine to the anesthetic ropivacaine may be beneficial.

The Effect of Sumatriptan, Theophylline, Pregabalin and Caffeine on Prevention of Headache Caused By Spinal Anaesthesia (PDPH): A Systematic Review.

Spinal anaesthesia (SA) is a common method during surgery due to easy administration, rapid effects, relaxes muscles and controls pain. But, post-dural puncture headache (PDPH) is a common problem after SA that occurs in 6%-36% of SA. We assessed the effect of four common treatment drugs sumatriptan, theophylline, pregabalin and oral caffeine on prevention of PDPH. In this systematic review, all randomized clinical trials (RCTs) during January 2015 and December 2021 were searched from PubMed, Google Scholar, Web of Science, Cochrane review and Clinical Key with a specific search strategy. The article qualities were assessed by two independent authors and were screened for relevant sources based on inclusion and exclusion criteria. Moreover, the included articles data were extracted and checked for regular basis. A total of 421 articles were identified and 193 articles were removed following a preliminary review and finally, 14 articles were included in review. Overall, we identified five RCTs on the effect of caffeine, two RCTs on the effect of sumatriptan, three RCTs on theophylline, three RCTs on pregabalin and one RCT on theophylline and sumatriptan in PDPH prevention. This review supports the effects of theophylline, pregabalin and sumatriptan in the prevention of PDPH incidence and treatment of PDPH intensity, but we cannot draw the same conclusions about caffeine due to some negative results about the caffeine effect. Nevertheless, this extracted conclusion should be considered and interpreted with caution and limited generalizations due to the small number of studies, the variety of evaluated drugs and measures, the low sample size and the bias presented.

Ondansetron 8 mg and 4 mg with normal saline against post-operative headache and nausea/vomiting after spinal anesthesia: a randomized double-blind trial.

The study aims to evaluate the efficacy of ondansetron in preventing post-spinal headache, considering the high prevalence of the headache in pregnant women and the common use of the adjuvants for prophylaxis against post-operative nausea and vomiting (PONV). This double-blind clinical trial included the 195 patients who were referred to Taleghani Hospital (in Arak, Iran) for cesarean section (C/S) under spinal anesthesia, and then the subjects were assigned to three equally sized groups using block randomization. Participants in the first, second, and control groups received 8 mg, 4 mg of ondansetron, and normal saline, respectively, 5 minutes before surgery. A final volume of 5 cc was prepared by adding normal saline. Participants were examined for headache one week after surgery, and then data analysis was performed using SPSS 20. The incidence of post-spinal headache was significantly higher in the placebo group than in the ondansetron 8-mg and 4-mg groups at 24 hours after surgery (P < 0.010). But, no significant difference was observed between two ondansetron groups (P ≤ 0.05). The overall incidence of the headache was generally lower in ondansetron 8-mg (26.66% vs. 33.68.05%) and 31.66% in ondansetron 4-mg (P < 0.001). Moreover, the PONV incidence was significantly higher in the placebo group than in the other two groups at 24 hours (P < 0.001). The hemodynamic variables were same in three groups. The ondansetron 8-mg dose can be effective to prevent headache after spinal anesthesia for C/S. Moreover, the ondansetron 8-mg and ondansetron 4-mg have same effect in control of PONV after spinal anesthesia for C/S.