Co-administration of dexmedetomidine and levobupivacaine results in better onset and duration of epidural anesthesia in lower extremity orthopedic surgery

H. Zulkifli, Ihsan Affandi, Rizal Zainal , Theodorus .

H. Zulkifli
Sriwijaya University, South Sumatera, Indonesia

Ihsan Affandi
Sriwijaya University, South Sumatera, Indonesia

Rizal Zainal
Sriwijaya University, South Sumatera, Indonesia. Email: rizalprabu@gmail.com

Theodorus .
Sriwijaya University, South Sumatera, Indonesia
Online First: April 28, 2019 | Cite this Article
Zulkifli, H., Affandi, I., Zainal, R., ., T. 2019. Co-administration of dexmedetomidine and levobupivacaine results in better onset and duration of epidural anesthesia in lower extremity orthopedic surgery. Bali Journal of Anesthesiology 3(1): 1-4. DOI:10.15562/bjoa.v3i1.61


Background: The goal of this study is to know the efficacy of the addition of 0.5 mcg/kg dexmedetomidine to 15 mL isobaric 0.5% levobupivacaine on the onset and duration of sensory and motor blockade of epidural anesthesia in lower extremity orthopedic surgery.

Methods: Randomized clinical double-blind trials were conducted in Dr. Mohammad Hoesin Hospital Palembang. A total of 34 patients underwent lower extremity surgery met the inclusion and exclusion criteria. Data were analyzed by independent t-test and Mann-Whitney test using SPSS 22.0 software.

Result: The onset of sensory block in group D was 5.41±1.84 minutes compared to 17.59± 2.65 in Group C (p <0.001), as seen in Table 2. The sensory block duration was 362.41±25.66 minutes in Group D compared to 215.82±15.69 in Group C (p <0.001). The onset of the motoric block in group D was 16.53±1.81 minutes compared to 26.12±2.78 in Group C (p <0.001), while the motoric block duration was 301.29±20.55 minutes in Group D compared to 167.35±17.24 in Group C (p <0.001).

Conclusion: The addition of 0.5mcg/kg dexmedetomidine to 15 ml isobaric 0.5% levobupivacaine in epidural anesthesia provide faster onset and prolonged duration in both motoric and sensory block in patients undergoing lower extremity surgery



Csongradi JJ, Mihm FG. Lower Leg, Ankle, Foot, and Other Lower-Extremity Procedures. In: Anesthesiologist’s manual of surgical procedures. Fifth Edition. Jaffe RA, Samuels SI (Eds). Wolters Kluwer, 2014, pp 1627-72.

Heavener JE. Local Anesthetics. CurrOpin Anesthesiology. 2007; 20: 336-42. DOI: 10.1097/ACO.0b013e3281c10a08

McLeod GA, Burke D. Levobupivacaine. Anesthesia. 2001; 56: 331-41. DOI: 10.1046/j.1365-2044.2001.01964.x

Burlacu CL, Buggy DJ. Update on local anesthetics: focus on levobupivacaine. Therapeutics and Clinical Risk Management. 2008; 4(2): 381-92. DOI: 10.2147/TCRM.S1433

Ramaswamy S, Wilson JA, Colvin L. Non-opioid-based adjuvant analgesia in perioperative care. Continuing Education in Anaesthesia, Critical Care & Pain. 2013; 1-6. DOI: 10.1093/bjaceaccp/mkt012

Schnabel A, Friebem CHF, Reichl SU, et al. Is intraoperative dexmedetomidine a new option for postoperative pain treatment? A meta-analysis of randomized controlled trials. International Association for the Study of Pain. 2013; 1140-149. DOI: 10.1016/j.pain.2013.03.029

Kaur S, Attri JP, Kaur G, et al. Comparative evaluation of ropivacaine versus dexmedetomidine and ropivacaine in epidural anesthesia in lower limb orthopedic surgeries. Saudi Journal of Anesthesia. 2014; 8(4): 463-69. DOI: 10.4103/1658-354X.140838

Rastogi B, Singh VP, Mangla D, et al. Dexmedetomidine as an adjuvant to epidural 0.75% ropivacaine in patients undergoing infraumbilical surgery: a clinical study. Global Anesthesia and Perioperative Medicine. 2015; 1(1): 19-23. DOI: 10.15761/GAPM.1000106

Kopacz DJ, Allen HW, Thomson GE. A comparison of epidural levobupivacaine 0,75% with racemic bupivacaine for lower abdominal surgery. AnesthAnalg. 2000; 90: 642-8. DOI: 10.1097/00000539-200003000-00026

Garcia JB, Oliviera JR, Silva EPA, et al. Comparative study of 0.5% levobupivacaine and 0.5% racemic bupivacaine associated to sufentanil in epidural anesthesia for cesarean delivery. Rev Bras Anestesiol. 2001; 51(5): 337-84. DOI: 10.1590/S0034-70942001000500002

Sharma A, Kumar NJ, Azharuddin M, et al. Evaluation of low-dose dexmedetomidine and neostigmine with bupivacaine for postoperative analgesia in orthopedic surgeries: A prospective randomized double-blind study. Journal of Anaesthesiology Clinical Pharmacology. 2016; 32(2): 187-91. DOI: 10.4103/0970-9185.173355

Soliman R, Zohry G. Assessment the effect of fentanyl and dexmedetomidine as an adjuvant to epidural bupivacaine in parturients undergoing normal labor. Journal of Anesthesiology & Clinical Science. 2016; 5(2): 1-7. DOI: 10.7243/2049-9752-5-2

Bajwa SJ, Bajwa SK, Kaur J, et al. Dexmedetomidine and clonidine in epidural anesthesia: A comparative evaluation. Indian Journal of Anaesthesia. 2011; 55(2): 116-21. DOI: 10.4103/0019-5049.79883

Paranjpe JS. Dexmedetomidine: expanding role in anesthesia. Medical Journal. 2013; 6(1): 5-13. DOI: 10.4103/0975-2870.108625

Butterworth JF, Mackey DC, Wasnick JD. Local anesthetics. In: Morgan & Mikhail’s Clinical Anaesthesiology. Fifth Edition. New York, McGraw-Hill, 2013, pp262-76.

Bernads CM, Shen DD, Sterling ES, et al. Epidural cerebrospinal fluid, and plasma pharmacokinetics of epidural opioids (part 1): differences among opioids. Anesthesiology. 2003; 99(2): 455-65. DOI: 10.1097/00000542-200308000-00029

Liu SS, Lin Y. Local Anesthetics. In: Barash Clinical Anesthesia. Seventh Edition. Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC, Ortega R (Eds). Philadelphia, Lippincott Williams & Wilkins, 2013, pp 561-79.

Casati A, Santorsola R, Aldegheri G, et al. Intraoperative epidural anesthesia and postoperative analgesia with levobupivacaine for major orthopedic surgery: a double-blind, randomized comparison of racemic bupivacaine and ropivacaine. Journal of Clinical Anesthesia. 2003; 15: 126-31. DOI: 10.1016/S0952-8180(02)00513-5

Smet I, Vlaminck E, Vercauteren M. Randomized controlled trial of patient-controlled epidural analgesia after orthopedic surgery with sufentanil and ropivacaine 0,165% or levobupivacaine 0,125%. British Journal of Anaesthesia. 2008; 100: 99-103. DOI: 10.1093/bja/aem309

Grosu I, Lavand’homme P. Use of dexmedetomidine for pain control. F1000 medicine reports. 2010; 2: 1-4. DOI: 10.3410/M2-90

Eskandr A, Maseeh SA. The Effect of Dexmedetomidine on Lumbar Epidural Injection for Failed Back Surgery Syndrome. Anesthesiology and Practice. 2016: 1-4. DOI: 10.1155/2016/7198048

Cortinez LI, Hsu YW, Sum-Ping ST, et al. Dexmedetomidine pharmacodynamics: Part II: Crossover comparison of the analgesic effect of dexmedetomidine and remifentanil in healthy volunteers. Anesthesiology. 2004; 101(5): 1077-83.

Cheung CW, Qiu Q, Ying ACL, et al. The effects of intra-operative dexmedetomidine on postoperative pain, side-effects and recovery in colorectal surgery. Anesthesia. 2014; 69: 1214-221. DOI: 10.1111/anae.12759

Shehabi Y, Botha JA, Ernest D, et al. Clinical application, the use of dexmedetomidine in intensive care sedation. Crit Care & Shock. 2010; 13(2): 40-50.

Wu HH, Wang HT, Jin JJ, et al. Does Dexmedetomidine as a Neuraxial Adjuvant FacilitateBetter Anesthesia and Analgesia? A Systematic Review and Meta-Analysis. PLoS ONE. 2014; 9(3): 93114. DOI: 10.1371/journal.pone.0093114

Babu MSS, Verma AK, Agarwal A, et al. A comparative studying the postoperative spine surgeries: Epidural ropivacaine with dexmedetomidine and ropivacaine with clonidine for postoperative analgesia. Indian Journal of Anaesthesia. 2013; 57(4): 371-76. DOI: 10.4103/0019-5049.118563

Shaikh SI, Mahesh SB. The Efficacy and safety of epidural dexmedetomidine and clonidine with bupivacaine in patients undergoing lower limb orthopedic surgeries. Anesthesiol Clin Pharmacol. 2016; 32: 203-9. DOI: 10.4103/0970-9185.182104

Soliman R, Eltaweel M. Comparative study of dexmedetomidine and fentanyl as an adjuvant to epidural bupivacaine for postoperative pain relief in adult patients undergoing total knee replacement: a randomized study. Journal of Anesthesiology & Clinical Science. 2016; 5(1): 1-7. DOI: 10.7243/2049-9752-5-1

Pathak L. Effect of postoperative epidural analgesia after major orthopedic surgeries, a retrospective study. Journal of Universal College of Medical Sciences. 2015; 03(10): 20-5. DOI: 10.3126/jucms.v3i2.14286

Mahendru V, Tewari A, Katyal S, et al. A comparison of intrathecal dexmedetomidine, clonidine, and fentanyl as adjuvants to hyperbaric bupivacaine for lower limb surgery: a double-blind controlled study. Journal of Anaesthesiology Clinical Pharmacology. 2013; 29(4): 496-502. DOI: 10.4103/0970-9185.119151

Lin YN, Li Q, Yang RM, et al. Addition of dexmedetomidine to ropivacaine improves cervical plexus block. Acta Anaesthesiology Taiwanica. 2013; 51: 63-6. DOI: 10.1016/j.aat.2013.06.001

Soni P. Comparative study for better adjuvant with ropivacaine in epidural anesthesia. Anesth Essays Res. 2016; 10: 218-2. DOI: 10.4103/0259-1162.174470

Article Views      : 623
PDF Downloads : 238