![]() The objective of the study was to evaluate and compare safety and efficacy of intrathecal clonidine as adjuvant to bupivacaine with control normal saline.Methods: American Society of Anesthesiologist grade 1 and 2 patients (60 patients) were randomly divided into two groups of 30 patients each for lower limb surgeries. Clonidine, partially selective α2-agonist, is being evaluated as a neuraxial adjuvant with intrathecal bupivacaine. In this article we will discuss these other pharmacological management of challenging behaviors in NDD.īackground: Various adjuvants have been used in intrathecal anesthesia to avoid intraoperative visceral and somatic pain and prolong postoperative analgesia. Researches in the past couple of decades have found these medications much effective in behavioral management, with added benefit of lower long term side effects. Much less attention hasīeen given to medications like alpha 2 agonists. A common practice of pharmacological management of behavioral problems in NDD is to use antipsychotics and other psychotropic medications, often without any primary psychiatric disorder. Due to underlying sympathetic over activity, many of this group of patients can get easily dysregulated, making it difficult for their caregivers to care for them. Not having a proper guideline also makes it difficult for physicians to select appropriate medications. These patients often end up with polypharmacy of multiple psychotropic medications and complexities secondary to the associated side effects,which may often be irreversible. Neurodevelopmental Disorders (NDD) are associated with high rates of comorbid behavioral problems leading to increased need for crisis interventions, ER visits and health care spending. In summary, it can be suggested that adding dexmedetomidine to the anesthetic ropivacaine may be beneficial. ![]() The duration of analgesia was longer in the dexmedetomidine group (p = 0.001). Pain in dexmedetomidine group was less than fentanyl group in 2 to 8 hours after surgery (p <0.05). 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). 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 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). 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). 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. Sensory and motor blocks at or above the T8 dermatome in each group were measured. In the second group, fentanyl with ropivacaine was prescribed. In the first group, dexmedetomidine was prescribed. Patients were divided into two groups based on the block pattern. ![]() In this double-blind clinical trial, 64 patients who were candidates for 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.
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