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To compare the efficacy and safety of intrathecal dexmedetomidine and magnesium sulphate as adjuvants to 0.5% hyperbaric bupivacaine in patients undergoing elective DHS fixation, focusing on onset and duration of sensory and motor block, hemodynamic stability, and quality of postoperative analgesia.
Spinal anesthesia is a preferred technique for lower limb orthopedic surgeries due to its rapid onset, reliable sensory and motor blockade, and minimal systemic side effects. Hyperbaric bupivacaine 0.5% is commonly used; however, its duration may be insufficient for prolonged procedures or postoperative analgesia. To enhance and prolong anesthesia and analgesia, various intrathecal adjuvants have been investigated.
Dexmedetomidine, a selective α2-adrenergic agonist, has shown promise in improving the quality and duration of spinal anesthesia by providing prolonged sensory and motor blockade, stable hemodynamics, and enhanced postoperative analgesia. Similarly, magnesium sulphate, an NMDA receptor antagonist, exerts antinociceptive effects by modulating calcium influx in nerve cells, potentially prolonging analgesia without significant motor blockade.
Dynamic hip screw (DHS) fixation is a common surgical intervention for intertrochanteric femur fractures, particularly in elderly patients. These procedures demand reliable intraoperative anesthesia and effective postoperative pain control to facilitate early mobilization and reduce complications.
Despite individual studies evaluating these agents, direct comparisons between intrathecal dexmedetomidine and magnesium sulphate as adjuvants to bupivacaine in DHS fixation remain limited. This study aims to compare their efficacy and safety in enhancing spinal anesthesia, thereby optimizing perioperative care in patients undergoing elective DHS fixation.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Group D (Dexmedetomidine) | Active Comparator |
| |
| Group M (Magnesium Sulphate) | Active Comparator |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Dexmedetomidine | Drug | 2.5 mL 0.5% hyperbaric bupivacaine + 5 µg dexmedetomidine (0.5 mL), total volume 3 mL |
|
| Measure | Description | Time Frame |
|---|---|---|
| Highest Dermatome Level of Sensory Block | Sensory block level assessed using a pinprick test and recorded as the highest dermatome level with loss of sensation. | 24 hours after intervention |
| Duration of postoperative analgesia | The outcome is Measured by Vas Score to assess pain intensity. It consists of a numeric version of the visual analogue scale. It is a horizontal line with an eleven point numeric range. It is labeled from zero to ten, with zero being an example of someone with no pain and ten being the worst pain possible. This scale can be administered verbally. Vas score for 24 h will be assessed at 0., 1, 12 and 24 h postoperatively and will be recorded. | 24 hours after intervention |
| Degree of Motor Block | Motor block assessed using the Modified Bromage Scale (0-3), where higher scores indicate greater motor block. | 24 hours after intervention |
| Measure | Description | Time Frame |
|---|---|---|
| Heart Rate | Heart rate measured in beats per minute (bpm) | 24 hours after intervention |
| Incidence of Adverse Effects | Bradycardia Hypotension Nausea Vomiting Sedation (Assessed By Ramsay Sedation Scale (RSS) ) Shivering Respiratory depression Delayed motor block Flushing Warm sensation Headache Pruritus Urinary retention Neurological complications (e.g., transient paresthesia) |
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Inclusion Criteria:
Exclusion Criteria:
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| ID | Term |
|---|---|
| D020927 | Dexmedetomidine |
| D008278 | Magnesium Sulfate |
| ID | Term |
|---|---|
| D007093 | Imidazoles |
| D001393 | Azoles |
| D006573 | Heterocyclic Compounds, 1-Ring |
| D006571 | Heterocyclic Compounds |
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| Magnesium Sulphate | Drug | 2.5 mL 0.5% hyperbaric bupivacaine + 50 mg magnesium sulphate (0.5 mL), total volume 3 mL |
|
| 24 hours after Intervention |
| Mean Arterial Pressure | Mean arterial pressure measured in mmHg | 24 hours after intervention |
| Oxygen Saturation | Peripheral oxygen saturation measured by pulse oximetry by percentage | 24 hours after intervention |
| D017616 |
| Magnesium Compounds |
| D007287 | Inorganic Chemicals |
| D013431 | Sulfates |
| D013464 | Sulfuric Acids |
| D013456 | Sulfur Acids |
| D013457 | Sulfur Compounds |