The aim of this study was to enhance the effectiveness of anesthesiological
support and reduce the percentage of complications during endoscopic biportal
discectomy surgeries by optimizing the technique of spinal anesthesia.
The study was structured around a comparative analysis of the effectiveness
of dexmedetomidine and fentanyl, used as adjuvants in combination with intrathecal
administration of bupivacaine during endoscopic biportal discectomy, aimed at
identifying the advantages and disadvantages of these techniques; a comparative
evaluation of the effectiveness of general and spinal anesthesia with the use of
adjuvants during endoscopic biportal discectomy; an investigation into the
effectiveness of spinal anesthesia using bupivacaine in combination with different
doses of dexmedetomidine as an adjuvant; and an exploration of the impact of
bupivacaine and adjuvants on the manifestation of proinflammatory cytokine levels
during spinal anesthesia.
To address these questions, we examined 150 patients who underwent
endoscopic biportal discectomy surgeries. The average age of the examined patients
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was 41.3±8.2 years, with an average weight of 70.2±12.8 kg. Among the patients,
there were 105 (70%) males and 45 (30%) females.
In the first stage of the study, using block randomization according to the
sample size, patients were allocated to the following groups:
̶Group bupivacaine (Marcaine spinal 0.5%, Astrazeneca, Cenexi, France)
(Group 1);
̶ Group bupivacaine and fentanyl (Fentanyl-Farmak 0.005%, Ukraine) (Group
2).
̶ Group bupivacaine and dexmedetomidine (Dexmedetomidine Ever-Pharma,
Austria) (Group 3).
Patients received 2.5 ml of intrathecal hyperbaric bupivacaine with 0.5 ml
(Group 1), or 2.5 ml of intrathecal hyperbaric bupivacaine with 25 mcg of fentanyl
(Group 2), or 2.5 ml of intrathecal hyperbaric bupivacaine with 5 mcg of
dexmedetomidine (Group 3).
On the second stage of the study, for comparative analysis of the effectiveness
of general and spinal anesthesia using adjuvants, patients were allocated into the
following groups:
̶ Group I (N=30) - general anesthesia using sevoflurane and propofol;
̶ Group 2 (N=30) - comprised of patients from Group 3 of the first stage of
the study, who underwent intrathecal administration of 2.5 ml bupivacaine + 5 mcg
dexmedetomidine
On the third stage of the study, for comparative analysis of hemodynamic
effects and the frequency of complications during spinal anesthesia using
bupivacaine in combination with different doses of dexmedetomidine as an adjuvant,
patients were divided into the following groups based on the intrathecal dose of
dexmedetomidine:
̶ Group 1 (N=30) - intrathecal administration of 2.5 ml bupivacaine + 2.5 mcg
dexmedetomidine;
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̶ Group 2 (N=30) - comprised of patients from Group 3 of the first stage of
the study (intrathecal administration of 2.5 ml bupivacaine + 5 mcg
dexmedetomidine);
̶ Group 3 (N=30) - intrathecal administration of 2.5 ml bupivacaine + 10 mcg
dexmedetomidine.
On the fourth stage of the study, to investigate the impact of adjuvants on the
expression of proinflammatory cytokines during spinal anesthesia, biochemical
blood tests were conducted in patients included in the first stage of our study to
assess the levels of proinflammatory cytokines:
̶ Group 1 (N=30) - intrathecal administration of 2.5 ml bupivacaine;
̶ Group 2 (N=30) - intrathecal administration of 2.5 ml bupivacaine + 25 mcg
fentanyl;
̶ Group 3 (N=30) - intrathecal administration of 2.5 ml bupivacaine + 5 mcg
dexmedetomidine.
During the conducted research, it was found that prior to the onset of Bromage
3, the bupivacaine with dexmedetomidine group had less time to achieve the highest
sensory level compared to the bupivacaine with fentanyl group (p=0.000023). The
highest sensory levels in the bupivacaine with dexmedetomidine and bupivacaine
with fentanyl groups were at T6 and T5 dermatomes, respectively, while in the
bupivacaine with saline group, they were at T6 and T7 dermatomes.
Complete regression of motor block (Bromage 0) was achieved in all patients
with the longest duration in the bupivacaine with dexmedetomidine group
(p=0.00012). Moreover, the time to regression to sensory level S1 and regression of
two sensory levels in the bupivacaine with dexmedetomidine group was
significantly greater than in other groups (p=0.000014). These patients also
exhibited lower pain intensity six hours after the surgery, indicating the longest
duration of postoperative analgesia in the bupivacaine with dexmedetomidine group
(p=0.000010).
