AUTHOR=Zeng Sisi , Li Xuechao , Xu Hongchun , Ye Qin , Li Zhaogang , Wang Fangjun 

TITLE=The optimal dose of dexmedetomidine as a 0.59% ropivacaine adjuvant for epidural anesthesia in great saphenous varicose vein surgery, based on hemodynamics and anesthesia efficacy: a randomized, controlled, double-blind clinical trial

JOURNAL=Frontiers in Medicine

VOLUME=11

YEAR=2024

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2024.1426512

DOI=10.3389/fmed.2024.1426512

ISSN=2296-858X

ABSTRACT=<sec id="sec1"><title>Objective</title><p>This study aimed to explore the optimal dose of dexmedetomidine as a 0.59% ropivacaine adjuvant for epidural anesthesia on perioperative hemodynamics and anesthesia efficacy in patients undergoing great saphenous varicose vein surgery.</p></sec><sec id="sec2"><title>Methods</title><p>A total of 90 patients were randomly divided into three groups: 0.25 μg/kg dexmedetomidine combined with 0.59% ropivacaine epidural infusion group (ED<sub>1</sub> group), 0.5 μg/kg dexmedetomidine combined with 0.59% ropivacaine epidural infusion group (ED<sub>2</sub> group), and 0.75 μg/kg dexmedetomidine combined with 0.59% ropivacaine epidural infusion group (ED<sub>3</sub> group). Hemodynamics, anesthesia efficiency, and adverse reactions were recorded.</p></sec><sec id="sec3"><title>Main results</title><p>Compared with the ED<sub>1</sub> group, the ED<sub>2</sub> group had lower systolic blood pressure at T<sub>1-3</sub> (T<sub>1</sub>, 95%CIs, 6.52–21.93, <italic>p</italic> &lt; 0.001; T<sub>2</sub>, 95%CIs, 2.88–18.21, <italic>p</italic> = 0.004; T<sub>3</sub>, 95%CIs, 0.49–18.17, <italic>p</italic> = 0.035), and the diastolic blood pressure at T<sub>1-2</sub> was decreased (T<sub>1</sub>, 95%CIs, 4.55–14.36, <italic>p</italic> &lt; 0.001; T<sub>2</sub>, 95%CIs, 0.37–12.17, <italic>p</italic> = 0.033). Compared with the ED<sub>2</sub> group, the ED<sub>3</sub> group had higher systolic blood pressure at T<sub>1-2</sub> (T<sub>1</sub>, 95%CIs, 5.90–21.46, <italic>p</italic> &lt; 0.001; T<sub>2</sub>, 95%CIs, 2.07–17.55, <italic>p</italic> = 0.008) and higher diastolic blood pressure at T<sub>1-3</sub> (T<sub>1</sub>, 95%CIs, 2.91–12.81, <italic>p</italic> = 0.001; T<sub>2</sub>, 95%CIs, 1.32–13.23, <italic>p</italic> = 0.011; T<sub>3</sub>, 95%CIs, 0.14–11.52, <italic>p</italic> = 0.043). Compared with the ED<sub>2</sub> group, the heart rate was significantly decreased at T<sub>1-4</sub> in the ED<sub>3</sub> group (T<sub>1</sub>, 95%CIs, 2.25–15.72, <italic>p</italic> = 0.005; T<sub>2</sub>, 95%CIs, 2.35–13.82, <italic>p</italic> = 0.003; T<sub>3</sub>, 95%CIs, 0.50–9.79, <italic>p</italic> = 0.025; T<sub>4</sub>, 95%CIs, 1.46–10.36, <italic>p</italic> = 0.005). The myocardial oxygen consumption in all three groups was significantly decreased at each time point compared to T<sub>0</sub> (<italic>p</italic> &lt; 0.05 or &lt; 0.001), and no significant between-group differences were detected (<italic>P</italic>&gt;0.05). Compared with the ED<sub>1</sub> group, the anesthesia efficiency of ED<sub>2</sub> and ED<sub>3</sub> groups was markedly enhanced, but the risk of bradycardia in ED<sub>2</sub> and ED<sub>3</sub> groups was dramatically increased (6 of 28 [21.4%] vs. 14 of 30 [46.7%] and 14 of 27 [51.9%], <italic>p</italic> = 0.023), one patient in the ED<sub>3</sub> group experienced difficulty urinating, and remaining adverse reactions were mild in all three groups.</p></sec><sec id="sec4"><title>Conclusion</title><p>A measure of 0.5 μg/kg dexmedetomidine is the optimal dose as a 0.59% ropivacaine adjuvant for epidural anesthesia in patients undergoing great saphenous varicose vein surgery.</p></sec><sec><title>Clinical trial registration</title><p><ext-link xlink:href="http://www.chictr.org.cn/" ext-link-type="uri" xmlns:xlink="http://www.w3.org/1999/xlink">http://www.chictr.org.cn/</ext-link>, registration number: ChiCTR2200060619.</p></sec>