{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T19:31:15Z","timestamp":1786649475799,"version":"build-2736575974"},"reference-count":13,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,9]]},"abstract":"\n Background and Aims:<\/jats:title>\n One major limitation of the spinal block remains the inability to extend the duration of the block intraoperatively unless planned before with spinal or epidural catheters and\/or intrathecal additives. This study was designed to compare the effects of intravenous dexmedetomidine versus low-dose ketamine\u2013dexmedetomidine combination infusion on spinal anaesthesia in lower limb orthopaedic surgeries.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n \n This randomised study was conducted in 60 patients scheduled for unilateral lower limb surgeries under spinal anaesthesia. Patients were randomised into Group D (\n n<\/jats:italic>\n = 30) (0.5 \u00b5g\/kg of intravenous (IV) dexmedetomidine bolus followed by maintenance infusion at 0.5 \u00b5g\/kg\/h) and Group LKD (\n n<\/jats:italic>\n = 30) (IV bolus of 0.5 \u00b5g\/kg of dexmedetomidine and 0.2 mg\/kg of ketamine, followed by maintenance infusions of dexmedetomidine and ketamine at 0.5 \u00b5g\/kg\/h and 0.2 mg\/kg\/h, respectively). Ramsay Sedation Scale score of 3\u20134 was maintained. The\n t<\/jats:italic>\n -test or the Wilcoxon\u2013Mann\u2013Whitney\n U<\/jats:italic>\n test was used to compare the parameters between groups.\n <\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n The mean sacral segment 1 (S1) regression time was 390.3 [standard deviation (SD):84.38] [95% confidence interval (CI): 360.13, 420.53] versus 393.23 (SD: 93.01) (95% CI: 363.04, 423.43) min in Group D versus Group LKD respectively ((\n P<\/jats:italic>\n = 0.701). The number of episodes of hypotension was significantly higher in Group D (19 patients) compared to Group LKD (nine patients) (\n P<\/jats:italic>\n = 0.001). Pre- and postoperative stress markers (24 h) and the incidence of postoperative nausea and shivering were comparable between the two groups (\n P<\/jats:italic>\n > 0.05). Tramadol requirement in the postoperative period was significantly less in Group LKD compared to Group D (\n P<\/jats:italic>\n = 0.003).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n The duration of S1 regression was similar between group dexmedetomidine (Group D) and group low-dose ketamine and dexmedetomidine (Group LKD).<\/jats:p>\n <\/jats:sec>","DOI":"10.4103\/ija.ija_14_24","type":"journal-article","created":{"date-parts":[[2024,8,16]],"date-time":"2024-08-16T03:01:45Z","timestamp":1723777305000},"page":"795-800","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Comparison of intravenous dexmedetomidine versus ketamine\u2013dexmedetomidine combination on spinal block characteristics in patients undergoing lower limb orthopaedic surgery \u2013 A randomised clinical trial"],"prefix":"10.4103","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-2089-7689","authenticated-orcid":false,"given":"Annapureddy Sai","family":"Krishna","sequence":"first","affiliation":[{"name":"Department of Anaesthesia, Yashodha Hospital, Bijapur, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1203-7233","authenticated-orcid":false,"given":"Jyotsna","family":"Agarwal","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, Hamdard Institute of Medical Sciences and Research, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4447-2988","authenticated-orcid":false,"given":"Samiksha","family":"Khanuja","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0469-4807","authenticated-orcid":false,"given":"Sandeep","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, Hamdard Institute of Medical Sciences and Research, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-4026-9317","authenticated-orcid":false,"given":"Adam","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, Hamdard Institute of Medical Sciences and Research, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0412-1235","authenticated-orcid":false,"given":"Khairat Mohammad","family":"Butt","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, Hamdard Institute of Medical Sciences and Research, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2024,8,16]]},"reference":[{"key":"R1-20260426","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1186\/s12871-023-02275-x","article-title":"Intrathecal dexmedetomidine as an adjuvant to plain ropivacaine for spinal anesthesia during cesarean section: A prospective, double-blinded, randomized trial for ED50 determination using an up-down sequential allocation method","volume":"23","author":"Mo","year":"2023","journal-title":"BMC Anesthesiol"},{"key":"R2-20260426","doi-asserted-by":"crossref","first-page":"S220","DOI":"10.4103\/ija.ija_701_21","article-title":"A comparison of fentanyl, dexmedetomidine and combination of fentanyl with dexmedetomidine on the quality of subarachnoid block and postoperative analgesia: A double-blind controlled study","volume":"66","author":"Belgrami","year":"2022","journal-title":"Indian J 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trial","volume":"26","author":"Hassan","year":"2021","journal-title":"Anaesth Pain Intensive Care"},{"key":"R6-20260426","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1007\/s12630-018-1101-7","article-title":"Bromage motor blockade score \u2013 A score that has lasted more than a lifetime","volume":"65","author":"Craig","year":"2018","journal-title":"Can J Anesth"},{"key":"R7-20260426","doi-asserted-by":"crossref","first-page":"202","DOI":"10.4103\/1658-354X.130719","article-title":"Effects of intravenous dexmedetomidine on hyperbaric bupivacaine spinal anesthesia: A randomized study","volume":"8","author":"Dinesh","year":"2014","journal-title":"Saudi J Anaesth"},{"key":"R8-20260426","doi-asserted-by":"crossref","first-page":"74","DOI":"10.11604\/pamj.2022.41.74.28865","article-title":"Effects of IV dexmedetomidine as a premedication on clinical profile of bupivacaine spinal anaesthesia in lower abdominal surgeries: A randomized clinical study","volume":"41","author":"Choudhary","year":"2022","journal-title":"Pan Afr Med J"},{"key":"R9-20260426","doi-asserted-by":"crossref","first-page":"55","DOI":"10.4236\/ojanes.2018.83006","article-title":"Effects of continuous intravenous infusion of dexmedetomidine on the duration of spinal anesthesia: A prospective, double-blind, randomized, controlled trial","volume":"8","author":"Watanabe","year":"2018","journal-title":"Open J Anesthesiol"},{"key":"R10-20260426","first-page":"11","article-title":"Low dose of intravenous ketamine for prevention of hypotension after subarachnoid block","volume":"4","author":"Fatima","year":"2021","journal-title":"Int J Health Clin Res"},{"key":"R11-20260426","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.ajme.2011.11.001","article-title":"Effect of intravenous dexmedetomidine infusion on some proinflammatory cytokines, stress hormones and recovery profile in major abdominal surgery","volume":"48","author":"Yacout","year":"2022","journal-title":"Alexandria Med J"},{"key":"R12-20260426","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1007\/s00240-022-01319-0","article-title":"Neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and lymphocyte-monocyte ratio (LMR) in predicting systemic inflammatory response syndrome (SIRS) and sepsis after percutaneous nephrolithotomy (PNL)","volume":"50","author":"Kriplani","year":"2022","journal-title":"Urolithiasis"},{"key":"R13-20260426","doi-asserted-by":"crossref","first-page":"S34","DOI":"10.4103\/ija.IJA_998_20","article-title":"Discharge readiness after minor gynaecological surgeries comparing dexmedetomidine and ketamine premedication in bispectral index (BIS) guided propofol-based anaesthesia","volume":"65","author":"Kaur","year":"2021","journal-title":"Indian J Anaesth"}],"container-title":["Indian Journal of 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