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Background: Spinal anesthesia (SA) is a frequently used method by anesthesiologists in patients who may not need general anesthesia or have a contraindication for applying general anesthesia. Nevertheless, numerous contemplations need to be considered by anesthesiologists when using this method. Objectives: We compared the effect of intravenous (IV) administration of dexamethasone versus dexmedetomidine alongside the subarachnoid injection of Bupivacaine in terms of spinal anesthesia (SA) quality in opium-addicted patients. Patients and Methods: This parallel randomized clinical trial (RCT) was conducted on opium-addicted patients aged 18 to 65 with The American Society of Anesthesiologists (ASA) class of I/II candidates for surgery under SA. In one group, dexmedetomidine at a dose of 0.5 μg/kg body weight was injected intravenously 10 minutes before surgery and then at a dose of 0.5 μg/kg body weight during surgery. In another group, 8 mg dexamethasone was injected intravenously 10 minutes before surgery, and then normal saline at a rate of 0.5 μg/kg/h was infused during surgery. The primary outcomes were the onset of sensory block, the onset of motor block, the regression of two levels of sensory block, and the duration of motor block. The secondary outcomes were total analgesia time and the time to the first analgesia requirement. Results: Totally, 57 patients divided into two groups were included in the final analysis. The results showed that the two groups differed significantly in none of the assessed baseline variables (P > 0.05). The mean duration between performing SA and the onset of sensory block in the Dexamethasone and Dexmedetomidine groups was 4.8 ± 2.2 and 4.2 ± 1.9 minutes, respectively (P = 0.290). The mean duration between performing SA and the onset of motor block in the dexamethasone and dexmedetomidine groups was 5.9 ± 2.6 and 5.1 ± 2.3 minutes, respectively (P = 0.251). The mean duration between performing SA and the regression of two levels of sensory block in the dexamethasone and dexmedetomidine groups was 63.6 ± 27.7 and 82.0 ± 17.1 minutes, respectively (P = 0.004). The mean duration of motor block in the dexamethasone and dexmedetomidine groups was 75.0 ± 32.1 and 97.5 ± 19.4 minutes, respectively (P = 0.377). The mean total analgesia time in the dexamethasone and dexmedetomidine groups was 86.9 ± 32.9 and 109.3 ± 16.3 minutes, respectively (P = 0.002). The mean duration between performing SA and the first requirement for analgesic agent administration in the dexamethasone and dexmedetomidine groups was 206.21 ± 93.19 and 267.86 ± 76.02 minutes, respectively (P = 0.008). Conclusions: It seems that the quality of spinal anesthesia in opium-addicted patients who received concurrent IV dexmedetomidine was better than that of those who received concurrent IV dexamethasone.

Background: There are limited available scientific sources of data and rare controlled studies to guide the anesthesiologist regarding preoperative analgesic care in opioid addict patients, despite the increasing prevalence of opioid dependency. Objectives: In the present study, we aimed to evaluate the effect of using Dexmedetomidine (Dex) during femoral neck surgery on the postoperative analgesic consumption in opium addict patients. Patients and Methods: The present study is a double-blind randomized clinical trial. Patients suffering from femoral neck fracture with a history of opium addiction who were candidates for surgery under spinal anesthesia were included. After induction of spinal anesthesia using hyperbaric bupivacaine, either Dex or normal saline was infused for patients. Dex with a dose of 0.5 µg/kg/h in the intervention group and normal saline with a dose of 0.5 cc/kg/h in the control group was administered. After the surgery, pain intensity of the patients in recovery was assessed in 10-minute intervals based on visual analog scale (VAS) until 2 hours postoperatively. Time to pain and the total amount of opium consumption for pain control in 24 hours postoperatively were calculated and compared between the 2 groups. Results: Finally, 25 patients in each group were studied. Demographic and baseline characteristics of the patients in the 2 groups were not significantly different. Mean morphine consumption in recovery until 2 hours postoperatively showed no significant difference between Dex and control groups (P = 0.24). However, the mean opioid use during 24 hours postoperatively was significantly difference and it was lower in the group receiving Dex infusion (P < 0.001). Conclusions: It is likely that intravenous Dex infusion during femoral neck fracture surgery under spinal anesthesia can lead to the less opioid use throughout the 24 hours postoperatively in opium addict patients.