A COMPARISON OF DEXMEDETOMIDINE AND FENTANYL AS AN ADJUVANT TO INTRATHECAL HYPERBARIC BUPIVACAINE IN ELECTIVE LOWER LIMB SURGERIES

Abstract

Background: Spinal block is a popular modality for lower limbs surgery. Various adjuvant is being use to improve the quality and duration of anesthesia and analgesia. So, we compare the efficacy of fentanyl and dexmedetomidine added to intrathecal bupivacaine in spinal block.

Methods: In this prospective observational study, 30 patients undergoing elective lower limb surgeries in the age group 18-60 years belonging to both sexes, patients were allocated into two groups. Via intrathecal approach, the patients received injection bupivacaine heavy (0.5%) 3.0 ml plus injection dexmedetomidine 10µg in Group D (n=15), injection fentanyl 25µg in Group F (n=15) respectively. Time to reach modified Bromage 3 motor block, the highest sensory level and regression from block, rescue analgesic request and duration of the drug effect, hemodynamic changes and side effects were compared between the groups.

Result: The onset times to reach T10 dermatome and complete motor block were not significantly different between the groups. But Group D had significantly longer sensory and motor block times than patients in Group F. Dexmedetomidine group showed significantly less and delayed requirement of rescue analgesic. The heart rate (HR) and mean arterial pressure (MAP) were comparable between the groups.

Conclusions: Using highly selective α₂ adrenergic agonist dexmedetomidine 10 micrograms is a valuable adjuvant to bupivacaine for spinal block lower limb surgeries which augments quality of spinal block and provides intraoperative sedation and hemodynamic stability.