Comparative Study of Intrathecal Dexmedetomidine versus Fentanyl Combined With Hyperbaric Bupivacaine for Perioperative Analgesia in Elective Lower Limb Orthopaedic Surgeries: A Double Blind Controlled Study
Journal Title: Scholars Journal of Applied Medical Sciences - Year 2018, Vol 6, Issue 6
Abstract
Abstract: Spinal anaesthesia is the most commonly used technique for lower abdominal surgeries as it is very economical, easy to administer, more rapid return to complete alertness when compared to general anaesthesia, superior postoperative analgesia and patient satisfaction, decreasing both the need for postoperative analgesics and the incidence of postoperative nausea and vomiting and reduced the cost of outpatient surgical procedures by decreasing the necessity of recovery room and subsequent hospital admissions. In recent years, use of intrathecal adjuvant has gained popularity with the aim of prolonging the duration of block, prolonged postoperative pain control, better success rate, patient satisfaction, decreased resource utilization compared with general anaesthesia and faster recovery. The quality of the spinal anaesthesia has been reported to be improved by the addition of opioids (such as morphine, fentanyl and sufentanil) and other drugs (such as clonidine, magnesium sulfate, neostigmine, ketamine and midazolam). Hence, the present study is being undertaken to evaluate and compare the effects of dexmedetomidine and fentanyl as intrathecal adjuvants to bupivacaine. The study population was randomized using random number table generated from computer software. Random intervention assignment slip was placed in serially numbered opaque and sealed envelopes. These envelopes were opened following enrolment of the case. 90 total patients randomly divided into 3 groups (n = 30): Group A: Hyperbaric bupivacaine 15mg + dexmedetomidine 5µg (diluted up to 3.5 ml with preservative-free normal saline) were given intrathecally. Group B: Hyperbaric bupivacaine 15mg + fentanyl 25 µg (diluted up to 3.5 ml with preservative-free normal saline) was given intrathecally. Group C: Hyperbaric bupivacaine 15mg (diluted up to 3.5 ml with preservative-free normal saline) alone was given intrathecally. Dexmedetomidine seems to be a better alternative to fentanyl as additive to intrathecal hyperbaric bupivacaine since it produces more prolonged sensory and motor block with similar kind of haemodynamic stability, better post-operative analgesia and sedation and is associated with less adverse effects. This kind of block may be more suitable for lower limb orthopaedic surgeries of longer duration and Dexmedetomidine produces more prolonged sensory and motor block with similar kind of haemodynamic stability, better post-operative analgesia and sedation and is associated with less adverse effects. Intrathecal does of dexmedetomidine used in the present study need further clinical studies to prove its efficacy and safety and to be considered as the suitable dose of dexmedetomidine for supplementation of spinal local anaesthesia.
Authors and Affiliations
Dr. Debabrata Nath Sharma, Dr. Kaberi Sarkar
Keywords
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