Comparative Study of Intrathecal 0.5% Hyperbaric Bupivacaine with Dexmedetomidine and Fentanyl for Lower Abdominal Surgeries: A Randomized Double-blind Clinical Trial
Abstract
Background: In this modern year, the intrathecal adjuvants use has gained good acceptance in the field of anesthesiology. The
spinal anesthesia quality is very much improved with addition of opioids and other drugs and as we know, no drug is without
side effects. Spinal block has rapid onset, lower risk of infection rate and is very cost effective. However, post-operative pain
is a very significant problem as the drugs used have limited duration of action. Hence, the administration of analgesics plays
a key role postoperatively. To increase the duration and to reduce side effects, various local anesthetics and analgesics are
used in combination. Some of the drugs have been used as adjuvants in spinal anesthesia to prolong intra- and post-operative
analgesia which includes opioids, α2 agonists, vasoconstrictors, and other drugs.
Aim of the Study: The aim of the current study is to compare the efficacy of dexmedetomidine and fentanyl added to intrathecal
bupivacaine to evaluate the onset and duration of sensory and motor block, post-operative analgesia, hemodynamic effects,
and adverse effects of either drug in lower abdominal surgeries.
Materials and Methods: Sixty patients with the American Society of Anesthesiologists Grade I and II posted for lower abdominal
surgeries were allocated to two groups randomly (30 patients each): Group D received 2.5 ml 0.5% hyperbaric bupivacaine and
5 μg of dexmedetomidine intrathecally and Group F received 2.5 ml 0.5% hyperbaric bupivacaine and 25 μg of fentanyl intrathecally.
Results: Patients in Group F had faster onset of sensory block and motor block than Group D (P = 0.000). Patients in Group D
had significantly longer duration of motor and sensory blockade as compared to those in Group F (P = 0.000). Post-operative
analgesia was significantly longer in Group D than Group F (P = 0.000). Incidence of side effects among the two groups was
not statistically significant.
Conclusions: Fentanyl has its own benefits like faster onset compared with dexmedetomidine, but prolonged duration of motor
and sensory blockade with post-operative analgesia was seen with dexmedetomidine without significant side effects.
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