A comparative study between intrathecal isobaric ropivacaine 0.75% plus dexmedetomidine and isobaric ropivacaine 0.75% plus fentanyl for lower limb surgeries

Abstract

Background:Spinal anesthesia is used commonly intraoperatively. However, local anesthetics are associated with relatively short duration of action. A number of adjuvants have been used to prolong the postoperative analgesia.Objectives:To compare efficacy of dexmedetomidine and fentanyl when given intrathecally as an adjuvant to 2.5 ml of 0.75% isobaric ropivacaine.Materials and Methods:Sixty selected patients were randomized to receive 2.5 ml of 0.75% isobaric ropivacaine with dexmedetomidine 5 mcg (Group RD) or 20 mcg of fentanyl (Group RF) intrathecally for lower limb surgeries, block characteristics, hemodynamic changes, and adverse effects were compared.Results:Efficacy of both the drugs when given intrathecally was studied. Mean time needed for sensory blockade at T10 was 156.4667 ± 33.78 s in Group RD and 185.2000 ± 35.17 s in Group RF. The results are clinically and statistically significant (P - 0.002). The mean of total duration of sensory block in Group RD was 194.400 min while it was 139.9000 min in Group RF which was clinically and statistically significant (P - 0.0001). Time taken for onset of motor block was almost same in both groups. The mean of total duration of motor block in Group RD was 136.7333 min while it was 94.8667 min in Group RF which was clinically and statistically significant (P - 0.000).Conclusion:Dexmedetomidine at a dose of 5 μg added to 2.5 ml of ropivacaine provided earlier sensory blockade, prolonged duration of sensory and motor blockade for patients under intrathecal anesthesia for lower limb surgeries with no sedation.

Comparative addition of dexmedetomidine and fentanyl to intrathecal bupivacaine in orthopedic procedure in lower limbs

“…The highest decline occurred 5 min after spinal injection and was rather stable afterwards. Unlike our findings, other studies did not report any significant difference between fentanyl and dexmedetomidine regarding hemodynamic status [ 12 , 13 , 15 – 18 ]. Decline in HR and blood pressure are common effects of opioids.…”

“…Previous studies have reported different rate of side effects. Similar to our findings, Ravipati [ 15 ] observed pruritus only in fentanyl group while nausea and vomiting was more common in dexmedetomidine, with no significant difference between groups. There is also only one study reporting increase in hemodynamic side effects, bradycardia and hypotension, in dexmedetomidine [ 24 ].…”

“…Similarly, Mahendru et al [ 12 ] found no significant difference in onset of motor block between dexmedetomidine and fentanyl groups. While Yektas [ 13 ] and Ravipati [ 15 ] reported faster onset of motor block for dexmedetomidine compared to fentanyl. Other studies have also mentioned lower time to reach the highest sensory level in dexmedetomidine compared to fentanyl [ 12 – 19 ].…”

“…In our study, the highest sensory level in BD and BF group were T6 and T5 while in BN group was T6 and T7 dermatomes. One study reported the highest sensory level at T5 dermatome [ 15 ] and Mahendru [ 12 ] reported in T6 dermatome. Other study reported the highest sensory level at T5 dermatome in dexmedetomidine and T6 in fentanyl group [ 20 ].…”

Comparison of dexmedetomidine and fentanyl as adjuvant to intrathecal levobupivacaine in lower segment cesarean section: A prospective, randomized double blind study

“…mean onset time of sensory and motor blockade was significantly shorter in Group LF than Group LD or Group L. Contrary to our finding, other studies report that time of onset of sensory and motor blockade was earlier in dexmedetomidine group than fentanyl group. 17,18 The differences in sensory and motor onset time could be due to the use of isobaric levobupivacaine (0.5%), volume of the used diluent, rapidity of intrathecal injection and more lipophilic nature of fentanyl.…”