A COMPARATIVE STUDY OF PLAIN ROPIVACAINE 0.75% AND DEXMEDETOMIDINE 1 ΜG/Kg ADDED TO ROPIVACAINE 0.75% DURING EPIDURAL ANAESTHESIA IN PATIENTS UNDERGOING LOWER ABDOMINAL SURGERIES

Abstract

BACKGROUNDEpidural anaesthesia can be used as a sole anaesthetic for procedures involving the lower limbs, pelvis, perineum and lower abdomen. Different local anaesthetics are used for epidural anaesthesia, most popular being Lignocaine, Bupivacaine and now Ropivacaine. Ropivacaine is a new amino amide long-acting local anaesthetic and has got all the advantages of ideal local anaesthetic for epidural anaesthesia. Dexmedetomidine, a highly selective α2 agonist, is the most recent agent. It has sedative, analgesic and haemodynamic stabilising effects in addition to reduction of anaesthetic drug requirement when used as an adjuvant in regional anaesthesia. MATERIALS AND METHODSWith Institutional Ethical Committee clearance, this prospective non-blinded randomised clinical study was conducted at Seven Hills Hospital, Visakhapatnam, to compare clinical effects of epidural Ropivacaine 0.75% alone with Ropivacaine plus Dexmedetomidine 1 µg/kg for lower abdominal surgeries among 60 patients of ASA Grade I and II as per inclusion and exclusion criteria. These patients were selected in random fashion [computer-based randomisation] to avoid any kind of bias and to allow comparability of results. Group-A patients received 20 mL of 0.75% Ropivacaine plus 1 mL of sodium chloride 0.9% epidurally and Group-B patients received 20 mL of 0.75% Ropivacaine plus 1 mL of Dexmedetomidine 1 µg/kg diluted with Sodium chloride 0.9%, so that the volume will be completed to 1 mL epidurally in strict aseptic conditions in sitting position at L2-L3 interspace and monitored for sensory and motor blockade parameters and complications occurred among both groups were observed. RESULTSResults showed that the average time of onset of sensory blockade Group-B (4.2 ± 1.21 min) was significantly earlier when compared to Group-A (9.333 ± 2.84 min). Time taken to achieve Highest Sensory Level in Group-B (12.97 ± 2.87 min) was less when compared to Group-A (18.73 ± 2.03 min), duration of sensory blockade in Group-A was shorter with mean value of 284.1667 ± 25.86 minutes compared to mean value of 368.83 ± 25.16 minutes in Group-B. The average onset of motor block for Group-B (17.07 ± 4.60 min) was earlier than Group-A (25.07 ± 3.95 min). The mean total duration of motor blockade of Group-B (302.16 ± 31.03 min) was longer than Group-A (223.5 ± 24.71 min). Coming to complications, Group-A had higher complications when compared to Group-B, but the difference was not statistically significant. But in case of complication-Bradycardia, the proportion of patients having bradycardia was significanlty more in Group-B when compared with Group-A. CONCLUSIONWith this study, we concluded that Dexmedetomidine at a dose of 1 μg.kg -1 added to Ropivacaine 0.75% for epidural anaesthesia provides early onset of sensory and motor blockade and prolongs the duration of analgesia and motor blockade when compared to Ropivacaine 0.75% alone in patients undergoing lower abdominal surgeries. KEYWORDSEpidural Anaesthesia, Ropivacaine, Dexmedetomidine. HOW TO CITE THIS AR...