Addition of Dexmedetomidine and Fentanyl to Intrathecal Hyperbaric Bupivacaine for Lower Limb Surgeries: A Randomized, Comparative Study

Abstract

Background and aim: There is an unmet need to prolong analgesia duration following regional anesthesia; dexmedetomidine as an adjuvant for the intrathecal block has gained popularity over the last few years. The present study compares the onset, duration of sensory and motor block, postoperative analgesia, hemodynamic changes, and adverse effect of dexmedetomidine or fentanyl as an adjuvant to hyperbaric bupivacaine administered intrathecally.Methods: With approvals, 60 American Society of Anesthesiologists (ASA) physical status I and II adult patients undergoing lower limb surgeries under subarachnoid block were randomized to receive either 5 µg dexmedetomidine (group BD, n=30) or 25 μg fentanyl (group BF, n=30) intrathecally along with 12.5 mg hyperbaric bupivacaine. The time to onset of sensory and motor blockade, time to peak block, intraoperative hemodynamic variations, duration of postoperative analgesia, and associated intraoperative and postoperative complications, if any, were recorded and compared statistically. SPSS v16 (IBM Corp., New York, United States) was used, and P<0.05 was considered significant.Results: The onset of sensory block in group BD was 1.54 ± 0.38 minutes and 3.4 ± 0.40 minutes (P<0.001) in group BF. Time taken for the sensory level to reach T10 in group BD was 3.11± 0.43 minutes and 5.55 ± 0.60 minutes (P<0.001) in group BF. Time taken for two-segment regression in group BD was 160.06 ± 6.85 minutes and 110.4 ± 6.03 minutes (P<0.001) in group BF. The onset of motor block was 2.58 ± 0.437 minutes in group BD and 4.43 ± 0.43 minutes (P<0.001) in group BF. The total duration of analgesia in group BD was 365.8 ± 24.76 minutes and 213.33 ± 20.19 minutes (P<0.001) in group BF. Minimum intraoperative hemodynamic variations were found in group BD, and two groups had comparable side effects. Conclusion: Dexmedetomidine 5 μg added to intrathecal bupivacaine produced early-onset and prolonged block compared with fentanyl 25 μg. No significant attributable adverse effects were noted for both the drugs except the fall in blood pressure, which was gradual in dexmedetomidine but a steep fall in fentanyl.

Dexmedetomidine vs. fentanyl as adjuvants to hyperbaric bupivacaine for unilateral spinal anesthesia in lower limb orthopedic surgeries: a randomized trial

“…6 Also, Kalbande et al found that falls in HR, SBP, and DBP were higher and steeper in the group who received fentanyl 25 µg than those who received DEX 5 µg and were statistically significant. 13 According to block characteristics, our results showed that there was no statistical significance between both groups as regards the highest sensory level, the time taken to reach Bromage III in the side blocked and the time taken to reach the highest sensory level. But time to two-segment regression, time for sensory regression to S1 and time to regression to Bromage 0 in the side blocked, were longer in Group D than Group F, and these differences were highly significant.…”