COMPARATIVE EVALUATION OF ADDITION OF FENTANYL AND DEXMEDETOMIDINE TO ROPIVACAINE FOR EPIDURAL ANAESTHESIA & ANALGESIA IN LOWER ABDOMINAL AND LOWER LIMB ORTHOPEDIC SURGERIES

Rashpal Singh Gill, Gaurav Acharya, Abhimanyu Rana, K. K. Arora, Dewesh Kumar*, Lokesh Kumar Sonkaria

ABSTRACT

Background: Opioids as epidural adjunct to local anaesthetics (LA) have been in use since long and α-2 agonists are being increasingly used for similar purpose. The aim of this study was to compare the effects of epidurally administered Ropivacaine plus Dexmedetomidine versus Ropivacaine plus fentanyl in lower orthopaedic and limb surgeries. Methods: A total of one hundred patients of both gender aged 21-50 years, American Society of Anesthesiologists (ASA) physical status I and II who underwent lower limb orthopedic surgery were enrolled into the present study. Patients were randomly divided into two groups: Ropivacaine + Dexmedetomidine (RD) and Ropivacaine + Fentanyl (RF), comprising 50 patients each. Inj. Ropivacaine, 15 ml of 0.75%, was administered epidurally in both the groups with addition of 1 μg/kg of dexmedetomidine in RD group and 1 μg/kg of fentanyl in RF group. At the end of study, data was compiled systematically and analyzed using ANOVA with post-hoc significance, Chi-square test and Fisher's exact test. Results: Postoperative analgesia was prolonged significantly in the RD group (358.3±7.864) and consequently low dose consumption of local anaesthetic LA (63.68±9.958 vs 85.96±13.988) during epidural top-ups postoperatively. Sedation scores were much better in the RD group and highly significant on statistical comparison (P<0.001). Conclusions: Dexmedetomidine seems to be a better alternative to fentanyl as an epidural adjuvant as it provides comparable stable hemodynamics, early onset, and establishment of sensory anesthesia, prolonged post-op analgesia, lower consumption of post-op LA for epidural analgesia, and much better sedation levels.

Keywords: Dexmedetomidine, epidural anesthesia, fentanyl, lower limb surgery, ropivacaine.