Comparative Study of Dexmedetomidine versus Fentanyl as an Adjuvant to Ropivacaine (0.75%) in Epidural Anaesthesia in Lower Limb Orthopaedic SurgeryArticle Text (original) (raw)
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Saudi Journal of Anaesthesia, 2011
Background and Aims: Opioids as epidural adjunct to local anesthetics (LA) have been in use since long and α-2 agonists are being increasingly used for similar purpose. The present study aims at comparing the hemodynamic, sedative, and analgesia potentiating effects of epidurally administered fentanyl and dexmedetomidine when combined with ropivacaine. Methods: A total of one hundred patients of both gender aged 21-56 years, American Society of Anaesthesiologist (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 patie nts 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. Besides cardio-respiratory parameters and sedation scores, various block characteristics were also observed which included time to onset of analgesia at T10, maximum sensory analgesic level, time to complete motor blockade, time to two segmental dermatomal regressions, and time to first rescue analgesic. 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. Value of P<0.05 is considered significant and P<0.001 as highly significant. Results: The demographic profile of patients was comparable in both the groups. Onset of sensory analgesia at T10 (7.12±2.44 vs 9.14±2.94) and establishment of complete motor blockade (18.16±4.52 vs 22.98±4.78) was significantly earlier in the RD group. Postoperative analgesia was prolonged significantly in the RD group (366.62±24.42) and consequently low dose consumption of local anaesthetic LA (76.82±14.28 vs 104.35±18.96) during epidural top-ups postoperatively. Sedation scores were much better in the RD group and highly significant on statistical comparison (P<0.001). Incidence of nausea and vomiting was significantly high in the RF group (26% and 12%), while incidence of dry mouth was significantly higher in the RD group (14%) (P<0.05). 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.
International Journal of Contemporary Medical Research [IJCMR], 2019
Introduction: Epidural anasthesia is a common method for anaesthetic management after lower limb orthopaedic surgery. The aim is to study the anesthetic effects along with hemodynamics and adverse effects, if any when fentanyl and dexmeditomidine are used as an adjuvant to 0.75% Ropivacaine in epidural anesthesia for major lower limb orthopaedic surgery. Material and methods: The study included 100 cases classified randomly into two groups (each=50): Group RF: Patient receiving epidural anesthesia with 15 ml of 0.75% Ropivacaine and 1microgram/kg Fentanyl. Group RD: Patients receiving epidural anesthesia with 15 ml of 0.75% Ropivacaine and 1microgram/Kg of Dexmeditomidine. Results: The quality of analgesia was better with dexmedetomidine than fentanyl group (p<0.05), andthe requirement for first rescue top up was significantly latter with dexmedetomidine than fentanyl group (p<0.05).In our study while comparing the adverse effects between the two groups we did not found any significant difference between the two groups statistically. The incidence of nausea and vomiting was higher in fentanyl group while incidences of urinary retention, shivering and dry mouth was higher in dexmedetomidine group. Conclusion: Dexmedetomidine is a better adjuvant to epidural ropivacaine compared to fentanyl for epidural anaesthesia in patients undergoing lower limb orthopaedic procedures.
2018
Adequate and timely acute perioperative pain management after major orthopedic surgery is an essential part of perioperative anesthesia to facilitate patient comfort and early mobilization. Epidural anesthesia is commonly used technique for surgical anesthesia as well as postoperative analgesia. It provides good postoperative pain relief lead to early mobilization and rehabilitation with minimum discomfort. The newer amide local anesthetic agent ropivacaine shows better alternative for bupivacaine as it has physiochemical properties similar to bupivacaine but has less systemic toxicity and greater margin of safety. It is s-enantiomer form so has less cardiac and neurotoxicity in comparison to bupivacaine. It also has early recovery of motor function lead to early mobilization and shorter stay in hospital which also has benefit as decrease chances of thromboembolism.
Journal of Evolution of Medical and Dental Sciences
BACKGROUND Epidural anaesthesia is now increasingly being used for lower limb surgeries for its certain advantages. Different adjuvants have been used with epidural ropivacaine to prolong the intraoperative and postoperative analgesia. Evidence is growing in favour of dexmedetomidine as an epidural adjuvant. Different doses of dexmedetomidine have been used with epidural ropivacaine with variable success in modifying the block characteristics and adverse event profile. The aim of the present study was to compare the block characteristics between epidural ropivacaine with dexmedetomidine (2 µg/kg) as adjuvant and epidural ropivacaine alone in patients undergoing lower limb surgeries. MATERIALS AND METHODS In this randomised, double-blinded study, 88 adult patients of either sex, aged between 40-65 years, scheduled for elective lower limb surgery under epidural anaesthesia, were randomly allocated into two groups to receive either 0.75% ropivacaine alone (Group A) or dexmedetomidine (2 µg/kg) as an adjuvant to ropivacaine 0.75% (Group B) in epidural space. Data from 40 patients of each group were finally analysed. The time to achieve T6 sensory block (Primary outcome), time to reach maximum sensory block, time to achieve complete motor block, time to two-segment regression of sensory block and duration of analgesia were noted in all cases. The incidences of adverse events such as nausea, vomiting, hypotension, dry mouth, bradycardia, desaturation, respiratory depression, etc. were also noted. Statistical analysis was performed using independent sample Student's 't' test for normally distributed variables and Pearson Chi-square test for categorical data. The level of significance was set as P < 0.05. RESULTS The time to achieve sensory block at T6 level in group B (9.45±1.04 minutes) was significantly shorter than group A (13.65±1.12 minutes), P<0.05. The time to achieve maximal sensory block and time to achieve complete motor block were also found shorter in dexmedetomidine group. Sensory block regressed later in dexmedetomidine group compared to control (157.03±7.87 versus 118.47±7.32 minutes, respectively, P <0.05). The time to first rescue epidural top-up was prolonged in dexmedetomidine group compared with ropivacaine alone group (346.12±17.29 versus 327.98±17.60 minutes, respectively). Incidences of adverse events were comparable. CONCLUSION Epidural dexmedetomidine is a reliable adjuvant with ropivacaine (0.75%) to provide early onset of sensory block and longer duration of analgesia in lower limb surgeries.
Innovative publication, 2016
Background: Ropivacaine, the pure S enantiomer of propivacaine, due to its less lipophilicity than bupivacaine does not produce cardiotoxicity or neurotoxicity and causes less motor blockade. Dexmedetomidine the newer selective alpha 2 adrenergic agonist has several advantages when given through epidural route as a neuraxial adjuvant. Aim: To compare 0.75% Inj.Ropivacaine with Inj.Fentanyl and 0.75% Inj.Ropivacaine with Inj.Dexmedetomidine epidurally for the duration of analgesia, hemodynamic changes, degree of motor blockade and occurrence of side effects. Materials and Methods: 60 patients undergoing lower limb orthopaedic surgeries were randomized to two groups. Group RF (n=30) received 0.75% Inj.Ropivacaine 20 cc with Inj.Fentanyl 50 mcg whereas Group RD (n=30) received 0.75% Inj.Ropivacaine 20 cc with Inj.Dexmedetomidine 50 mcg in normal saline diluted upto 1cc. Quality of sensory block, motor block, pulse rate, blood pressure, pain assessment and any adverse outcome were noted. Statistical analysis was done by student's paired t-test for intragroup comparison and unpaired t-test for intergroup comparison and p<0.05% was taken to be significant. Results: Dexmedetomidine fastens the onset of analgesia, prolongs the duration of analgesia thereby reducing the doses of rescue analgesics post operatively, improves the quality of motor blockade without aggravating changes in haemodynamic parameters and has less adverse effects. Conclusion: We conclude that dexmedetomidine serves as a good neuraxial adjuvant when added to 0.75% ropivacaine in epidural anaesthesia given for lower limb orthopaedic surgery.
Journal of Evolution of Medical and Dental Sciences, 2019
BACKGROUND LA with IV sedation is referred to as twilight anaesthesia. The choice and route of anaesthesia administration is paramount to the patient's overall surgical experience. The qualities of a good sedative or anaesthetic agent include sedation, anxiolysis, analgesia and amnesia. This study was planned to compare effects of IV Dexmedetomidine and IV Fentanyl that lead to changes in hemodynamic response. Aims and Objectives 1. To compare Dexmedetomidine and Fentanyl in surgery requiring Local Anaesthetic with respect to IV sedation, analgesia, anxiolysis and hemodynamic changes. 2. To compare post-operative recovery time. 3. To compare side effects of the drugs. 4. To compare patient satisfaction. MATERIALS AND METHODS A total of 60 patients in the age group of 18-60 yrs. of either sex undergoing elective surgery requiring local anaesthetic agent with IV sedation, categorized under ASA 1, 2 were included. These patients were divided into 2 groups of 30 patients each. Sample size was taken for convenience. Group A patients received Dexmedetomidine 1 mcg/kg IV loading dose over 10 mins followed by 0.2 mcg/Kg/hr IV infusion. Group B patients received fentanyl 1 mcg/Kg IV over 10 mins followed by 0.5 mcg/Kg/hr IV infusion. Heart rate mean arterial blood pressure, respiratory rate, SpO2 were recorded every 10 mins. Tramadol 2 mg/Kg slow IV was given as rescue analgesic and the surgeon used an additional dose of local anaesthetic. Ramsay sedation score was assessed. Visual Analogue Scale of more than 3, analgesia was provided with 75 mg slow IV diclofenac. Aldrete score was assessed in recovery room. RESULTS From statistical data derived, it was observed that dexmedetomidine provided more sedation (RSS: 2+0.6 with fentanyl, RSS: 3±1.3 with dexmed), anxiolysis and hemodynamic stability as compared to fentanyl. For analgesia, results were comparable for both groups (5.9-6.9 with dexmed, 7.4-8.3 with fentanyl). Bradycardia (13.3% in dexmed and 3.3% in fentanyl) and hypotension (6.6% in dexmed and 3.3 % in fentanyl) were more common with dexmedetomidine than with fentanyl. Itching was 30 % more common with fentanyl while only 3.3% in dexmed. CONCLUSION Dexmedetomidine provides better sedation and anxiolysis by decreased heart rate, systolic BP, diastolic BP, mean BP. Analgesic effect is comparable in both groups. Dexmedetomidine causes less nausea and vomiting, shorter recovery period and a higher level of patient and surgeon's satisfaction than fentanyl.
Global Anesthesia and Perioperative Medicine, 2015
Background: Epidural block provides surgical anesthesia as well as post-operative analgesia in patients undergoing lower abdominal surgeries. Ropivacaine, is safe and effective for regional anesthetic techniques. Dexmedetomidine, alpha-2 agonist, as adjuvant to local anesthetic is reported to have synergistic effect for epidural anesthesia. The present study was designed with the aim to evaluate the efficacy and safety of dexmedetomidine as an adjuvant to epidural 0.75% ropivacaine in patients undergoing infraumbilical surgery. Method: Eighty adult consented patients 18-58 yr of age, of either sex, of ASA grade I/II undergoing infraumbilical surgeries were enrolled for the present study. Patients were randomised in two groups of 40 patients each: Group A received epidural ropivacaine only whereas Group B received epidural ropivacaine and dexmedetomidine. Patients of group A received 15 ml 0.75% ropivacaine + 1 ml Normal Saline and group B received 15 ml 0.75% ropivacaine + 0.6 µ kg-1 dexmedetomidine in 1 ml NS (group B) epidurally. Various block characterstics sensory onset time, time to complete motor block, time to two dermatome regression, duration of sensory analgesia and motor block, sedation scores, hemodynamic changes and any side effect were all recorded and statistically analysed by one way ANOVA and chi-square test. The p value<0.05 is considered significant and p<0.001 as highly significant. Results: The demographic profile of patients was comparable in both the groups. Onset of sensory block (2.50 ± 0.877 vs 7.00 ± 1.198 min) and establishment of complete motor blockade (17.20 ± 4.10 vs 23.90 ± 3.57 min) was significantly earlier in the ropivacaine with dexmedetomidine group. Postoperative analgesia was prolonged significantly in the ropivacaine with group (429.25 ± 58.34 min). Sedation scores were also higher in the dexmedetomidine group with statistically highly significant difference (p<0.001). Incidence of nausea, vomiting and shivering were were more in patients of ropivacaine alone group with statistically significant difference (p=0.003) Conclusion: Dexmedetomidine is effective adjuvant with ropivacaine for epidural block as it prolongs duration of motor block and analgesia with adequate sedation and minimal side effects.
Introduction: Epidural blockade is one of the best procedures, providing better intra operative hemodynamic control, post operative pain relief and rapid recovery from surgery specially pelvic surgeries and orthopedic surgeries. Selective alpha 2 adrenergic agonist used as adjuvant in epidural blockade. Dexmedetomidine a more powerful and highly selective alpha 2 adrenoceptor agonist than clonidine. This study was designed to investigate appropriate doses 1.0, 1.5, 2.0 mcg/kg of dexmedetomidine added to bupivacaine for epidural block to prolong postoperative pain relief and reduce the requirement of rescue analgesia in pelvic and lower limb orthopedic surgeries with least side effects. Material and methods: In our randomized control trial study, total 100 ASA class I and II patients of age between 15 to 65 years undergoing lower limb orthopedic and pelvic surgeries were given epidural block and studied for addition of dexmedetomidine on intra operative hemodynamic and post operative analgesia. Patients received 0.5% bupivacaine 20 ml alone in one group and with added Dexmedetomidine 1.0, 1.5, 2.0 mcg/kg in the other 3 groups respectively. All the patients were monitored for onset of sensory and motor blockade, intra operative hemodynamic, post operative analgesia, adverse effect and complications. Result: Onset of sensory and motor blockade was same in all four groups. Addition of Dexmedetomidine increases the post operative pain free period significantly with all doses of dexmedetomidine. An increase of dose beyond 1.5 mcg/Kg did not further improved pain free period and in fact lowered by 1.24 hours and the incidences of complications started appearing which were absent up to 1.5 mcg/Kg dose. The incidence of side effects like hypotension, Bradycardia and shivering were not seen in patients receiving 1.0 and 1.5 mcg/Kg of Dexmedetomidine with bupivacaine. In patients receiving 2.0 mcg/Kg dexmedetomidine with bupivacaine 24 % of the patients had hypotension and Bradycardia and 4 % had shivering. Conclusion: Addition of Dexmedetomidine in dose range of 1.0 to 1.5 mcg/Kg substantially prolongs postoperative analgesia without altering block characteristics offered by Bupivacaine for epidural blockade with no side effects and appears to be safe and reliable adjuvants.
Southern African Journal of Anaesthesia and Analgesia
This randomised, double-blind study was designed to assess the analgesic efficacy of dexmedetomidine as compared with fentanyl as an adjunct to local anaesthetic in thoracic epidural for upper abdominal surgeries. Methods: Forty adult patients of American Society of Anesthesiologists grade I-II undergoing upper abdominal surgery were randomly allocated into two groups to receive 50 μg fentanyl or 50 μg dexmedetomidine as an adjunct to 10 ml 0.125% bupivacaine via thoracic epidural. Anaesthesia was induced with morphine, propofol and vecuronium and maintained by isoflurane with 60% nitrous oxide in oxygen. In the postoperative period patient-controlled analgesic pumps were used to deliver similar types of mixtures via the epidural catheter. Patients were evaluated for rescue analgesic requirements, haemodynamic stability, postoperative pain, sedation and any adverse events. Results: The groups were comparable regarding intraoperative analgesic requirements, recovery times and postoperative pain scores. The total consumption of rescue analgesia was significantly less in the dexmedetomidine group as compared with the fentanyl group (p = 0.049). Two patients in the fentanyl group had vomiting and one had pruritus. None of the patients had bradycardia, hypotension, excessive sedation or respiratory depression. Patients receiving epidural dexmedetomidine were more satisfied with the technique than those receiving fentanyl (p < 0.001). Conclusion: It was concluded that the addition of dexmedetomidine with 0.125% bupivacaine in thoracic epidural provides effective perioperative analgesia with greater patient satisfaction compared with fentanyl.
Pakistan Journal of Medical and Health Sciences, 2021
Objective: To compare the analgesic effectiveness of Dexmedetomidine and Fentanyl as an adjuvant to 0.5% Bupivacaine in spinal anaesthesia for patients undergoing lower limb surgery. Study Design: Randomized controlled trial. Place & Duration:The study was conducted at department of Anesthesia, Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi for duration from 15thJuly2020 to 15thFebruary 2021. Methods: In this study 52 patients of both genders undergoing lower limb surgeries were included. Patient’s ages were ranging from 20 to 70 years. All the patients were divided into two Groups. Group A included 26 patients and received Inj. Dexmedetomidine 10 μg in 0.5ml normal saline with 12.5mg of 0.5% hyperbaric bupivacaine, Group B had 26 patients and received 25mg fentanyl with 12.5mg of 0.5% hyperbaric bupivacaine. Time to achieve T10 blockade, time to first rescue analgesia were examined and compare between both groups. All the statistical data was analyzed by SPSS 24.0. P-...