A Comparison of Intrathecal Dexmedetomidine and Fentanyl as Adjuvant to Spinal Bupivacaine in Lower Abdominal and Lower Limb Surgeries- A Double Blind Randomised Study.

ABSTRACT

Spinal anaesthesia is a popular regional anaesthetic technique. Hyperbaric bupivacaine is the most common intrathecally used local anaesthetic. Use of intrathecal adjuncts with local anaesthetic helps to prolong the duration of analgesia and decreases the local anaesthetic dosage. We compared dexmedetomidine and fentanyl as adjuncts to intrathecal hyperbaric bupivacaine.METHODSA randomised double blind control study was conducted on 120 patients posted for elective lower abdominal and lower limb surgery under spinal anaesthesia in a tertiary care hospital. Group A received 2.5 mL of 0.5% hyperbaric bupivacaine with 0.5 mL of 0.9% saline into the sub-arachnoid space. Group B received 2.5 mL of 0.5% hyperbaric bupivacaine with 0.5 mL of dexmedetomidine (5 µg) into sub-arachnoid space. Group C received 2.5 mL of 0.5% hyperbaric bupivacaine with 0.5 mL of fentanyl (25 µg).RESULTSThere was a statistically significant drop in HR as early as 25 minutes in the dexmedetomidine group compared to saline group (p=0.033); and at 30 minutes in fentanyl group compared to saline group (p=0.015). Significant drop in SBP was seen at 30 minutes after the centrineuraxial blockade in the dexmedetomidine group compared to saline group (p=0.012) and remained so till 180 minutes after the blockade.CONCLUSIONSThe combination of 0.5% hyperbaric bupivacaine with dexmedetomidine (5 µg) is better compared to 0.5% hyperbaric bupivacaine with fentanyl (25 µg) or 0.5% hyperbaric bupivacaine alone in providing analgesia, as the combination offers a convenient, simple, inexpensive, effective and safe means of good post-operative analgesia for lower abdominal & lower limb surgery.