Dexmedetomidine Versus Fentanyl As An Adjuvant To Low Dose Intrathecal Bupivacaine In Elderly Patients Undergoing Lower Limb Orthopaedic Surgery

ABSTRACT

Introduction– Regional anaesthesia is the method of choice for most elderly patients undergoing elective lower limb orthopedic surgery since it results in reduced blood loss and transfusion needs, modification of the neuroendocrine stress response, producing less postoperative delirium and deep vein thrombosis. Subarachnoid block (SAB) is the most commonly used technique for these procedures as this is the low cost, quickest, most predictable and reliable method of regional anaesthesia. In this study, we aimed to compare the effect of low dose bupivacaine plus fentanyl, and bupivacaine plus dexmedetomidine in terms of characteristics of subarachnoid block, hemodynamic changes, postoperative analgesia and side effects in elderly patients undergoing lower limb orthopaedic surgery. Method– The present cross sectional prospective hospital based study was conducted in the department of anaesthesia, pt J.N.M medical college Raipur (C.G.) India, during study period July 2017 to June 2018. Sixty ASA II and III, elderly patients scheduled to undergo elective lower limb orthopaedic surgeries were allocated into two groups to receive either bupivacaine plus fentanyl (group F) or bupivacaine plus dexmedetomidine (group D) intrathecally. The onset and duration of sensory and motor block, maximum sensory block level and time to achieve highest level of block, duration of analgesia, sedation scores, hemodynamic changes and side effects were recorded and statistically compared between two groups. Results– The groups were comparable with respect to age, height, and weight, and ASA physical status.There was no significant difference between both the groups regarding onset time of sensory block and motor block. Group D had significantly longer duration of sensory block. Motor block was prolonged in group D as compared to group F. The mean duration of analgesia in Group D was 214±39.8 min while it was 369± 33.98 min in Group F, which was statistically significant (p=0.0001). There was no significant difference in hemodynamic parameters and side effects between both the groups. Conclusion– Dexmedetomidine and fentanyl as adjuvant with low dose intrathecal bupivacaine provides satisfactory anesthesia and analgesia with haemodynamic stability in elderly patients undergoing lower limb orthopedic surgeries. However, the clinical advantage of dexmedetomidine over fentanyl is that, it prolongs duration of block and provides excellent quality of post–operative analgesia compared to fentanyl