A Comparative Study between Dexmedetomidine and Fentanyl as Intrathecal Adjuvants to Bupivacaine for Lower Abdominal Surgery

Title: A Comparative Study between Dexmedetomidine and Fentanyl as Intrathecal Adjuvants to Bupivacaine for Lower Abdominal Surgery

Authors: Dr Amit Pradhan, Dr Mahendra Kumar Nayak, Dr Tarangini Das, Dr Ranjeeta Mahapatra, Dr Debasis Mishra

DOI: https://dx.doi.org/10.18535/jmscr/v4i11.06

Abstract

References

Corresponding Author

Abstract

Aims and Objectives: Many adjuvants have been used with local anaesthetics in spinal subarachnoid block for better intraoperative and prolonged postoperative analgesia. The aim of this study is to compare the effects of dexmedetomidine and fentanyl as intrathecal adjuvant to hyperbaric bupivacaine on the onset and duration of sensory and motor block in lower abdominal surgeries.

Materials and Method-Ninety patients of ASA status I and II posted for lower abdominal surgery were randomly divided into two groups. Group D was administered hyperbaric bupivacaine 2.5ml + dexmedetomidine 5µg in 0.5 ml normal saline and group F was administered hyperbaric bupivacaine 2.5ml + fentanyl 25 µg in 0.5 ml normal saline . Duration and quality of sensory and motor block were assessed.

Results-Sensory and motor block in group D patients were longer than group F patients. Time taken for sensory blockade regression to S2 level was longer in D(396.67±24.12 min) group than F(190.60±26.12min) group which was statistically significant. Time taken for motor block regression to bromage 0 is longer in D(388.5±21.24min) group than F(134.8±19.76min) group which was also statistically significant.

Conclusion- Intrathecal dexmedetomidine when added as adjuvant to bupivacaine heavy (0.5%) provided better and prolonged analgesia in comparison to intrathecal fentanyl.

Keyword- Fentanyl, Bupivacaine, Intrathecal, Dexmedetomidine.

References

1. Mulroy M F. Regional anaesthetic techniques. Int Anesthesiol Clin 1994; 32(3):81-98.

2. Choi Dw, Ahn HJ, Kim MH. Bupivacaine-sparing effect of fentanyl in spinal anesthesia for Cesarean delivery. Reg Anesth Pain Med 2000; 25: 240-245.

3. Kusniemi KS, Pihlajamaki KK, Pitkanen MT, Helenius HY, Kirvela OA. The use of bupivacaine and fentanyl for spinal anesthesia for urologic surgery. Anesth Analg 2000; 91: 1452-1456.

4. Al-Mustafa MM, Abu-Halaweh SA, Aloweidi AS, Murshidi MM, Ammari BA, Awwad ZM, et al. Effect of dexmedetom-idine added to spinal bupivacaine for urological procedure.Saudi Med J 2009;30:365-70.

5. Anand VG, Kannan M, Thavamani A, Bridgit MJ. Effects of dexmedetomidine added to caudal ropivacaine in paediatric lower abdominal surgeries. Indian J Anaesth 2011;55:340-6

6. El-Hennawy AM, Abd-Elwahab. Addition of clonidine or dexmedetomidine to bupivacaine prolongs caudal analgesia in children. Br J Anaesth 2009;103;268-74.

7. Kararmaz. A. Kaya S, Turhanoglu. S. et al., “Low dose bupivacaine fentanyl spinal anaesthesia for transurethral prostetect-omy”, Anaesthesia 2003. 58 (6) : 526 – 30.

8. S. Y. Kim, J. E. Cho, J. Y. Hong, B. N. Koo, J. M. Kim and H. K. Kil. Comparison of intrathecal fentanyl and sufentanil in low-dose dilute bupivacaine spinal anaesthesia for transurethral prostatectomy. British Journal of Anaesthesia 103 (5): 750–4 (2009).

9. Nguyen M, Vandenbroucke F, Roy JD, Beaulieu D, Seal RF, Lapointe R, Dagenais M, Roy A, Massicotte L. Evaluation of the addition of bupivacaine to intrathecal morphine and fentanyl for postoperative pain management in laparascopic liver resection. Reg Anesth Pain Med. 2010 May-Jun;35(3):261-6.

10. Idowu OA, Sanusi AA, Eyelade OR. Effects of intrathecally administered fentanyl on duration of analgesia in patients undergoing spinal anaesthesia for elective caesarean section. Afr J Med Med Sci. 2011 Sep;40(3):213-9.

11. AL-Ghanem SM,Massad IM,AI-Mustafa. Effect of adding dexmedetomidine versus fentanyl to intrathecal bupivacaine on spinal block characteristics in gynecol-ogical procedures:A double blind controlled study.Am J Appl Sci.2009; 6:882-7

12. Eid HEA, Mohamed AS, Youssef H et al. Dose-related prolongation of hyperbaric bupivacaine spinal anesthesia by dexmedetomidine. Ain Shams J Anesthesiol 2011; 4(2): 83-95.

13. Mohamed AA, Fares KM, Mohamed SA. Efficacy of intrathecally administered dexmedetomidine versus dexmedetomidine with fentanyl in patients undergoing major abdominal cancer surgery. Pain Physician. 2012 Jul-Aug;15(4):339-48.

14. Jain D, Kumar D, Khan RM, Kumar N et al. Perioperative effect of epidural dexmedetomidine with intrathecal bupivacaine on haemodynamic parameter and quality of analgesia. South Afr J Anaesth Analg 2012;18(1):105-109.

15. S. Fyneface-Ogan, O. Gogo Job, and C. E. Enyindah et al. Comparative Effects of Single Shot Intrathecal Bupivacaine with Dexmedetomidine and Bupivacaine with Fentanyl on Labor Outcome. ISRN Anesthesiology,Volume 2012.

16. Gehan A. Tarbeeh , Ayman A. Mohamed et al. Eﬀects of intrathecal bupivacaine–fentanyl versus bupivacaine–dexmedetom-idine in diabetic surgical patients. Egyptian journal of Anaethesia(2013) 29, 13-18.

17. Alka Shah, Ila Patel, Rachana Gandhi et al. Haemodynamic effects of intrathecal dexmedetomidine added to ropivacaine intraoperatively and for postoperative analgesia. International Journal of Basic & Clinical Pharmacology | January-February 2013 | Vol 2 | Issue 1, 26-29.

18. Kanazi GE, Aouad MT, Jabbour-Khoury SI, Al Jazzar MD, Alameddine MM, Al-Yaman R, et al. Effect of low-dose dexmedetomidine or clonidine on the characteristics of bupivacaine spinal block. Acta Anesthesiol Scand 2006;50:222-7.

19. Gupta R,Verma R,Bogra J.A Comparative study of intrathecal dexmedetomidine and fentanyl as adjuvants to Bupivacaine.J Anaesthesiol Clin Pharmacol.2011.july-sept;27(3):339-343

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