Role of fentanyl vs dexmedetomidine as an adjuvant to ropivacaine in epidural anaesthesia for infra–umblical surgeries.

Apurva abhinandan mittal; Archna Agarwal; Sathiyanarayanan Pilendran; Trilok chand; Arpita Saxena

Volume : V, Issue : III, March - 2016

Role of fentanyl vs dexmedetomidine as an adjuvant to ropivacaine in epidural anaesthesia for infra–umblical surgeries.

Apurva Abhinandan Mittal, Archna Agarwal, Sathiyanarayanan Pilendran, Trilok Chand, Arpita Saxena

Abstract :

Role of fentanyl vs dexmedetomidine as an adjuvant to ropivacaine in epidural anaesthesia for infra–umblical surgeries. Background: Epidural fentanyl has been widely used in neuraxial blockades. However, the addition of opioids has an increased incidence of pruritus,nausea,vomiting and respiratory depression. Dexmedetomidine, a highly selective alpha 2 agonist can produce analgesia and sedation without compromising respiratory function. Material and Methods: This is a prospective randomized double blinded case control study which included 120 adult ASA grade I and II patients requiring infra–umbilical gynecologic or orthopedic surgery. Patients were randomly divided into three groups. The patient received either 18.5 ml 0.75% Ropivacaine with dexmedetomidine 1mcg /kg(0.5 ml) (Group–1) or 18.5 ml 0.75% Ropivacaine with fentanyl 1 mcg/ kg(1ml) (Group–2) or 18.5 ml 0.75% Ropivacaine with 0.5 ml of 0.9% normal saline (Group–3). Block characteristics along with hemodynamic parameters, sedation and adverse effects, if any were recorded. Results: In our study, both dexmedetomidine and fentanyl as an adjuvant to ropivacaine provided better block characteristics compared to ropivacaine alone in relation to time of onset of sensory blockade at T10 level, maximum height of sensory block, time to reach maximum sensory blockade level, time to reach complete motor block, time to two segmental regression, time of segmental regression to L5 and time of complete motor recovery at the cost of increased incidence of hypotension and vasopressor use. Conclusion: As compared to fentanyl, epidural dexmedetomidine provides better sensory motor block in patients of infraumblical surgeries but with increased yet manageable hypotension.