OBJECTIVE:

Our study compared the effect of epidural ropivacaine plus dexmedetomidine with epidural ropivacaine plus fentanyl for comparing the sedative, and analgesia potentiating effects of epidurally administered fentanyl and dexmedetomidine when combined with ropivacaine in total hip replacement surgeries during intra and post operative period.

Materials and Methods:

Sixty patients undergoing total hip replacement were randomized into two groups. In first group Inj. Ropivacaine, 20 ml of 0.5%, with addition of 1 μg/kg of dexmedetomidine(RD group) was administered epidurally while second group received Inj. Ropivacaine, 20 ml of 0.5%, with addition of 1 μg/kg of fentanyl ( RF group).  The intraoperative pain and postoperative pain relief was evaluated by a visual analog scale (VAS) using a 10cm visual analog scale. sedation scores and 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.

Results:

Onset of sensory analgesia at T10 (6.87±1.86 vs 9.89±5.67) and establishment of complete motor blockade (15.89±9.52 vs 19.12±8.79) was significantly earlier in the RD group than in RF group. Postoperative analgesia was prolonged significantly in the RD group (387.62±14.38 vs 278.37±14.67) and consequently less consumption of ropivacaine(54.34±17.23 vs 87.38±12.63) during epidural top–ups postoperatively. Sedation scores were better in the RD group and highly significant on statistical comparison (P<0.05). Incidence of nausea and vomiting was significantly high in the RF group (26% and 6%), and incidence of pruritis was also significantly higher in the RF group (23%) (P<0.05).

Conclusions:

Our results showed dexmedetomidine  to be a better alternative than fentanyl as an epidural adjuvant as it provides 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.