Comparative Efficacy of Fentanyl Vs Dexmedetomidine Intrathecally as an Adjuvent to Isobaric Levo-Bupivacaine in Infra-Umbilical Surgery: A Prospective Randomized Study

Abstract

Background: Fentanyl is a potent, highly lipophilic, synthetic opioid analgesic used as an adjuvant in spinal anaesthesia. Dexmedetomidine is also a potent, lipophilic, selective α2-adrenergic agonist. Compared to Dexmedetomidine, it has an earlier onset of block, better intraoperative analgesia with increased side effects(such as, nausea, vomiting or respiratory depression). Aim: To compare Fentanyl(25 ug) versus Dexmedetomidine(10 ug) as an adjuvant with 0.5% isobaric Levo-Bupivacaine in infra-umbilical surgeries. Material & Methods: A prospective, randomized, controlled study. Department of Anaesthesia, K. D. Medical College, Hospital and Research Centre in Mathura. Patients between 20-60 years of either sex, ASA Grade I – II, scheduled for elective infra-umbilical procedures with no co-morbid conditions. Simple random method(sealed envelope). Results: The sensory block duration is 7.71±0.31 hrs in D group and 3.78±0.83 hrs in group F with p value <0.05. The mean time taken for attaining motor blockade is 2.06 ± 1.17 mins in D group, 2.45 ± 1.39mins in F group. but statistically not significant between group D and in F group (p=0.2). The motor block duration is 7.33 ± 0.28hrs in group D and 3.39 ± 0.91 hrs in F group which suggestive of statistically highly significant (p=0.001). Conclusion: In infra-umbilical surgery, levo-Bupivacaine with adjuvant dexmedetomidine (10 ug) intrathecally has a longer duration of sensory and motor block with preserved hemodynamic stability and lesser adverse effects in comparison to adjuvant fentanyl(25 ug). However, onset of sensory block is earlier with fentanyl.