Efficacy of epidural dexmedetomidine versus epidural fentanyl for lower abdominal surgeries using combined spinal epidural (CSE) technique with isobaric ropivacaine

Résumé

Background: The synergism between epidural local anesthetics and opioids is well established, but various other adjuvants have been used with local anesthetics in regional anesthesia to provide analgesia. Dexmedetomidine an α2 agonist is being used as neuraxial adjuvant for the same.

Objectives: To evaluate the effectiveness of analgesia, level of block, hemodynamic parameters, rescue analgesic consumption and side effects of dexmedetomidine and fentanyl when given as adjuvant to epidural ropivacaine.

Study Design: Prospective Observational study

Methods: 100 patients of ASA I and II of either sex, aged between 18-65 years posted for elective lower abdominal surgeries were divided into two groups of 50 each. Group F received 10ml of 0.5% isobaric ropivacaine with fentanyl 1µg/kg while group D received 10ml of 0.5% isobaric ropivacine with dexmedetomidine 1µg/kg for postoperative analgesia.

Results: The demographic profile of patients was comparable in both the groups. Onset of sensory and motor block was earlier in group D as compared to group F (p<0.001) . Heart rate and blood pressure were lower group D as compared to group F. Post -operative VAS score for pain at 24 hours was lower in group D as compared to group F (p<0.001) , thus indicating less rescue analgesic requirement and a better patient satisfaction score in group D. The side effect profile of both the groups was comparable (p=0.242) .

Conclusion: Dexmedetomidine seems to be a better alternative to fentanyl as an epidural adjuvant providing stable hemodynamics, early onset of block, prolonged analgesia and lower consumption of rescue analgesia.

Implication: Dexmedetomidine should be explored for providing post-operative analgesia via epidural route.