ANALGESIC EFFICACY AND HAEMODYNAMIC PROFILE OF DEXMEDETOMIDINE VERSUS FENTANYL AS EPIDURAL ADJUVANTS – A PROSPECTIVE STUDY

Abstract

BACKGROUND: Combined spinal epidural anaesthesia is the most popular anaesthetic technique for major gynaecological surgeries. Epidural adjuvants enhance the quality and duration of surgical anaesthesia. Adjuvants like opioids or alpha 2 agonists provide a dose sparing effects on local anaesthetics and accelerate the onset of sensory blockade of epidural anaesthesia. Our study was aimed to compare the hemodynamic, sedative and analgesia potentiating effects of Dexmedetomidine and Fentanyl when added to epidural Bupivacaine for gynaecological surgeries. METHODOLOGY: Patients of ASA Grade I and II, aged between 30 and 65 years who were scheduled for major gynaecological surgeries were included in the study. Patients were randomly divided into two groups, Group D (N = 51) and Group F (N = 51). Group D received epidural injection of 0.5 mcg/kg of Dexmedetomidine diluted to 5ml with Normal Saline (NS) and Group F received 0.5mcg/ kg of Fentanyl diluted to 5 ml with NS, in addition to a spinal dose of 3ml of 0.5 % Bupivacaine. When two segment regression of sensory level was noted, epidural block was supplemented with 0.5 mcg /kg of the study drug in combination with 1.5 ml/segment of 0.5% Bupivacaine. Duration of sensory block, motor block, and incidence of bradycardia, hypotension, nausea and pruritus were assessed. RESULTS: The duration of analgesia and motor block were signicantly longer in the Dexmedetomidine group. The incidence of bradycardia was more in the Dexmedetomidine group, but the incidence of hypotension was nearly the same. CONCLUSION: Dexmedetomidine seems to be a better alternative to Fentanyl as an epidural adjuvant due to early onset of sensory anaesthesia and prolonged postoperative analgesia.