Abstract
Background and Aims. The potentiating effect of short acting lipophilic opioid fentanyl and a more selective α2 agonist dexmedetomidine is used to reduce the dose requirement of bupivacaine and its adverse effects and also to prolong analgesia. In this study, we aimed to find out whether quality of anaesthesia is better with low dose bupivacaine and fentanyl or with low dose bupivacaine and dexmedetomidine Methods. This prospective randomised double-blinded study was carried out in a AL-Zahra teaching Hospital a 150 patients by randomly allocating them into two groups using a computer generated randomisation table. Group F (n = 75) received bupivacaine 0.5% heavy (0.8 ml)+fentanyl 25 μg (0.5 ml) + normal saline 0.3 ml and Group D (n = 75) received bupivacaine 0.5% heavy (0.8 ml) + dexmedetomidine 5 μg (0.05 ml) + normal saline 0.75 ml, aiming for a final concentration of 0.25% of bupivacaine (1.6 ml), administered intrathecally. Time to reach sensory blockade to T10 segment, peak sensory block level (PSBL), time to reach peak block, time to two segment regression (TTSR), the degree of motor block, side-effects, and the perioperative analgesic requirements were assessed. Results. there were no significant differences between the groups in the time to reach T10 segment block (P > 0.05) and TTSR (P > 0.05);time to reach PSBL (P < 0.05) and modified Bromage scales (P < 0.05) were significant. PSBL (P = 0.000) and time to first analgesic request (P = 0.000) were highly significant. All patients were haemodynamically stable and no significant difference in adverse effects was observed. Conclusion .Both groups provided adequate anaesthesia for all lower abdominal surgeries with haemodynamic stability. Dexmedetomidine is superior to fentanyl since it facilitates the spread of the block and offers longer post-operative analgesic duration. Keywords : Dexmedetomidine, fentanyl, low dose bupivacaine, opioids, spinal anaesthesia DOI: 10.7176/JHMN/90-09 Publication date: June 30 th 2021
Highlights
Spinal anaesthesia is a simple technique with rapid onset of action
We aimed to find out whether quality of anaesthesia is better with low dose bupivacaine and fentanyl or with low dose bupivacaine and dexmedetomidine
We assessed time to reach T10 block level, peak sensory block level (PSBL), time to reach peak block level, time to two segment regression (TTSR) and degree of motor blockade.Sensory block level which was defined as the loss of pain sensation to pin prick test in the midclavicular line, was measured every 1 min until it reached T10 level, and the surgeons were asked to start and every 2 min until it reached PSBL
Summary
Spinal anaesthesia is a simple technique with rapid onset of action. a commonly used anaesthetic like lidocaine has neurotoxic effects and this has been been largely replaced by other agents such as bupivacaine. The potentiating effect of short acting lipophilic opioid fentanyl and a more selective α2 agonist dexmedetomidine is used to reduce the dose requirement of bupivacaine and its adverse effects. These spinal adjuncts are used to reduce side-effects of local anaesthetics, and to prolong analgesiaFor lipophilic opioids like fentanyl and sufentanil, the risk of respiratory depression is predominantly limited to the first 2 h after intrathecal injection.[2]. The potentiating effect of short acting lipophilic opioid fentanyl and a more selective α2 agonist dexmedetomidine is used to reduce the dose requirement of bupivacaine and its adverse effects and to prolong analgesia.
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