Comparative effects of dexmedetomidine and fentanyl as adjuvants to hyperbaric bupivacaine in elective caesarean sections: an observational study at tertiary care centre

Abstract

Aim: The aim of the present study to compare the effects of Dexmedetomidine and fentanyl as adjuvants to hyperbaric bupivacaine in elective ceasearen sections. Methods: This prospective study was done in the Department of anaesthesiology, LD hospital an associated hospital of GMC, Srinagar, India from December 2019 to November 2020. The participants included 130 parturient with gestational age ≥37 weeks and ASA I and II candidates for elective caesarean section under spinal anesthesia were included in this study. All 130 patients were randomly and equally divided into the following two groups: Group B-D received 10 mg hyperbaric bupivacaine 0.5%+10 μg dexmedetomidine. Group B-F received 10 mg hyperbaric bupivacaine 0.5%+25 μg fentanyl. Hemodynamic monitoring including SBP and DBP, mean arterial pressure (MAP), heart rate (HR) and peripheral oxygen saturation level (SpO2) were recorded. Patient’s pain score was assessed using visual analogue scale (VAS); scored from 0–10 (where 0=no pain and 10=the worst pain imaginable) during the recovery room (T0) and at one, three, and six hours (T1, T3, and T6) in the postoperative period. If the VAS score was more than 3, a rescue dose of tramadol (100 mg) was administered intravenously. Results: The mean dose of mephentermine in the B-D and B-F groups were 5.45±6.74 and 6.79±5.69mg, respectively. The Mann–Whitney test showed that there was no significant difference between the two groups (P=0.78). With respect to the bradycardia, the mean dose of atropine in the B-D and B-F groups were 0.12±0.28 and 0.06±0.15 mg, respectively. According to the Mann–Whitney test, in this regard, no significant difference was seen between the two groups. (P=0.32). The results of the Mann–Whitney U-test indicated that the onset of block in the B-D group (97.88±32.78 seconds) was significantly faster than in the B-F group (112.03±36.68 seconds) (P=0.041). Considering the level of sensory block, T4 level was shown in 81 (62.31%) patients, from whom 47 (58.02%) and 34 (41.98%) patients were in the B-D and B-F groups, respectively. Moreover, T6 level was observed in 49 (37.69%) patients, from whom 19 (38.78%) and 30 (61.22%) patients were in the B-D and B-F groups, respectively. Chi-squared test revealed that there was no statistically significant difference between the two groups (P=0.13). Conclusion: Compared with fentanyl, it seems that adding 10μg dexmedetomidine to bupivacaine has a better effect on postoperative pain management in cesarean section under spinal anesthesia.