Comparative study between dexmedetomidine/nalbuphine and midazolam/nalbuphine in monitored anesthesia care during ear surgery

Abstract

BackgroundMonitored anesthesia care (MAC) is the practice of administrating local anesthesia in combination with IV sedatives, anxiolytics and/or analgesic drugs during certain surgical procedures. Most of ear surgeries can be done under monitored anesthesia care.MethodologyThis is a randomized, double blind, prospective study and 100 patients undergoing ear surgery under MAC were divided into two groups of 50 patients each. The patients in group (D) received dexmedetomidine 1 μg/kg IV over 10 min followed by 0.7 μg/kg/h + nalbuphine 100 μg/kg IV and in group (M) received midazolam 20 μg/kg IV followed by 20 μg/kg/h + nalbuphine 100 μg/kg over 10 min. Assessment of sedation by Ramsay sedation score, requirement of intraoperative rescue sedation, intraoperative VAS, intraoperative rescue analgesia, intraoperative hemodynamics, intraoperative bleeding, intraoperative complications, postoperative visual analogue score and postoperative rescue analgesia requirement, time to achieve full recovery and satisfaction scores of patients and surgeon were recorded.ResultsGroup (D) showed more sedation by Ramsay sedation score than the midazolam (M) group. Fifty percent in group (M) needed more rescue sedation than 26% in group (D) (p < 0.05). Intraoperative VAS was significantly higher in group (M) than in group (D) that led to the use of more rescue analgesia in 60% of group (M). Intraoperative heart rate and mean blood pressure were significantly lower in group (D) than in group (M) (p < 0.05). There was no statistical difference between the two groups as regards respiratory rate or SpO2. Intraoperative bleeding is less significantly less in group (D). Intraoperative hypotension was significantly higher in group (D) (30%) than in group (M) (20%). Bradycardia was insignificantly higher in group (D). As regards postoperative VAS, group (D) was significantly lower than group (M). This led to the use of more rescue analgesia in 94% of group (M). There was no statistically significant difference between the two groups as regards recovery time. Patient’s satisfaction was significantly higher in group (D) (80%) compared with group (M) (60%) (p >0.05). The same as regards doctor’s satisfaction where satisfaction was significantly higher in group (D) (76%) than in group (M) (54%).ConclusionWe concluded that the combination of dexmedetomidine/nalbuphine is a better alternative to midazolam/nalbuphine in MAC since it provides analgesia, amnesia and sedation with better intraoperative and postoperative patient satisfaction with better surgical field exposure.