Abstract
Objective: Spinal or epidural anesthesia techniques provide the best method of anesthesia for lower abdominal and lower limb surgeries. Small doses of adjuvants administered spinally provide profoundly prolonged segmental analgesia with good post-operative pain relief. The objective of the present study is to evaluate the efficacy of dexmedetomidine (10 μg) versus fentanyl (25 μg) as an adjuvant added to bupivacaine in spinal anesthesia for patients undergoing lower abdominal and gynecological surgeries and assessment of duration of post-operative analgesia.
 Methods: Hospital-based randomized double-blind controlled study conducted in tertiary teaching hospital of Kakinada and Rajahmundry. The period of study is February 2013–July 2018. Patients were divided into two groups of 25 each. In the first group, dexmedetomidine was added as adjuvant to bupivacaine whereas in the second group fentanyl was added as an adjuvant to bupivacaine. The visual analog scale used to assess the analgesic effect. Time at which the rescue analgesic given was noted which gives the duration of post-operative analgesia.
 Results: Results were analyzed in both groups. The software used for statistical analysis was GraphPad for windows 10.0.5. Continuous variables were analyzed with student t-test and analysis of variance. Post-operative analgesia duration is significantly prolonged in the dexmedetomidine group with a mean 308.64±12.50 compared to fentanyl group where the mean is 253.12 min±14.30. There is a statistically significant difference (p<0.0001) between the two groups.
 Conclusion: Intrathecal dexmedetomidine supplementation to spinal bupivacaine seems to be a good alternative to intrathecal fentanyl since it produces prolonged post-operative analgesia with minimal side effects and excellent quality of spinal analgesia.
Highlights
Most commonly used technique for lower abdominal surgeries is spinal anesthesia, as it is very economical and easy to administer [1]
Dexmedetomidine has been in use as an adjuvant along with local anesthetics to provide analgesia during and after the period of spinal analgesia
Results were analyzed in both the groups based on various parameters such as age, sex, American society of Anesthesiologists (ASA) grade, types of surgery, onset of sensory and motor blockade, post-operative analgesia duration, and side effects experienced in both the groups
Summary
Most commonly used technique for lower abdominal surgeries is spinal anesthesia, as it is very economical and easy to administer [1]. Various adjuvants have been used generally to reduce the intraoperative visceral and somatic pain, thereby providing prolonged post-operative analgesia. The spinal route has gained immense popularity in surgeries involving lower abdominal and gynecological procedures. Spinal anesthesia provides profound muscular relaxation, which is ideal for intraabdominal and gynecological procedures decreasing intraoperative blood loss and consequent complications [2]. It is currently believed that spinal or epidural anesthesia techniques provide the best method of anesthesia for lower abdominal and lower limb surgeries in patients having poor ventilatory performance
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