Epidural Bupivacaine with Dexmedetomidine or Fentanyl for Lower Abdominal and Lower Limb Surgeries - A Randomized Prospective Study

Abstract

Background: Epidural anaesthesia with catheter insertion offers a useful anaesthetic technique for lower abdominal and lower limb surgeries. Further it can also be used to offer effective post operative analgesia. Adjuvants added to local anaesthetics improve the quality of epidural block and prolong block-ade. Objectives: To assess and compare the effects of dexmedetomidine and fentanyl as adjuvants to epi-dural bupivacaine in lower limb and lower abdominal surgeries Materials and Methods: This randomized prospective study was conducted in a referral teaching hospital in Kolar, Karnataka. Sixty adult patients of either sex belonging to ASA physical status I and II and aged between 18 to 50 years undergoing elective lower abdominal and lower limb surgeries under epidural anaesthesia were studied. Patients were random-ly allotted to group D who received epidural bupivacaine with dexmedetomidine and to Group F who re-ceived bupivacaine with fentanyl. The onset and duration of sensory and motor blocks with haemodynamic variability were assessed. The requirement of rescue analgesics and side effects were recorded. Continuous data is analysed using student t-test and categorical data using Chi-square test and Mann-Whitney U test. P value <0.05 was considered as statistically significant. Results: Time to attain adequate sensory and motor block was faster in Group D in comparison to Group F (p<0.001). Two segment regression, the duration of analgesia and time to complete motor recovery was prolonged in Group D when compared to Group F. On-set of sensory blockade and motor blockade were faster in group D compared to group F. Duration of senso-ry and motor blockade were prolonged in group D compared to compared to group F. Conclusion: Epidural bupivacaine with dexmedetomidine is associated with faster onset of and prolonged sensory and motor blockade with lesser requirement of rescue analgesia compared to bupivacaine with fentanyl. Keywords: Epidural analgesia, Bupivacaine, Dexmedetomidine, Fentanyl, RCT