A comparative evaluation of efficacy of epidural dexmedetomidine and fentanyl as adjunct to 0.2% ropivacaine for post-operative analgesia in elective abdominal surgeries
Keywords:Abdominal surgeries, Epidural analgesia, Ropivacaine, Dexmedetomidine, Fentanyl
Background: Epidural analgesia as a central nuraxial technique which involves use of local anesthetics injected into the epidural space to produce a reversible loss of sensation and is the one of the most common regional technique used for lover abdominal and lover limb surgeries epidural analgesia provides excellent pain relief for surgical procedures below the umbilicus. This study compared the efficacy of epidural dexmedetomidine and fentanyl in addition to 0.2% ropivacaine for post-operative analgesia in elective abdominal surgeries.
Methods: Total of 150 patients American Society of Anesthesiologists (ASA) I and II between 20-60 years, undergoing major abdominal surgery were included in this study. The patients divided in three groups of 50 patients each. First group R (ropivaciain 0.2% 9 ml with 1ml normal saline) second group RF (ropivacain 0.2% 9 ml with fentanyl 1 ml) and third group RD (ropivaciain 0.2% 9 ml with dexmedetomidine 1 μ/kg).
Results: There is no significant difference in age, weight, sex, and ASA grade in all three groups.
Hypotension was observed in 4 (8%) patients of R group, 2 (4%) in RD group and 4 (8%) in RF group. The shivering was present in 2 (4%) R group and 2 (4%) in RD group. Nausea, vomiting was present in R group 2 (4%) and 2 (4%) in RF group. There was no significant difference between the three groups with respect to hemodynamic parameters like heart rate, systolic and diastolic blood pressure and respiratory rate.
Conclusions: Dexmedetomidine is a better adjuvant to ropivacaine through epidural route when compared to fentanyl for providing early onset prolonged post-operative analgesia, sedation and stable hemodynamic parameters in intra-abdominal surgeries.
Turner G, Scott DA. A comparison of epidural ropivacaine infusion alone and with three different concentration of fentanyl for 72 hours of postoperative analgesia following major abdominal surgery. Reg Anesth. 1998;23:A39.
Grewal A. Dexmedetomidine: New avenues. J Anaesthesiol Clin Pharmacol. 2011;27(3):297-302.
Raj PP. Textbook of Regional Anesthesia. Churchill Livingstone. 2002;505(24):35-46.
Bajwa SJ, Bajwa SK, Kaur J, Singh G, Arora V, Gupta S, et al. Dexmedetomidine and clonidine in epidural anaesthesia: A comparative evaluation. Indian J Anaesth. 2011;55(2):116-21.
Kalso EA, Poyhia R, Rosenberg PH. Spinal antinociception by dexmedetomidine a highly selective α2-adrenergic agonist. Pharmacol Toxicol. 1991;68(2):140.
Vieira AM, Schnaider TB, Brandão AC, Pereira FA, Costa ED, Fonseca CE, et al. Epidural clonidine or dexmedetomidine for post-cholecystectomy analgesia and sedation. Rev Bras Anestesiol. 2004;54(4):473-8.
Kanazi GE, Aouad MT, KJabbour-Khoury SI, Al Jzzar, Le Meddine MM, et al. Effect of low dose dexmedetomidine or clonidine on the charecterestics of spinal bupivacaine block. Acta Anaesthesiol Scand. 2006;50(2):222-7.
Salgad PF, Sabbag AT, Silva PC, Brienze SL, Dalto HP, Módolo NS, et al. Synergistic effect between dexmedetomidine and 0.75% ropivacaine in epidural anaesthesia Hospital de Base da Faculdade de Medicina de São José do Rio Preto, SP. Rev Assoc Med Bras. 2008;54(2):110-5.
Talke P, Richardson CA, Scheinin M, Fisher DM. Postoperative pharmacokinetics and sympatholytic effects of dexmedetomidine. Anesth Analg. 1997;85(5):1136-42.
Gupta R,Verma R, Bogra J, Kohli M, Raman, R Kushwaha JK. A comparative study of intrathecal dexmedetomidine and fentanyl as adjuvants to bupivacaine J Anaesthesiol Clin Pharmacol. 2011;27(3):339-43.
Bhana N, Goa KL, McClellan KJ. Dexmedetomidine. Drugs. 2000;59(2):263-70.
Jaakola ML, Salonen M, Lehtinen R, Scheinin H. The analgesic action of dexmedetomidine: A novel alpha2-adrenoceptor agonist-in healthy volunteers. Pain. 1991;46(3):281-5.