Fentanyl as Adjuvants to Ropivacaine for Epidural Anesthesia in Lower Limb Orthopaedic Surgeries

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Fentanyl as Adjuvants to Ropivacaine for Epidural Anesthesia in Lower Limb Orthopaedic Surgeries

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Background: Epidural anesthesia is the most commonly used technique for providing not only peri-operative surgical anesthesia but also post-op analgesia in lower abdominal and limb surgeries. The addition of an adjuvant not only increases the effectiveness of a local anesthetic by prolonging and intensifying the sensory blockade but also causes reduction in dose of local anesthetic agent. In comparison to bupivacaine, ropivacaine is known to have lesser cardiotoxicity and motor blockade, with similar pain relief at equivalent analgesic doses. Fentanyl is partial agonist on μ opioid receptor. Mainly acting on the substantia gelatinosa of the dorsal horn of spinal cord. Dexmedetomidine is a selective a -2 agonist which provides sedation, anxiolysis, hypnosis, analgesia and sympatholysis. To evaluate dexmedetomidine and fentanyl as adjuvant for epidural local Anesthetics, for lower limb orthopedic surgeries in term of: Comparative evaluation of sensory and moter blockadge in relation of onset, duration and intensity Duration of postoperative analgesia Hemodynamics parameter. Materials and Methods: 100 patients of either sex with ASA grade I and II, 21 to 50 yrs old, posted for elective lower limb orthopedic surgeries were randomly selected and divided into 2 groups of 50 each, Group RDgiven 15 ml of 0.75% Ropivacaine along with Dexmedetomidine 1 μg/kg, Group RF- given 15 ml of 0.75% Ropivacaine along with fentanyl 1 μg/kg. After taking all aseptic precautions, 18 G epidural catheter was placed in space L3-L4 with the help of Touhy Epidural needle with use of LOR technique and fixed at 15 cm marking. Each patient was observed for, onset of sensory and Motor block, Height and Intensity of Motor Block Duration of post operative analgesia and Level of sedation. Result: In comparison to addition of fentanyl as 1 microgram/kg (Group RF), addition of dexmedetomidine as 1 microgram/kg in 15 ml of 0.75 percent Ropivacaine (RD Group) for epidural anesthesia has early onset of sensory and motor block (p <0.001), lesser time for achieving complete motor block (P<0.001) prolong duration of motor block and postoperative analgesia (P<0.001). Bradycardia and hypotension were found more in Group RD and nausea and vomiting were found more in Group RF but these findings in both the groups were statistically not significant. Conclusion: Addition of dexmedetomedine 1 μg/kg to ropivacaine, as comparison to addition of fentanyl, for epidural anesthesia has early onset of sensory and prolong duration of motor block and postoperative analgesia, without an increased incidence of side effects.

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