Epidural Dexmedetomidine as Adjuvants to Ropivacaine for Post-Operative Analgesia

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Epidural Dexmedetomidine as Adjuvants to Ropivacaine for Post-Operative Analgesia

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Background: Epidural anaesthesia is a central neuraxial block technique which has the ability to prolong or extend the block via an indwelling catheter. Ropivacaine is a long-acting amino amide local anaesthetic. The onset of sensory and motor blockade may be delayed with ropivacaine. Fentanyl is a commonly used adjuvant for neuraxial block and dexmedetomidine has been used increasingly as adjuvant due to the added benefits and lower side effects. The present study is being undertaken to evaluate quality of epidural anaesthesia using fentanyl and dexmedetomidine as adjuvants to ropivacaine in infra umbilical surgeries for post operative analgesia. Aims: The major aim of the study was to compare the quality of epidural anaesthesia for post-operative analgesia using fentanyl and dexmedetomidine as adjuvants to ropivacaine in infra umbilical surgeries. Materials and Methods: 60 patients of both genders aged 18–60 years, ASA I/II physical status undergoing elective infra-umbilical surgeries were randomized into 2 groups. Group RD(n=30) patients received 17ml of 0.75% Ropivacaine + 1μg/kg Dexmedetomidine and group RF (n=30) patients received 17ml of 0.75% Ropivacaine + 1μg/kg Fentanyl. Epidural block characteristics observed included time to onset of analgesia at T10, maximum sensory analgesic level, time to complete motor blockade, time to first rescue analgesic and local anesthetic consumption. Data was compiled and analysed using ANOVA, Chi-square test and Fisher’s exact test. Value of P<0.05 is considered significant. Results: Demographic data was comparable between the 2 groups. Heart rate and mean arterial pressure values were lower in RD group compared to RF group. Time to onset of analgesia was 9.56 + 1.32 min in group RF and 7.28 + 1.27 min in group RD (p value < 0.001). Maximum sensory level achieved was T5 in group RF whereas in group RD it was T4 (p value < 0.001). Time taken to achieve maximum sensory level [12.82 + 2.74 min vs 17.54 + 2.88 min] (p value<0.001) and time for complete motor blockade [17.24 + 2.56 min vs 22.71 + 2.50 min] (p value<0.001) in minutes were earlier in group RD compared to group RF. Duration of analgesia was 367.80 + 12.59 min in group RD and 237.94 +14.08 min in group RF. There was significant difference in mean total dose consumption of local anaesthetic used over 24 hours post-operatively. Conclusion: Dexmedetomidine is a better epidural adjuvant for post-operative analgesia compared to fentanyl as it provides prolonged post-operative analgesia and lower consumption of local anaesthetic.

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