Comparative Study of Dexmedetomidine versus Fentanyl as an adjuvant to Ropivacaine (0.75%) in Epidural Anaesthesia in Lower Limb Orthopaedic Surgery
,
Abstract
Background: Dexmedetomidine and Fentanyl both possess hypnotic, sedative, analgesic properties and have been utilised as an additive in epidural anaesthesia. The purpose of this study is to compare the sedative and analgesic effects of Dexmedetomidine and Fentanyl when added epidurally with Ropivacaine (0.75%) during lower limb orthopaedic surgery.
Methods: The study comprised of 60 patients, both male and female, aged 18 to 60, who had ASA classification I or II for tibia fibula surgery. Two groups of patients were split up at random: Group RD contains– Ropivacaine (0.75%) 15ml + Dexmedetomidine (1microgm/kg) 0.5ml + 0.5ml sterile water (Total volume-16ml) and Group RF - Ropivacaine 15ml (0.75%) + 1ml Fentanyl (1microgm/kg) (Total volume-16 ml). The epidural space was maintained 4 cm within and situated between L3 and L4 space. Investigations were conducted on parameters such as sensory and motor block features, sedation score, hemodynamic factors and pain assessment. Using the student `t` test, statistical analysis was performed using STATAIC13 software.
Results: Onset of sensory analgesia at L1 and Complete sensory and motor blockage occurred much earlier in the RD group. Higher sedation scores and significantly prolonged postoperative analgesia was observed in RD group.
Conclusion: Dexmedetomidine is a safer and more effective epidural adjuvant than fentanyl because it provides stable hemodynamics, extended post-operative analgesia, early onset and development of sensory and motor effects and sedation.
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[12] Ghai B, Jafra A, Bhatia N, Chanana N, Bansal D, Mehta V. Opioid sparing strategies for perioperative pain management, other than regional anaesthesia: A narrative review. J Anaesthesiol Clin Pharmacol. 2022; 38:362-19
[13] Lavand'homme P, Estebe JP. Opioid-free anesthesia: a different regard to anesthesia practice. Curr Opin Anaesthesiol. 2018; 31:556-61.
[14] Bohringer C, Astorga C, Liu H. The Benefits of Opioid Free Anesthesia and the Precautions Necessary When Employing It. Transl Perioper Pain Med. 2020; 7:152-7
[15] Kalbande JV, Deotale KD, N AK, Karim HMR. Addition of Dexmedetomidine and Fentanyl to Intrathecal Hyperbaric Bupivacaine for Lower Limb Surgeries: A Randomized, Comparative Study. Cureus. 2022;14.
[16] Bogra J, Arora N, Srivastava P. Synergistic effect of intrathecal fentanyl and bupivacaine in spinal anesthesia for cesarean section. BMC Anesthesiol. 2005; 5(1):5.
[17] Bajwa SJ, Arora V, Kaur J, Singh A, Parmar SS. Comparative evaluation of dexmedetomidine and fentanyl for epidural analgesia in lower limb orthopedic surgeries. Saudi J Anaesth. 2011; 5(4):365-70.
[18] Kampe S, Kiencke P, Delis A, Auweiler M, König DP, Kasper SM. The continuous epidural infusion of ropivacaine 0.1% with 0.5 microg x mL(-1) sufentanil provides effective postoperative analgesia after total hip replacement: a pilot study. Can J Anaesth. 2003; 50(6):580-5.
[19] Sawhney KY, Grewal K, Katyal S, Singh G, Kaur A. A randomized double blinded comparison of epidural infusion of Bupivacaine, Ropivacaine, Bupivacaine-Fentanyl, Ropivacaine-Fentanyl for post operative pain relief in lower limb surgeries. J Clin Diagn Res. 2015; 9:19-23.
[20] Kampe S, Weigand C, Kaufmann J, Klimek M, König DP, Lynch J. Post operative analgesia with no motor block by continuous epidural infusion of Ropivacaine 0.1% and Sufentanyl after total hip replacement. Anesth Analg. 1999; 89:395-8.
[21] Timo E Salomäki, Laitinen JO, Nuutinen LS. A randomized double blind comparison of epidural versus intravenous fentanyl infusion for analgesia after thoracotomy. Anesthesiology.1991; 75:790-5.
[22] Gupta L, Agarwal J, Saxena KN. Opioid-free anaesthesia: The conundrum and the solutions. Indian J Anaesth. 2022; 66:256-22
[23] Kaur S, Attri JP, Kaur G, Singh TP. Comparative evaluation of Ropivacaine versus Dexmedetomidine and Ropivacaine in epidural anaesthesia in lower limb orthopaedic surgeries. Saudi J Anaesth. 2014; 8:463–9.
[24] Gupta R, Bogra J, Verma R, Kohli M, Kushwaha JK, Kumar S. Dexmedetomidine as an intrathecal adjuvant for postoperative analgesia. Indian J Anaesth. 2011; 55(4):347-51.
[25] Rastogi B, Singh VP, Mangla D, Gupta K, Jain M, Pandey MN. Dexmedetomidine as an adjuvant to epidural 0.75% Ropivacaine in patients undergoing infraumbilical surgery: a clinical study. Global anaesthesia and perioperative medicine 2015; 1:19-23.
[26] Salgado PF, Nascimento P, Modolo NS, M.I.R. Sabbag, Priscila C. Adding Dexmedetomidine to Ropivacaine 0.75% for Epidural Anesthesia. Does it improve the quality of the Anesthesia? Anesthesiology. 2005; 103:974.
[27] 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; 55:116-21.
[28] Oriol-Lopez SA, Maldonado-Sanchez KA, Hernandez-Bernal CE, Castelazo-Arredondo JA, Moctezuma LR. Epidural dexmedetomidine in regional anesthesia to reduce anxiety. Revista Mexicana de Anestesiologia. 2008; 31:271-7.
[29] Gupta K, Rastogi B, Gupta PK, Jain M, Gupta S, Mangla D. Epidural 0.5% Levobupivacaine with Dexmedetomidine versus Fentanyl for vaginal hysterectomy: a prospective study. Indian J Pain 2014; 28:149-54.
[30] Bhana N, GOA KL, Mcclellan KJ. Dexmedetomidine. Drugs. 2000; 59:263-8.
[31] Kiran S, Jinjil K, Tandon U, Kar S. Evaluation of dexmedetomidine and fentanyl as additives to ropivacaine for epidural anesthesia and postoperative analgesia. J Anaesthesiol Clin Pharmacol. 2018; 34(1):41-45.
[2] Kuthiala G, Chaudhary G. Ropivacaine: A review of its pharmacology and clinical use. Indian J Anaesth. 2011; 55:104-10.
[3] McClellan KJ, Faulds D. Ropivacaine: an update of its use in regional anaesthesia. Drugs. 2000; 60:1065-93.
[4] Safiya.I. Shaikh, K. Rohini. Comparison of epidural bupivacaine 0.5% with epidural ropivacaine 0.75% for lower limb orthopaedic procedures. The internet journal of Anaesthesiology 2012; 30(2).
[5] Jeon HR, Chae WS, Lee SJ, Lee JH, Cho SH, Kim SH, et al. A comparison of Sufentanyl and Fentanyl for patient controlled epidural analgesia in arthroplasty. Korean J Anesthesiol. 2011; 60: 41–46.
[6] Ravindran R, Sajid B, Ramadas KT, Susheela I. Intrathecal Hyperbaric Bupivacaine with Varying Doses of Buprenorphine for Postoperative Analgesia after Cesarean Section: A Comparative Study. Anesth Essays Res. 2017; 11: 952-7.
[7] Kathirvel S, Sadhasivam S, Saxena A, Kannan TR, Ganjoo P. Effects of intrathecal ketamine added to bupivacaine for spinal anaesthesia. Anaesthesia. 2000; 55:899-904.
[8] Shadangi BK, Garg R, Pandey R, Das T. Effects of intrathecal midazolam in spinal anaesthesia: a prospective randomised case control study. Singapore Med J. 2011; 52:432-5.
[9] Saravana Babu M, Verma AK, Agarwal A, Tyagi CM, Upadhyay M, Tripathi S. A comparative study in the post-operative spine surgeries: Epidural ropivacaine with dexmedetomidine and ropivacaine with clonidine for post-operative analgesia. Indian J Anaesth. 2013; 57(4):371-6.
[10] Yektaş A, Belli E. The effects of 2 µg and 4 µg doses of dexmedetomidine in combination with intrathecal hyperbaric bupivacaine on spinal anesthesia and its postoperative analgesic characteristics. Pain Res Manag. 2014; 19(2):75-81.
[11] Jain D, Kumar N, Khan RMz, Kumar D. Perioperative effect of epidural dexmedetomidine with intrathecal bupivacaine on haemodynamic parameters and quality of analgesia: original research. Southern African Journal of Anaesthesia and Analgesia. 2012; 18:105-9.
[12] Ghai B, Jafra A, Bhatia N, Chanana N, Bansal D, Mehta V. Opioid sparing strategies for perioperative pain management, other than regional anaesthesia: A narrative review. J Anaesthesiol Clin Pharmacol. 2022; 38:362-19
[13] Lavand'homme P, Estebe JP. Opioid-free anesthesia: a different regard to anesthesia practice. Curr Opin Anaesthesiol. 2018; 31:556-61.
[14] Bohringer C, Astorga C, Liu H. The Benefits of Opioid Free Anesthesia and the Precautions Necessary When Employing It. Transl Perioper Pain Med. 2020; 7:152-7
[15] Kalbande JV, Deotale KD, N AK, Karim HMR. Addition of Dexmedetomidine and Fentanyl to Intrathecal Hyperbaric Bupivacaine for Lower Limb Surgeries: A Randomized, Comparative Study. Cureus. 2022;14.
[16] Bogra J, Arora N, Srivastava P. Synergistic effect of intrathecal fentanyl and bupivacaine in spinal anesthesia for cesarean section. BMC Anesthesiol. 2005; 5(1):5.
[17] Bajwa SJ, Arora V, Kaur J, Singh A, Parmar SS. Comparative evaluation of dexmedetomidine and fentanyl for epidural analgesia in lower limb orthopedic surgeries. Saudi J Anaesth. 2011; 5(4):365-70.
[18] Kampe S, Kiencke P, Delis A, Auweiler M, König DP, Kasper SM. The continuous epidural infusion of ropivacaine 0.1% with 0.5 microg x mL(-1) sufentanil provides effective postoperative analgesia after total hip replacement: a pilot study. Can J Anaesth. 2003; 50(6):580-5.
[19] Sawhney KY, Grewal K, Katyal S, Singh G, Kaur A. A randomized double blinded comparison of epidural infusion of Bupivacaine, Ropivacaine, Bupivacaine-Fentanyl, Ropivacaine-Fentanyl for post operative pain relief in lower limb surgeries. J Clin Diagn Res. 2015; 9:19-23.
[20] Kampe S, Weigand C, Kaufmann J, Klimek M, König DP, Lynch J. Post operative analgesia with no motor block by continuous epidural infusion of Ropivacaine 0.1% and Sufentanyl after total hip replacement. Anesth Analg. 1999; 89:395-8.
[21] Timo E Salomäki, Laitinen JO, Nuutinen LS. A randomized double blind comparison of epidural versus intravenous fentanyl infusion for analgesia after thoracotomy. Anesthesiology.1991; 75:790-5.
[22] Gupta L, Agarwal J, Saxena KN. Opioid-free anaesthesia: The conundrum and the solutions. Indian J Anaesth. 2022; 66:256-22
[23] Kaur S, Attri JP, Kaur G, Singh TP. Comparative evaluation of Ropivacaine versus Dexmedetomidine and Ropivacaine in epidural anaesthesia in lower limb orthopaedic surgeries. Saudi J Anaesth. 2014; 8:463–9.
[24] Gupta R, Bogra J, Verma R, Kohli M, Kushwaha JK, Kumar S. Dexmedetomidine as an intrathecal adjuvant for postoperative analgesia. Indian J Anaesth. 2011; 55(4):347-51.
[25] Rastogi B, Singh VP, Mangla D, Gupta K, Jain M, Pandey MN. Dexmedetomidine as an adjuvant to epidural 0.75% Ropivacaine in patients undergoing infraumbilical surgery: a clinical study. Global anaesthesia and perioperative medicine 2015; 1:19-23.
[26] Salgado PF, Nascimento P, Modolo NS, M.I.R. Sabbag, Priscila C. Adding Dexmedetomidine to Ropivacaine 0.75% for Epidural Anesthesia. Does it improve the quality of the Anesthesia? Anesthesiology. 2005; 103:974.
[27] 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; 55:116-21.
[28] Oriol-Lopez SA, Maldonado-Sanchez KA, Hernandez-Bernal CE, Castelazo-Arredondo JA, Moctezuma LR. Epidural dexmedetomidine in regional anesthesia to reduce anxiety. Revista Mexicana de Anestesiologia. 2008; 31:271-7.
[29] Gupta K, Rastogi B, Gupta PK, Jain M, Gupta S, Mangla D. Epidural 0.5% Levobupivacaine with Dexmedetomidine versus Fentanyl for vaginal hysterectomy: a prospective study. Indian J Pain 2014; 28:149-54.
[30] Bhana N, GOA KL, Mcclellan KJ. Dexmedetomidine. Drugs. 2000; 59:263-8.
[31] Kiran S, Jinjil K, Tandon U, Kar S. Evaluation of dexmedetomidine and fentanyl as additives to ropivacaine for epidural anesthesia and postoperative analgesia. J Anaesthesiol Clin Pharmacol. 2018; 34(1):41-45.
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| Issue | Vol 10 No 2 (2024): Spring |
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| Section | Research Article(s) | |
| DOI | https://doi.org/10.18502/aacc.v10i2.15059 | |
| Keywords | ||
| Dexmedetomidine Fentanyl Epidural Anaesthesia Ropivacaine (0.75%) | ||
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How to Cite
1.
Biradar V, Patel M, Patel K, Panditrao M. Comparative Study of Dexmedetomidine versus Fentanyl as an adjuvant to Ropivacaine (0.75%) in Epidural Anaesthesia in Lower Limb Orthopaedic Surgery. Arch Anesth & Crit Care. 2024;10(2):131-137.
