Combination of Dexmedetomidine with Bupivacaine versus Fentanyl with Bupivacaine Intrathecally for Prolongation of Postoperative Analgesia in Lower Limb Surgeries: A Randomised Clinical Study
Introduction: Intrathecal adjuvants can be added to extend the duration of analgesia. To achieve this, several adjuvants, such as the combination of dexmedetomidine with bupivacaine versus fentanyl with bupivacaine, have been used with local anaesthesia during lower limb surgeries. Aim: To compare...
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JCDR Research and Publications Private Limited
2024-02-01
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| Series: | Journal of Clinical and Diagnostic Research |
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| Online Access: | https://www.jcdr.net/articles/PDF/19075/63889_CE[Ra1]_F[SK]_QC&Ref(SHK_SL)_PF1(R1_DK)_PFA(RI_KM)_PN(KM).pdf |
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| author | Arjun Peddapally Ezhilrajan Vaithiyalingam Shanmugavalli Ettiyan Haribabu Veeraraghavan |
| author_facet | Arjun Peddapally Ezhilrajan Vaithiyalingam Shanmugavalli Ettiyan Haribabu Veeraraghavan |
| author_sort | Arjun Peddapally |
| collection | DOAJ |
| description | Introduction: Intrathecal adjuvants can be added to extend the duration of analgesia. To achieve this, several adjuvants, such as the combination of dexmedetomidine with bupivacaine versus fentanyl with bupivacaine, have been used with local anaesthesia during lower limb surgeries.
Aim: To compare the combination of dexmedetomidine versus fentanyl with bupivacaine administered intrathecally for the onset and duration of sensory and motor block, as well as their side-effects and the prolongation of postoperative analgesia in lower limb surgeries.
Materials and Methods: A randomised clinical study was conducted on 120 American Society of Anaesthesiologists (ASA) grade I or II patients, aged between 18 and 65 years, who were admitted to the Department of Orthopaedics and General Surgery, Aarupadai Veedu Medical College and Hospital, Puducherry, India for lower limb surgeries under spinal anaesthesia. The patients were randomly assigned to two groups using a computer-generated technique. Group BD received 0.5% bupivacaine (2.5 mL)+10 mcg dexmedetomidine (0.5 mL), while Group BF received 0.5% bupivacaine (2.5 mL)+25 mcg fentanyl (0.5 mL). The onset and duration of sensory and motor blockade, haemodynamic parameters, sedation, and side-effects of the drugs were analysed. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 2.0 after collecting all the data.
Results: There were no statistically significant differences in the subjects’ demographics or duration of surgery. However, the duration of sensory block and motor block was significantly prolonged in Group BD compared to Group BF, with values of 720±32 and 640±32, respectively. The mean Heart Rates (HR) differed significantly between of the two groups (p-value=0.03). There was no significant difference in sedation scores between the two groups. Group BD showed a higher incidence of bradycardia (n=35) and hypertension (n=32).
Conclusion: The combination of dexmedetomidine with bupivacaine, when used intrathecally for lower limb surgeries, demonstrated superior effectiveness in terms of prolonging sensory and motor block duration and providing extended postoperative analgesia, compared to the combination of bupivacaine and fentanyl. However, it is important to note that patients receiving the dexmedetomidine-bupivacaine combination had a higher incidence of bradycardia and hypertension. Therefore, careful monitoring and management of haemodynamic parameters are necessary when using this combination. |
| first_indexed | 2024-03-08T01:48:47Z |
| format | Article |
| id | doaj.art-32283deb5ecc4c0aa79e4750f82639fd |
| institution | Directory Open Access Journal |
| issn | 2249-782X 0973-709X |
| language | English |
| last_indexed | 2024-03-08T01:48:47Z |
| publishDate | 2024-02-01 |
| publisher | JCDR Research and Publications Private Limited |
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| series | Journal of Clinical and Diagnostic Research |
| spelling | doaj.art-32283deb5ecc4c0aa79e4750f82639fd2024-02-14T11:21:21ZengJCDR Research and Publications Private LimitedJournal of Clinical and Diagnostic Research2249-782X0973-709X2024-02-011802303410.7860/JCDR/2024/63889.19075Combination of Dexmedetomidine with Bupivacaine versus Fentanyl with Bupivacaine Intrathecally for Prolongation of Postoperative Analgesia in Lower Limb Surgeries: A Randomised Clinical StudyArjun Peddapally0Ezhilrajan Vaithiyalingam1Shanmugavalli Ettiyan2Haribabu Veeraraghavan3IIIrd Year Postgraduate, Department of Anaesthesiology, Aarupadai Veedu Medical College and Hospital, Puducherry, India.Professor and Head, Department of Anaesthesiology, Aarupadai Veedu Medical College and Hospital, Puducherry, India.Associate Professor, Department of Anaesthesiology, Aarupadai Veedu Medical College and Hospital, Puducherry, India.Professor, Department of Anaesthesiology, Aarupadai Veedu Medical College and Hospital, Puducherry, India.Introduction: Intrathecal adjuvants can be added to extend the duration of analgesia. To achieve this, several adjuvants, such as the combination of dexmedetomidine with bupivacaine versus fentanyl with bupivacaine, have been used with local anaesthesia during lower limb surgeries. Aim: To compare the combination of dexmedetomidine versus fentanyl with bupivacaine administered intrathecally for the onset and duration of sensory and motor block, as well as their side-effects and the prolongation of postoperative analgesia in lower limb surgeries. Materials and Methods: A randomised clinical study was conducted on 120 American Society of Anaesthesiologists (ASA) grade I or II patients, aged between 18 and 65 years, who were admitted to the Department of Orthopaedics and General Surgery, Aarupadai Veedu Medical College and Hospital, Puducherry, India for lower limb surgeries under spinal anaesthesia. The patients were randomly assigned to two groups using a computer-generated technique. Group BD received 0.5% bupivacaine (2.5 mL)+10 mcg dexmedetomidine (0.5 mL), while Group BF received 0.5% bupivacaine (2.5 mL)+25 mcg fentanyl (0.5 mL). The onset and duration of sensory and motor blockade, haemodynamic parameters, sedation, and side-effects of the drugs were analysed. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 2.0 after collecting all the data. Results: There were no statistically significant differences in the subjects’ demographics or duration of surgery. However, the duration of sensory block and motor block was significantly prolonged in Group BD compared to Group BF, with values of 720±32 and 640±32, respectively. The mean Heart Rates (HR) differed significantly between of the two groups (p-value=0.03). There was no significant difference in sedation scores between the two groups. Group BD showed a higher incidence of bradycardia (n=35) and hypertension (n=32). Conclusion: The combination of dexmedetomidine with bupivacaine, when used intrathecally for lower limb surgeries, demonstrated superior effectiveness in terms of prolonging sensory and motor block duration and providing extended postoperative analgesia, compared to the combination of bupivacaine and fentanyl. However, it is important to note that patients receiving the dexmedetomidine-bupivacaine combination had a higher incidence of bradycardia and hypertension. Therefore, careful monitoring and management of haemodynamic parameters are necessary when using this combination.https://www.jcdr.net/articles/PDF/19075/63889_CE[Ra1]_F[SK]_QC&Ref(SHK_SL)_PF1(R1_DK)_PFA(RI_KM)_PN(KM).pdfanaesthesiadrug combinationslower limbpostoperative pain |
| spellingShingle | Arjun Peddapally Ezhilrajan Vaithiyalingam Shanmugavalli Ettiyan Haribabu Veeraraghavan Combination of Dexmedetomidine with Bupivacaine versus Fentanyl with Bupivacaine Intrathecally for Prolongation of Postoperative Analgesia in Lower Limb Surgeries: A Randomised Clinical Study Journal of Clinical and Diagnostic Research anaesthesia drug combinations lower limb postoperative pain |
| title | Combination of Dexmedetomidine with Bupivacaine versus Fentanyl with Bupivacaine Intrathecally for Prolongation of Postoperative Analgesia in Lower Limb Surgeries: A Randomised Clinical Study |
| title_full | Combination of Dexmedetomidine with Bupivacaine versus Fentanyl with Bupivacaine Intrathecally for Prolongation of Postoperative Analgesia in Lower Limb Surgeries: A Randomised Clinical Study |
| title_fullStr | Combination of Dexmedetomidine with Bupivacaine versus Fentanyl with Bupivacaine Intrathecally for Prolongation of Postoperative Analgesia in Lower Limb Surgeries: A Randomised Clinical Study |
| title_full_unstemmed | Combination of Dexmedetomidine with Bupivacaine versus Fentanyl with Bupivacaine Intrathecally for Prolongation of Postoperative Analgesia in Lower Limb Surgeries: A Randomised Clinical Study |
| title_short | Combination of Dexmedetomidine with Bupivacaine versus Fentanyl with Bupivacaine Intrathecally for Prolongation of Postoperative Analgesia in Lower Limb Surgeries: A Randomised Clinical Study |
| title_sort | combination of dexmedetomidine with bupivacaine versus fentanyl with bupivacaine intrathecally for prolongation of postoperative analgesia in lower limb surgeries a randomised clinical study |
| topic | anaesthesia drug combinations lower limb postoperative pain |
| url | https://www.jcdr.net/articles/PDF/19075/63889_CE[Ra1]_F[SK]_QC&Ref(SHK_SL)_PF1(R1_DK)_PFA(RI_KM)_PN(KM).pdf |
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