A prospective, randomised double blinded comparative study of epidural ropivacaine with fentanyl and ropivacaine with dexmedetomidine in lower limb orthopaedic surgeries in epidural anaesthesia

Gajanan Fultambkar; Racha Gayathri; B. Vijayanand

doi:10.18203/2320-6012.ijrms20243704

Authors

Gajanan Fultambkar Department of Anaesthesiology, Yashoda Hospitals, Secunderabad, Telangana, India
Racha Gayathri Department of Anaesthesiology, Yashoda Hospitals, Secunderabad, Telangana, India
B. Vijayanand Department of Anaesthesiology, Yashoda Hospitals, Secunderabad, Telangana, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20243704

Keywords:

Epidural anaesthesia, Ropivacine, Analgesia, Dexmedetomidine, Fentanyl

Abstract

Background: Opioids as epidural adjuvants have been used with local anaesthetics since long and now, α-2 agonists are being used for same purpose. Current study aims to compare the effects of ropivacaine combined with dexmedetomidine versus ropivacaine combined with fentanyl in patients undergoing lower limb orthopaedic surgeries.

Methods: Total of 90 American society of anaesthesiologists (ASA) I, ASA II patients scheduled to undergo lower limb orthopaedic surgeries under epidural anaesthesia were randomly divided into 2 groups. Group RF (n=45) received 20 ml of 0.75% ropivacaine with 1 µg/kg fentanyl and group ropivacaine with dexmedetomidine RD (n=45) received 20 ml of 0.75% ropivacaine with 1µg/kg dexmedetomidine as adjuvants. Onset of action, duration of analgesia, adverse effects and hemodynamic were monitored.

Results: Results show that age, sex, ASA grade did not differ significantly between two groups. Mean duration of sensory block (426.6 vs 520.43 mins; p<0.01), motor block (412.0 vs 503.37 mins; p<0.01) and analgesia (451.43 vs 552.93 mins; p<0.01) was significantly faster in RD group. No difference was observed between the study groups in hemodynamic parameters during and after the procedure. Incidence of nausea was significantly higher in RF group (15.6% vs 0%).

Conclusions: Administration of dexmedetomidine as adjuvant in epidural anaesthesia for orthopaedic surgical procedures reduces the onset time of sensory, motor block and extends duration of analgesia. Sedation with dexmedetomidine found superior to fentanyl in terms of efficacy, with lower incidence of adverse effects and greater effectiveness as a pre-emptive analgesic.

Metrics

Metrics Loading ...

References

Schultz AM, Werba A, Ulbing S. Perioperative thoracic epidural analgesia for thoracotomy. Eur J Anaesthesiol. 1997;14(6):600-3.

Benzon HT, Wong HY, Belavic AM, Jr, Goodman I, Mitchell D, Lefheit T, et al. A randomized double blind comparison of epidural fentanyl infusion versus patientcontrolled analgesia with morphine for postthoracotomy pain. Anesth Analg. 1993;76(2):316-22.

Lorenzini C, Moreira LB, Ferreira MB. Efficacy of ropivacaine compared with ropivacaine plus sufentanil for postoperative analgesia after major knee surgery. Anaesthesia. 2002;57(5):424-8.

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.

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):281-285..

Bloor BC, Abdul-Rasool I, Temp J, Jenkins S, Valcke C, Ward DS. The effects of medetomidine, an alpha2- adrenergic agonist, on ventilatory drive in the dog. Acta Vet Scand Suppl. 1989;85:65-70.

Soliman R, Eltaweel M. Comparative study of dexmedetomidine and fentanyl as an adjuvant to epidural bupivacaine for postoperative pain relief in adult patients undergoing total knee replacement: a randomized study. J Anesthesiol Clin Sci. 2016;5:1.

Soni P. Comparative study for better adjuvant with ropivacaine in epidural anesthesia. Anesth Essays Res. 2016;10(2):218-22.

Poupak R, Faiz SHR, Imani F. Comparative addition of dexmedetomidine and fentanyl to intrathecal bupivacaine in orthopedic procedure in lower limbs. BMC Anesthesiol. 2018;6;18(1):62.

Cham SC, Medha AS, Umesh LR, Bhupendra SC, Chandrashekharan C. Comparison of the Effects of Fentanyl and Dexmedetomidine in Supraclavicular Brachial Plexus Block Achieved with Ropivacaine. J Evolution Med Dental Sci. 2015;54(4):9427-36.

Kumar SP. Dexmedetomidine and fentanyl for epidural analgesia in lower limb orthopedic surgeries: a comparative evaluation. Int J Adv Med. 2019;6:511-4.

Sarkar A, Bafila NS, Singh RB, Rasheed MA, Choubey S, Arora V, et al. Comparison of epidural bupivacaine and dexmedetomidine with bupivacaine and fentanyl for postoperative pain relief in lower limb orthopedic surgery. Anesth Essays Res. 2018;12(2):572-80.

Vijayalaxmi KB, Mamta P, Kavan P, Mridul P. Comparative Study of Dexmedetomidine versus Fentanyl as an Adjuvant to Ropivacaine (0.75%) in Epidural Anaesthesia in Lower Limb Orthopaedic Surgery. Arch Anesthesiol Crit Care. 2024;10(2):131-7.

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.

Bharti N, Shweta NP, Indu B, Vikas G. Analgesic efficacy of dexmedetomidine versus fentanyl as an adjunct to thoracic epidural in patients undergoing upper abdominal surgery: a randomized controlled trial. Southern Afr J Anaesthesia Analgesia. 2018;24(1):16-21.

Ayyappan AS, Santhanakrishnan K. Comparison of epidural ropivacaine vs bupivacaine with addition of fentanyl or dexmedetomidine in major lower limb orthopaedic surgery. Indian J Clin Anaesthesia. 2017;4(1):56-63.

Casati A, Putzu M. Bupivacaine, Levobupivacaine and Ropivacaine: are they clinically different? Best Practice Res Clin Anaesthesiol. 2005;19(2):247-68.

Pradeep S, Roopesh K, Chavi S, Neha G, Ashok S, Prashasti S. Comparative evaluation of the effects of fentanyl and dexmedetomidine as an adjuvants in supraclavicular brachial plexus block achieved with ropivacaine. Int J Contemp Med Res. 2018;5(2):B25-9.

Sayak P, Ranabir C, Chaitali B. Comparison of perineural administration of dexmedetomidine and fentanyl as an adjuvant to 0.5% bupivacaine to enhance the quality of supraclavicular brachial plexus nerve block in upper limb surgeries-A prospective, triple-blind, randomized study. Asian J Med Sci. 2022;13(7):56-62.

Saikia A, Doley N, Das A. A clinical comparative study between fentanyl and dexmeditomidine as an adjuvant with 0.75% ropivacaine in epidural anaesthesia for lower limb orthopaedic surgery. Int J Contemp Med Res. 2019;6(6):F1-9.