COMPARATIVE EVALUATION OF ANALGESIC EFFECTS OF HYPERBARIC BUPIVACAINE WITH DEXMEDETOMIDE AND FENTANYL FOR FEMUR FRACTURE SURGERIES

摘要

Dexmedetomidine is a new addition to the class of a2 adrenergic agonists and Fentanyl, a synthetic opioid, has got numerous beneficial effects when used as adjuvants in spinal anaesthesia to prolong intraoperative and postoperative analgesia Aims and objectives: To evaluate dexmedetomidine and fentanyl as an adjuvant to hyperbaric bupivacaine in femur fracture surgeries surgeries, administered intrathecally and to compare the early onset of analgesia, duration of sensory and motor block, postoperative analgesia and changes in hemodynamic, of fentanyl and dexmedetomidine. Materials and methods: The study was carried out at the Department of Anesthesia of the Swamy Vivekanandha Medical College Hospital and Research Institute, Elayampalayam, Tiruchengode. This Prospective Randomized Observational study was carried out for one year and in patients aged between 20 and 75 years of either gender, undergoing elective femur fracture surgeries, classified in American Society of Anaesthesiologist (ASA) grade I and II were recruited. One hundred and twenty patients were randomly allocated to three groups of 40 patients. Results: The three groups were statistically similar to each other in age, gender, ASA (American Society of Anaesthesiologists) status, type of surgery, and duration of surgery. No significant differences was found between HBD with HBF and HBN groups in regression to Bromage 0 (p < 0.05). The mean duration of surgery in group HBD was 156.06± 42.7 minutes and 151.9± 40.0 minutes in group HBF. There were statistically significant differences between groups HBD, HBF and HBN in the time of onset of sensory block (p < 0. 05), time for two segmental regression from the highest sensory level (p < 0.05), sensory regression to SI from highest sensory level (p < 0.001), time to rescue analgesia (p < 0.001) and Numeric Rating Scale (NRS). The highest sensory block occurred in T6 dermatome in all the three groups. Conclusion: Dexmedetomidine as an adjuvant to hyperbaric bupivacaine has prolonged the duration of analgesia and decreased the consumption of analgesics than bupivacaine with fentanyl. It is effective in pain control, reduced post-anaesthesia care unit stay, decreased duration of ventilation, good haemodynamic stability, decreased complications and reduced agitation are other advantages observed in patients undergoing traumatized lower limb orthopaedic surgery.