Anaesthetic and Analgesic Efficacy of Dexmedetomidine versus Fentanyl as an Adjuvant to Epidural Levobupivacaine for Total Abdominal Hysterectomy: A Prospective, Randomized, Controlled Study

Pathak, Nidhi; Krishna, Bhavya

doi:10.18410/jebmh/2020/311

Cited by 2 publications

(1 citation statement)

References 28 publications

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“…In the present study, the mean duration of analgesia was maximum for the dexmedetomidine followed by the fentanyl group, tramadol group, and control group. Pathak N et al, in a prospective, randomized, double-blind study, reported that the duration of analgesia was higher in patients administered levobupivacaine with dexmedetomidine as compared to levobupivacaine with fentanyl [ 15 ]. Similarly, Mansour FR et al [ 16 ] and Saxena D et al [ 17 ] found a longer duration of analgesia when tramadol with bupivacaine was used than with bupivacaine alone.…”

Section: Discussionmentioning

confidence: 99%

Comparative Study of Epidural Dexmedetomidine, Fentanyl, and Tramadol as Adjuvant to Levobupivacaine for Lower Limb Orthopedic Surgeries

Shukla¹,

Singh²,

Singh³

et al. 2022

Cureus

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Background Dexmedetomidine, fentanyl, and tramadol as an adjuvant to local anesthetics improve postoperative analgesia when used in epidural anesthesia. We aimed to compare the efficacy of dexmedetomidine, fentanyl, and tramadol as an adjuvant to levobupivacaine in epidural anesthesia. Materials and methods This was a double-blinded randomized clinical trial (RCT). One-hundred twenty patients of either sex, aged 18-60 years, American Society of Anesthesiologists (ASA) physical status classification I and II, undergoing elective orthopedic procedures under epidural anesthesia were allocated into four groups of 30 each. The dexmedetomidine group received 15 ml of 0.5% levobupivacaine and 25 μg in 2 ml of dexmedetomidine, the fentanyl group received 15 ml of 0.5% levobupivacaine and 50 μg in 2 ml of fentanyl, the Tramadol group received 15 ml of 0.5% levobupivacaine and 100 mg of tramadol in 2 ml, and the control group received 15 ml of 0.5% levobupivacaine and 2 ml normal saline. Patients were monitored for the total duration of analgesia, time of first analgesic requirement, time to reach the T-10 level of sensory block, two-segment regression time of the sensory block, time to reach the motor block (Bromage 3), time to motor regression (Bromage 2), visual analog scale (VAS) scores at 0, 15 minutes, 30 minutes, and the first, second, sixth, twelfth, and twenty-fourth hours postoperatively, total analgesic consumption in 24 hours, and complications, if any, were recorded. Results During the inter-group comparison, VAS scores were lower, the duration of analgesia was longer, and the total analgesic consumption was less in the dexmedetomidine group compared to the fentanyl, tramadol, and control groups. The time to onset of sensory block to T-10 and the attainment of motor block up to Bromage 3 was lower in the dexmedetomidine group. Two segment regression and regression of motor block to Bromage score 2 was lowest for the dexmedetomidine group compared to the other groups. A lower incidence of hypotension and bradycardia was noted with dexmedetomidine. Conclusions Dexmedetomidine is the better alternative as an adjuvant to epidural anesthesia, with faster onset, good quality, and prolonged duration with no relevant adverse effects.

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Section: Discussionmentioning

confidence: 99%

Comparative Study of Epidural Dexmedetomidine, Fentanyl, and Tramadol as Adjuvant to Levobupivacaine for Lower Limb Orthopedic Surgeries

Shukla¹,

Singh²,

Singh³

et al. 2022

Cureus

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The Effects of Dexmedetomidine As an Adjuvant with Levobupivacaine To Epidural Analgesia on The Outcomes of Patients Undergoing Total Abdominal Hysterectomy Surgery

Purwoko,

Nugroho,

Santoso

et al. 2024

JAI b

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Background: Total abdominal hysterectomy (TAH) characterizes as major surgery with increased risk of morbidity. It depends on adequate pain management intra- and postoperatively. Anesthesia management of TAH widely uses a regional approach with the epidural technique which administers a local anesthesia agent into the epidural space.Objective: This study aims to determine the effectiveness of epidural levobupivacaine with fentanyl versus levobupivacaine with dexmedetomidine for epidural anesthesia in patients undergoing TAH.Methods: This is a prospective, single-blinded trial conducted among 20 patients aged 18 to 40 years who underwent elective TAH with American Society of Anesthesiologist (ASA) class I and II status. The control group received epidural levobupivacaine 0.5% with fentanyl as an adjuvant, while the dexmedetomidine group received levobupivacaine 0.5% with dexmedetomidine as an adjuvant. We then compared the degree of pain using a numeric rating scale (NRS) 24 hours after surgery, duration of analgesia, and incidence of postoperative nausea and vomiting (PONV) in both groups.Result: Duration of analgesia was 89.60 + 7.6332 min in group dexmedetomidine, while it was 78.0 + 10.4562 min in group fentanyl, respectively (P < 0.05). The means of NRS was 3.00 + 1.88562 in group dexmedetomidine and 4.80 + 1.1352 in group fentanyl (p=0.019). The incidence of PONV in group dexmedetomidine was three, while in group fentanyl was eight (p=0.025).Conclusion: Dexmedetomidine is preferred over fentanyl when added to levobupivacaine for epidural analgesia in TAH procedures. Dexmedetomidine offers superior quality with a prolonged duration of analgesia, lower NRS values, and a lower incidence of PONV rather than fentanyl.

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Anaesthetic and Analgesic Efficacy of Dexmedetomidine versus Fentanyl as an Adjuvant to Epidural Levobupivacaine for Total Abdominal Hysterectomy: A Prospective, Randomized, Controlled Study

Cited by 2 publications

References 28 publications

Comparative Study of Epidural Dexmedetomidine, Fentanyl, and Tramadol as Adjuvant to Levobupivacaine for Lower Limb Orthopedic Surgeries

Comparative Study of Epidural Dexmedetomidine, Fentanyl, and Tramadol as Adjuvant to Levobupivacaine for Lower Limb Orthopedic Surgeries

The Effects of Dexmedetomidine As an Adjuvant with Levobupivacaine To Epidural Analgesia on The Outcomes of Patients Undergoing Total Abdominal Hysterectomy Surgery

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