Comparative, Randomized, Prospective, Double Blinded, Evaluation of Epidural Ropivacaine with Dexmedetomidine or Fentanyl as Adjuvants in Patients Undergoing Total Abdominal Hystrectomy

Abstract

Background: Epidural is a versatile neuraxial anesthetic technique with an expanding area of indications. Fentanyl is an established adjuvant to be used in epidural for prolonging analgesia. Dexmedetomidine, a newer α2 agonist exhibits synergism with local anesthetics in epidural,prolonging the sensory/motor block duration time and postoperative analgesia.We compared fentanyl with dexmedetomidine in epidural anesthesia along with ropivacaine in infraumbilical surgeries regarding efficacy and side effects. Methods: The study was conducted in ASA, I-II patients aged between 40-70 years for total abdominal hysterctomy. Group 1 (FR) received Ropivacaine 0.75% , 20ml + Fentanyl 1µg /kg and Group 2 (DR) received Ropivacaine 0.75% , 20 ml + Dexmedetomidine 1µg /kg in single shot epidural anesthesia. They were evaluated for onset of sensory and motor block, hemodynamics, total duration of analgesia and motor block and any side effects associated with it. Results: Demographic profile and baseline hemodynamic parameters were comparable in both groups. Mean onset of sensory block (min) in group FR was 9.76 ± 1.69 & in group DR was 7.93 ± 0.98 (p<0.001). Mean total duration of sensory block was 354.66 ± 66.88 (min) in FR group whereas 413.33 ± 66.71 (min) in DR group (p<0.05).Mean total duration of motor block was 191.83 ± 28.45 min in FR group and 234.33 ± 24.66 min in DR group (p<0.001). Conclusion: Dexmedetomidine when added to ropivacaine as adjunct in epidural anesthesia provides better analgesia, good operating conditions and excellent sedation profile.