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Comparison of Epidural Bupivacaine and Dexmedetomidine with Bupivacaine and Fentanyl for Postoperative Pain Relief in Lower Limb Orthopedic Surgery. | LitMetric

Context: Different trials have shown that multimodal analgesia through different techniques is associated with superior pain relief. Opioids as epidural adjunct to local anesthetics have been in use for long and α agonists are being increasingly used for same. The present study aims at comparing the hemodynamic, sedative, and analgesic effects of epidurally administered fentanyl and dexmedetomidine when combined with bupivacaine.

Aims: The aim of this study was to compare the efficacy of epidural dexmedetomidine with bupivacaine versus epidural fentanyl with bupivacaine for postoperative pain relief.

Subjects And Methods: In this ongoing randomized double-blind study, 70 patients with ASA physical status classes I and II of either sex between 20 and 60 years scheduled for lower limb orthopedic surgeries under epidural block were randomly divided into two Groups ( = 35). After epidural block with 15 ml of 0.5% bupivacaine, Group I received 1 μg/kg of fentanyl and Group II received 1 μg/kg of dexmedetomidine. Onset and duration of sensory block, motor block, and time to request for the first postoperative analgesia were recorded.

Statistical Analysis Used: The statistical analysis was performed using SPSS (Statistical Package for the Social Sciences) Version 15.0 Statistical Analysis Software, Mann-Whitney U-test and Chi-square test.

Results: The time to achieve T sensory block was early in Group I (dexmedetomidine) (8.10 + 1.03 min) as compared to Group II (15.03 + 1.67 min). Onset of motor was earlier in Group I (15.10 + 1.49 min) as compared to Group II (22.77 + 1.41 min). In Group I (dexmedetomidine), the majority of patients required 2-3 rescue doses, while in Group II (fentanyl), the majority of patients required 3-4 rescue doses.

Conclusions: Dexmedetomidine seems to be a better alternative to fentanyl as an epidural adjuvant due to early onset of sensory anesthesia, prolonged postoperative analgesia, and lower consumption of rescue analgesia.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6020578PMC
http://dx.doi.org/10.4103/aer.AER_70_18DOI Listing

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