Publication:

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

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.