A comparison of intrathecal dexmedetomidine and fentanyl as an adjuvant to isobaric levobupivacaine for lower limb orthopaedic surgery

Introduction: Levobupivacaine is cardiostable. Fentanyl and dexmedetomidine as adjuvant to improve quality of block. Aim: To compare the efficacy and safety of 25 mcg of fentanyl vs 5 mcg dexmedetomidine as an adjuvant in 0.5% of 3ml of isobaric levobupivacaine in lower limb orthopaedic surgery. Objectives: Onset and duration of sensory block, maximum sensory block. Onset and duration of motor block, maximum motor block, time to regress sensory and motor block, postoperative analgesia. Level of sedation, hemodynamic changes, side effects. Materials and Methods Group A: 0.5% isobaric levobupivacaine 3ml +0.5 ml of NS =3.5ml. Group F: 0.5% isobaric levobupivacaine 3ml+25 mcg fentanyl diluted with NS =3.5ml. Group D: 0.5% isobaric levobupivacaine 3ml + 5 mcg dexmedetomidine diluted with NS =3.5ml. Subarachnoid block were achieved in L3-L4 interspaces. Parameters like pulse, SBP, DBP, MAP, SPO2, RR, level of sensory block, grade of motor block, sedation scale were recorded every min for 5 min, every 5 min till 30 min, every 15 min till 2 hr, every 30 min till end of surgery Intraoperatively side effects were recorded and treated. In postoperative period total analgesic, antiemetic requirement, sedation scale checked. Result: onset of sensory block was earlier in group F. maximum sensory block was in group D. Motor block regress faster in group A. postoperative analgesia was more in group D and side effects were less. Conclusion: Dexmedetomidine group has longer onset of and duration of sensory block and effective postoperative analgesia and fewer side effect as compared to fentanyl group.