A Comparative Study of Fentanyl and Dexmedetomidine with Ropivacaine for Epidural Anaesthesia in Major Abdominal Surgeries: Prospective, Randomised, Double Blind Study

Background Ropivacaine is a pure S (-) Enantiomer of Bupivacaine. The advantage over bupivacaine is the lower degree of motor blockade, lesser cardio toxicity, thus making it a safer alternative. Fentanyl and dexmedetomidine have been added as adjuncts to Ropivacaine for further improvement in analgesia without intensifying adverse effects. This study was designed to compare the clinical efficacy and adverse effects of epidural Ropivacaine combined with Fentanyl and Dexmedetomidine as adjuncts for pain control following major abdominal surgery. Methodology The study was conducted on 60 patients posted for elective major abdominal surgeries under general of ASA I, II and III physical status, between the ages 18-75 years. After appropriate premedication and insertion of epidural catheter, the surgery was done under general anaesthesia. They were randomly allocated into two groups to receive postoperative epidural infusion of either Ropivacaine 0.1 % with fentanyl 1 mcg/ml for 48 hours or ropivacaine with dexmedetomidine 1mcg/ml. The efficacy was compared in terms of onset, quality of analgesia and residual motor blockade and any other adverse events. Results The postoperative pain scores were similar among the two groups. There was no significant motor blockade with a mean VAS score which was consistently below 4 throughout the study period. The patients were hemodynamically stable and there were no significant adverse effects between the two groups. Conclusion The study concludes that ropivacaine in combination with fentanyl and dexmedetomidine provided satisfactory analgesia with minimal adverse effects with a better hemodynamic profile and analgesia with dexmedetomidine when compared to fentanyl.