A Randomized Study Comparing the Analgesic and Sedative Effect of Dexmedetomidine and Fentanyl with Ropivacaine for Epidural Analgesia in Patient Undergoing Percutaneous Nephrolithotomy

Aims and Background To prolong postoperative analgesia many adjuvants has been used opioids and alpha-2 agonists are very popular among them. This study was aimed at comparing the sedative and analgesic properties of epidural administration of fentanyl and dexmedetomidine as an adjuvant to ropivacaine. Methodology With Institutional ethics committee clearance this study was conducted at our hospital. After obtaining informed and written consent, a total of 60 patients scheduled for elective percutaneous nephrolithotomy (PCNL) were randomly allocated into two groups of 30 each. Patients of both genders, aged 21-60 y, ASA physical status I and II were enrolled. Group RD received 28 ml of inj ropivacaine 0.5 % + dexmedetomidine 1 g/kg and Group RF received 28 ml of ropivacaine 0.5 % + inj fentanyl 1 g/kg epidurally. Time of first rescue analgesia, hemodynamic parameters, sedation scores were recorded. Data were compiled systematically and analyzed using unpaired t-test, Chi square and Mann-Whitney U test. P less than 0.05 was considered significant. Results The demographic profile of patients was comparable in both groups. Postoperative analgesia was significantly prolonged in the Group RF as compared to Group RD, e. g.394.5 36.5 vs.268.5 28.3 min respectively. Sedation scores were better in the Group RD and highly significant on statistical comparison (P less than 0.001). Incidence of hypotension, nausea and vomiting was high in the Group RF, while incidence of dry mouth was higher in the Group RD. Conclusion Dexmedetomidine is a better adjuvant than fentanyl when added to epidural ropivacaine in terms of early onset of sensory and motor block, prolonged postoperative analgesia and better sedation with less side effects.