Volume : 7, Issue : 5, May - 2018

A PROSPECTIVE RANDOMIZED STUDY COMPARING THE EFFICACY AND CLINICAL PROFILE OF DEXMEDETOMIDINE AND FENTANYL AS AN ADJUVANT TO EPIDURAL ROPIVACAINE FOR POSTOPERATIVE PAIN RELIEF IN SPINE SURGERIES

Dr Bhaskar Manohar, Dr Akila Kaliannan

Abstract :

<p>&nbsp;Background: Dexmedetomidine, is a new addition to the class of alpha-2 agonists, and a close congener of</p> <div>Clonidine, has been used for this purpose with many bene􀃶cial effects. Dexmedetomidine, is an imidazoline</div> <div>derivative, which is 1600 times more selective for alpha-2 receptors than alpha-1 receptors. It acts on both pre- synaptic and post- synaptic</div> <div>sympathetic nerve terminals and on the central nervous system thereby decreasing the sympathetic out􀃸ow and Norepinephrine release</div> <div>causing sedative, anti -anxiety, analgesic, sympatholytic effects. The anti nociceptive action is due to its effect at the spinal cord alpha -2</div> <div>receptors</div> <div>Methods: Study design: Prospective, randomized, double blinded study</div> <div>Setting: Institute of Anaesthesiology and Critical Care, Rajiv Gandhi Government General Hospital, Chennai.</div> <div>STUDY POPULATION :60 Patients were selected and allocated in two groups</div> <div>RESULTS: 1) The onset of sensory analgesia was earlier in Ropivacaine Dexmeditomidine (RD) group (5.93&plusmn;0.700 min) than Ropivacaine</div> <div>Fentanyl (RF) group (7.67&plusmn;0.702 min).</div> <div>2) The peak effect of analgesia in our study was 12.07min. for RD group and 13.13min. for RF group which is statistically signi􀃶cant (Pvalue-</div> <div>0.1330).</div> <div>3) The mean duration of analgesia as measured by the time taken for 􀃶rst rescue analgesic was signi􀃶cantly longer in RD group than RF</div> <div>group (349.80&plusmn; 8.124min vs 298.20&plusmn;4.77min).</div> <div>4) Both the groups showed haemodynamic stability but the incidence of side effects such as hypotension and adycardia were more in</div> <div>patients who received dexmedetomidine , which was managed easily with inj</div> <div>Ephedrine 6mg and inj Atropine 0.6 mg.</div> <div>5) Visual Analogue Scale score in group RD was 1.79 and 2.31 in group RF and it was found to be signi􀃶cant during the whole period of</div> <div>observation (p&lt;0.05)</div> <div>6) The rescue analgesic requirement was less with RD group when compared to RF group in the whole study period.</div> <div>7) The administration of dexmedetomidine epiduraly produced sedation that was arousable, for many hours when compared to the plain</div> <div>ropivacaine group. The mean sedation score at various time intervals was signi􀃶cant between these two groups.</div> <div>8) No episode of respiratory depression was noted in RD group compared to RF group.</div> <div>CONCLUSION :It can be concluded from the study that epidural route provided adequate analgesia in spine surgeries in terms of VAS score</div> <div>in both the groups and analgesia was effective .However, Dexmedetomidine seems to be</div> <div>a better alternative to fentanyl as an epidural adjuvant as it provides comparably stable hemodynamics, early onset and establishment of</div> <div>sensory anesthesia, prolonged analgesia in the post operative period, lesser consumption of post-operative rescue analgesics and much</div> <div>better sedation levels.</div>