COMPARATIVE STUDY OF DEXMEDITOMIDINE WITH 0.5% HYPERBARIC BUPIVACAINE AND FENTANYL WITH 0.5% HYPERBARIC BUPIVACAINE INTRATHECALLY FOR SUBARACHNOID BLOCK IN INFRAUMBILICAL SURGERIES

Abstract

Background and Aims: A subarachnoid block is a frequently used technique for infraumbilical surgeries. Fentanyl and dexmedetomidineare commonly employed as adjuvants to extend both intraoperative and postoperative pain relief. This study aims to evaluate the effectiveness of adding dexmedetomidine versus fentanyl to intrathecal bupivacaine in infraumbilical procedures.
Methods: In this double-blind, randomized clinical trial, 64 patients scheduled for elective infraumbilical surgeries were randomly assigned to two groups. Through the intrathecal route, one group received 2.5 ml of 0.5% hyperbaric bupivacaine combined with 10 micrograms of dexmedetomidine (Group D), while the other group was given 25 micrograms of fentanyl (Group F), with a total volume of 3 ml for each patient. The study compared the onset and duration of sensory and motor blocks, the maximum sensory and motor levels, time to first analgesic request, total recovery time for sensory and motor function, hemodynamic changes, and any side effects between the two groups.
Results: There were no significant differences between the groups in terms of patient demographics, ASA physical status, or hemodynamic variability. However, the onset of sensory block was quicker in Group D, averaging 1.35 ± 0.64 minutes, compared to 1.50 ± 0.53 minutes in Group F (p = 0.006). Group D also showed a slightly faster onset of motor block at 3.01 ± 0.74 minutes compared to 3.09 ± 0.73 minutes in Group F. The duration of motor block was significantly longer in Group D, lasting 201.28 ± 31.65 minutes, compared to 149.48 ± 38.66 minutes in Group F (p = 0.04). Complete sensory recovery took 325.7 ± 31.5 minutes in Group D, while it was 215.75 ± 29.4 minutes in Group F (p < 0.000). Additionally, the duration of complete analgesia was longer in Group D (319.43 ± 74.57 minutes) compared to Group F (209.78 ± 39.88 minutes) (p < 0.000). The time until the first request for rescue analgesia was significantly extended in Group D (321.43 ± 20.4 minutes) compared to Group F (213.33 ± 32.6 minutes) (p < 0.0001), indicating a longer-lasting sensory block in Group D.
Conclusion: The use of dexmedetomidine as an adjuvant to bupivacaine in subarachnoid blocks for infraumbilical surgeries results in a longer duration of both sensory and motor block, as well as extended postoperative analgesia.