A Comparison of Dexmedetomidine and Fentanyl with Bupivacaine as an Efficient Painkiller acting as an assistant in Lower Limb Surgery

Abstract

Objective:

This study hopes to create a comparison between dexmedetomidine and fentanyl when they are paired with bupivacaine. The different effects of these drugs when paired with 0.5% bupivacaine will be studied in order to determine which is a more efficient painkiller. The effects will be studied on patients who are undergoing spinal anesthesia. This study is specifically focusing on patients who  are undergoing lower limbs surgery.

Study design:

This study design is utilizing a study population of patients undergoing lower limb surgery in a randomized controlled trial.

Place & duration: This study was conducted at Sindh Employees Social Security Hospital Landhi Karachi, Pakistan from August 2019 to August 2020.

Methods:

This study population for this paper was inclusive of both genders who were admitted for lower limb surgery. The inclusion criteria for patient age were between 18 years to 73 years of age. The study population was categorized as two groups the first was group 1 and the second was group 2. Group one consisted of 29 patients who received dexmedetomidine with bupivacaine. The composition of the spinal injection was as follows: 10 µg of dexmedetomidine in 0.5 ml of normal saline with the standard 0.5% hyperbaric bupivacaine which consisted of 12.5mg, this mixture was 0.5ml normal saline and given to each patient of group one. Similarly group 2 also consisted of 29 patients who were given a similar cocktail which consisted of fentanyl with hyperbaric bupivacaine. The composition of the spinal  injection for group 2 was as follows: 25mg fentanyl was used with the standard 0.5% hyperbaric bupivacaine which consisted of 12.5mg, this mixture given to each patient of group two. Study group was analyzed and noted for the time it took to achieve the t10 blockade. Another important aspect noted for this study was the time that it took to reach first rescue analgesia. Both these times were compared for each Group and the data was analyzed using the SPSS software where the p value was determined to be < 0.05. The most significant and important discovery noted when comparing the effects of these two drugs was the time it took to first rescue analgesia. In group 1 the time to rescue analgesia was noted to be 7.10967± 1.54 hours whereas for group 2 the time was taken as 3.44± 0.81 hours which concluded the p value as being less than 0.0001. However, the patient satisfaction rate different between the two groups, patients rated as being highly satisfied in the dexmedetomidine Group 1 as compared to group two.

Conclusion:

This study concluded that when comparing the time to first rescue analgesia group one performed better, which concluded that dexmedetomidine 10 μg with 0.5% bupivacaine showed more promising results than 25 mg fentanyl. However, when it came to analyzing the time to t10 blockade there was no significant difference noted between the two medications.