Epidural Ropivacaine and Dexmedetomidine with that of Epidural Ropivacaine and Fentanyl for Postoperative Analgesia in Lumbar Spine Surgeries- A Randomised Double-Blinded Study

Abstract

Introduction: Epidural with opioids as adjuvants are the most common agents of choice for postoperative analgesia in spine surgeries which promote early ambulation, increased patient satisfaction and improved outcome. Recently, epidural administration of α2 agonists in combination with local anaesthetics in low doses offers new dimensions in the management of postoperative pain. Aim: To compare the analgesic efficacy, sedation score and haemodynamic stability of Epidural Ropivacaine and Fentanyl (RF) with that of Ropivacaine and Dexmedetomidine (RD) in the postoperative period in lumbar spine surgeries. Materials and Methods: This was a randomised, double-blinded study conducted on 120 patients at IMS and SUM Hospital, Bhubaneswar, Khordha, India. Haemodynamic parameters, Visual Analogue Score (VAS), sedation score, time to 1st dose of rescue analgesics requirement and complications were observed. The study consisted of group RF that received ropivacaine and fentanyl and group RD that received ropivacaine and dexmedetomidine, with 60 patients in each group. Continuous variables were analysed with the unpaired t-test and categorical variables were analysed with Chi-square Test and Fisher-Exact test. Statistical significance was taken as p <0.05 Results: The mean age of participants in group RD was 39.73±7.192 years and in group RF was 40.67±7.434 years (p-value 0.872). Heart rate was in lower range in RD group throughout the study and was statistically significant with a p-value <0.05. VAS score was lower, sedation score was higher and time to 1st dose of rescue analgesia were longer in RD group compared to group RF (p<0.005). Complications like hypotension (33.3%), bradycardia (20%) were more common in group RD while nausea, vomiting (16.67%) and pruritis (10%) were noted in group RF. Conclusion: Dexmedetomidine seems to be a better neuraxial adjuvant with good postoperative analgesic efficacy, better patient comfort and hemodynamic stability compared with that of fentanyl.

Keywords

• pain
• rescue analgesic requirement
• visual analog scale