Comparing intrathecal dexmedetomidine and fentanyl as adjuvants to hyperbaric bupivacaine in elective casarian section, a study.

Abstract

Objective: The design of present study was to explore and compare different aspects of fentanyl and DEX when used as adjuvants to hyperbaric bupivacaine in neurexial anesthesia in cases of cesarean sections. Study Design: Randomized Single Blinded study. Setting: Department of Anesthesia, QAMC, Bahawalpur. Period: January, 2019 to December, 2019. Material & Methods: They were divided in three groups, each group consists of 35 patients having the name of group BN, group BF and group BD. Patients in group BN was given the injection bupivacaine alone, group BF, administered injection bupivacaine along with fentanyl 25 mg and group BD given DEX 10 mg with bupivacaine intrathecally between L4 and L5 intervertebral disc. Scrutiny of onset of sensory block to T5, along with time required to attain Bromage O scale (motor block). Regression of sensory block (recovery of sensory function) and time required to reach Bromage 3 scale (recovery of motor function) were also recorded. Hemodynamic parameters such as heart rate, systolic and mean arterial pressures along with Ramsay sedation score were also taken into account. Results: Similar demographic profile has been observed in all groups. All three groups differ in terms of onset of sensory and motor block with p value 0.00 when BN was compared with Group BD and BF. Statistically significant results also observed between group BF and group BD with group BD showing shortest time required for initiation of sensory block (p value .04)  and time to reach Bromage O scale (p value .02) . The duration for regression of four sensory segments shows the statistical significance (P 0.000) when all three groups were compared, however, no difference found between BF (175+12.85 min) and BD (171.88 + 12.33 min) which showed a P-value of 0.240. The time required to reach Bromage 3 score was statistically significant between all three groups (p value 0.00) and was also statistically significant between group BF and group BD (p value 0.00) with longest time taken by BD group to reach BROMAGE 3 scale. Both two research groups showed same degree of sedation and comfort for patient. Conclusion: Hyperbaric bupivacaine, in conjunction with dexmedetomidine and fentanyl produced satisfactory results in terms of faster sensory and motor block onset and prolonged time to take in regression of sensory and motor block in comparison to bupivacaine alone. Dexmedetomidine was better among the two adjuncts. Both adjuvants produce same degree of sedation and comfort for patient and relieved apprehension.