Postoperative Analgesia Of Additives Dexmedetomidine And Nalbuphine With Hyperbaric Ropivacaine For Infraumbilical And Lower Limb Surgeries.

Background:   Spinal anesthesia is commonly used for lower abdominal and lower limb surgeries due to its efficacy and cost-effectiveness. The addition of adjuvants to local anesthetics, such as dexmedetomidine and nalbuphine, aims to enhance analgesic effects and prolong the duration of anesthesia. This study compares the perioperative efficacy and postoperative analgesia of dexmedetomidine and nalbuphine when used as additives to hyperbaric ropivacaine for infraumbilical and lower limb surgeries. Methods: In this study, 65 ASA I and II patients aged 18-70 scheduled for lower limb or lower abdominal surgeries were randomly assigned to receive either 3 ml of 0.75% hyperbaric ropivacaine with 5 µg dexmedetomidine (Group RD) or 3 ml of 0.75% hyperbaric ropivacaine with 0.4 mg nalbuphine (Group RN). Spinal anesthesia was administered at the L3-L4 level. Onset and duration of sensory and motor blocks, pain intensity using the Visual Analogue Scale (VAS), and hemodynamic parameters were evaluated. Results: Group RD (dexmedetomidine) demonstrated significantly longer sensory block duration (349.15 minutes vs. 287.34 minutes) and motor block duration (293 minutes vs. 264.06 minutes) compared to Group RN (nalbuphine), with all differences being statistically significant (P < 0.001). The duration of analgesia was also extended in Group RD (412.58 minutes vs. 372.06 minutes) (P < 0.001). No significant differences were observed in age, gender distribution, ASA grades, onset times for sensory and motor blocks, pulse rate, or SpO2 levels between the groups. Complication rates were similar, with no significant difference in the incidence of complications (P = 0.613). Conclusion: Supplementing 3 ml of 0.75% hyperbaric ropivacaine with 5 µg dexmedetomidine significantly enhances the onset time and prolongs the duration of sensory and motor blockade compared to 3 ml of 0.75% hyperbaric ropivacaine with 0.4 mg nalbuphine, with both groups showing similar complication rates.