The Use of Intrathecal Dexmedetomidine and Fentanyl as Adjuvants to Bupivacaine – A Cross-sectional Analytical Study

Abstract Introduction: In spinal anesthesia, dexmedetomidine and fentanyl are frequently added as adjuncts to local anesthetics to extend analgesia and enhance postoperative pain management. The purpose of this prospective observational study was to evaluate the effectiveness of intrathecal fentanyl and dexmedetomidine as adjuvants to bupivacaine for the management of postoperative pain in patients having lower abdominal operations. Methods: Eligible patients who received intrathecal anesthetic with bupivacaine plus either fentanyl (Group F) or dexmedetomidine (Group D) were studied. Age, gender distribution, the American Society of Anesthesiologists classification, and length of operation were recorded as baseline variables. The longest length of the sensory block, the highest sensory level attained, the time it took to reach the maximum sensory level, and the results of the postoperative pain were measured as aspects of the sensory block. Results: Comparable levels of sensory block were attained by the dexmedetomidine and fentanyl groups. There was no significant difference in the maximum sensory level attained ( P = 0.89) or in the time from injection to the greatest sensory level ( P = 0.57). Nevertheless, as demonstrated by a longer time for two-segment regression from the maximum sensory level ( P < 0.001) and a delayed time to sensory regression to S1 ( P < 0.001), dexmedetomidine demonstrated a considerably longer duration of sensory block compared to fentanyl. In addition, compared to fentanyl, dexmedetomidine was linked to a lower total analgesic dose in the first 24 h postoperatively ( P = 0.03) and a noticeably longer duration to rescue analgesia ( P < 0.001). Discussion: Our study suggest that intrathecal dexmedetomidine provides prolonged sensory block duration and reduced postoperative analgesic requirements compared to fentanyl when used as an adjuvant to bupivacaine for intrathecal anesthesia. These results have significant implications for improved pain management and enhanced patient outcomes in various surgical procedures.