Comparative Study of Bupivacaine-Dexmeditomidine and Bupivacaine-Fentanyl with Bupivacaine Plain as Local Infiltration for Postoperative Analgesia After Abdominal Hysterectomy Under Subarachnoid Block

Introduction: Abdominal hysterectomy is a common surgical procedure associated with significant postoperative pain. Effective pain management is crucial to enhance recovery and reduce opioid dependency. Multimodal analgesia, including local wound infiltration with adjuvants, has been explored to optimize pain control. This study compares the efficacy of bupivacaine alone, bupivacaine with fentanyl, and bupivacaine with dexmedetomidine for postoperative analgesia in patients undergoing abdominal hysterectomy. Materials and Methods: This hospital-based observational study was conducted at MES Medical College over one year. A total of 81 patients undergoing elective abdominal hysterectomy under subarachnoid block were randomly allocated into three groups: Group B (20 ml of 0.25% bupivacaine), Group F (20 ml of 0.25% bupivacaine with 20 mcg fentanyl), and Group D (20 ml of 0.25% bupivacaine with 20 mcg dexmedetomidine). Postoperatively, hemodynamic parameters, pain scores using the Numeric Rating Scale (NRS), time to first rescue analgesia, and total rescue analgesic consumption were assessed over 24 hours. SPSS 15 was used for statistical analysis. A p value < 0.05 was considered as significant. Results: Among the groups, demographic characteristics and duration of surgery were comparable. Group D demonstrated a significantly prolonged duration of analgesia (5.4 ± 1.2 hours) compared to Group F (3.1 ± 1.1 hours) and Group B (2.6 ± 1.3 hours) (p < 0.001). The time to first rescue analgesia was longest in Group D (7.6 ± 1.5 hours) (p < 0.001). Total rescue analgesic consumption was lowest in Group D, followed by Group F, and highest in Group B (p < 0.001). Adverse effects were minimal across all groups. Hemodynamic stability was also seen among all groups. Conclusion: The addition of dexmedetomidine to bupivacaine for local wound infiltration provides superior postoperative analgesia compared to fentanyl or bupivacaine alone, with a significantly prolonged analgesic duration and reduced need for rescue analgesics. Dexmedetomidine is a promising adjuvant for improving postoperative pain management in abdominal hysterectomy.