Evaluation of Dexmedetomidine with Fentanyl versus Pentazocine for Sedation and Analgesia in Tympanoplasty Under Monitored Anesthesia

Background: Monitored anesthesia care (MAC) is widely utilized during tympanoplasty to provide effectivesedation and analgesia while maintaining patient cooperation. Dexmedetomidine, an α2-adrenergic agonist, isfavored for its sedative, analgesic, and anxiolytic properties without causing significant respiratory depression.The combination of dexmedetomidine with opioids such as fentanyl or mixed agonist-antagonists like pentazocinemay influence intraoperative conditions and postoperative recovery.Objective: To compare the efficacy, safety, and recovery profile of dexmedetomidine-fentanyl versusdexmedetomidine-pentazocine combinations for monitored anesthesia care during tympanoplasty.Methods: This prospective, randomized, comparative study was conducted on 120 adult patients undergoingtympanoplasty under MAC. Patients were randomly divided into two equal groups of 60 each. Group DF receiveda loading dose of dexmedetomidine 1 mcg/kg followed by a maintenance infusion of 0.5 mcg/kg/hr along with abolus of fentanyl 1 mcg/kg. Group DP received the same dexmedetomidine dosing regimen with a bolus ofpentazocine 0.3 mg/kg. Parameters assessed included the Ramsay Sedation Score, visual analog scale (VAS) forpain, intraoperative hemodynamics, adverse events, patient and surgeon satisfaction scores, and recovery times.Results: Both drug combinations provided satisfactory sedation and analgesia. Group DF demonstrated fasteronset of sedation and more profound analgesia, whereas Group DP was associated with more stablehemodynamics and fewer respiratory events. Recovery was slightly prolonged in the DP group, although bothgroups showed comparable patient and surgeon satisfaction scores.Conclusion: Both dexmedetomidine-fentanyl and dexmedetomidine-pentazocine combinations are effective for MAC during tympanoplasty. Fentanyl offers deeper sedation and quicker onset, while pentazocine provides amore stable hemodynamic profile. The choice between the two may be tailored based on patient condition andsurgical requirements.