Addition of Dexmedetomidine, Fentanyl and Their Combination to Intrathecal Hyperbaric Levobupivacaine 0.5% for Lower Limb Surgeries: A Randomised Comparative Study

Background and Objectives: Several adjuvants have been used with intrathecal local anesthetics to prolong intraoperative anesthesia and post operative analgesia. The aim of our study was to compare the safety and efficacy of dexmedetomidine, fentanyl and their combination as adjuvant to intrathecal hyperbaric levobupivacaine 0.5 % for lower limb surgeries. Material and Methods: This study was conducted on 96 patients who were enrolled for lower limb surgeries. They were randomly allocated into 3 groups of 32 each. Group F intrathecally received 2.5 ml of 0.5% hyperbaric levobupivacaine with 0.5 ml (25 mcg) fentanyl plus 0.5 ml normal saline. Group D intrathecally received 2.5 ml of 0.5% hyperbaric levobupivacaine with 0.5 ml (5 mcg) dexmedetomidine plus 0.5 ml normal saline. Group DF intrathecally received 2.5 ml of 0.5% hyperbaric levobupivacaine with 0.5 ml (5 mcg) dexmedetomidine plus 0.5 ml (25 mcg) fentanyl. The spinal block characteristics, hemodynamics and adverse effects were recorded. Results: Duration of sensory and motors blockade was significantly prolonged in Group DF as compared to Group D and Group F (P < 0.001). Time to first rescue analgesia was longer in group DF as compared to group D and Group F (P< 0.001). Total analgesia requirement of participants in group DF was significantly less as compared to Group F and Group D (P <0.001). Conclusion: We conclude that combination of intrathecal dexmedetomidine and fentanyl as adjuvant to 0.5% hyperbaric levobupivacaine, is a better alternative to fentanyl and dexmedetomidine for long duration surgeries of lower limb.