DEXMEDETOMIDINE VERSUS FENTANYL IN LOWER LIMB ORTHOPEDIC SURGERIES: A COMPARATIVE EVALUATION

opioids and local anesthetics have been the traditional choice in epidural analgesia. However opioids suffer from the issue of side effects and res piratory depression. The use of newer agent like dexmedetomidine is a viable option. The present study was formulated to provide a comparative assessment of whether fentanyl or dexmedetomidine is a better adjuvant for lower limb surgeries in which epidural route is used. The study included a pool of 30 subjects who were divided in two equal groups and administered fentanyl or dexmedetomidine. The results displayed a shorter duration of sensory block and motor block in dexmedetomidine group as compared to fentanyl. The overall efficacy of dexmedetomidine was better in the present study. Keywords: analgesia, dexmedetomidine, epidural, fentanyl

COMPARATIVE EVALUATION OF TRAMADOL AND FENTANYL FOR EPIDURAL ANALGESIA IN LOWER LIMB SURGERIES

Background:Epiduralandspinalblocksaremajorregionaltechniques with along history of effectiveuseforavarietyofsurgicalprocedures and pain relief. Epidural block with the catheter technique gives a better control of the level of analgesia and can be used for providingpost-operativepainreliefbyopioidsorlocalanaestheticagents.The purposeofthepresentstudywastocomparethe safetyandefficacyofepiduraltramadolversusepiduralfentanylas adjuvantstobupivacaineforlowerlimbsurgeries. Materials and methods:100 patients werer an domisedin to two groups with50 patient sineach group: Group BB-epidural administration of 20mL 0.5% plain bupivacaine with [50 mg (1 mL) tramadol + 1 mL NS= 2 mL].Group BF- epidural administration of 20 mL 0.5% plain bupivacainewith100mcg(2mL)of fentanyl.Settings and Design- Randomised double-blind trial. Results:The mean onset of sensory blockade and time for maximum sensory blockade was observed to be significantly reduced with the addition of fentanyl to bupivacaine as compared to tramadol and bupivacaine. The results showed statistically significant increase in the duration of analgesia with the addition of fentanyl to bupivacaine as compared to tramadol and bupivacaine. Conclusion:We can conclude that tramadol and fentanyl were effective adjuvants to bupivacaine when used epidurally in patients undergoing lower limb surgery. Although, epidural fentanyl with bupivacaine produces significantly faster onset of sensory blockadecompared to epiduralhowever,epiduraltramadolwithbupivacaineproducessignificantlyprolonged durationofanalgesiacomparedtoepiduralfentanyl.

Epidural Fentanyl and Fentanyl Plus Magnesium for Post-Operative Analgesia in Lower Extremity Surgery

Background: The present study was conducted to assess the efficacy of epidural fentanyl with a combination of epidural fentanyl and magnesium in lower extremity surgery. Subjects and Methods : This study was conducted on 100 ASA I/II patients scheduled to undergo elective lower limb orthopedic surgeries. Group I patients received epidural fentanyl 50 µg (1cc) diluted and made up to 6cc with normal saline. Group II patients received epidural fentanyl 50 µg (1cc)+ Magnesium sulphate 50mg (4 units in insulin syringe of 50% solution) diluted and made up to 6cc with normal saline. Patient data such as indication for surgery, the anesthetic details, intraoperative monitoring, post-operative follow-up, etc was recorded. Results: Each group had 36 males and 14 females. Time is taken for the highest sensory level in group I was 13.92 4.50 minutes and 12.24 3.43 minutes in groups I and II respectively. The mean duration of surgery was 99.00 13.31 minutes in group I and 92.20 15.21 in group II. Time for Regression to L1 was 118.80 13.41 and 119.60 17.85 minutes in group I and II respectively. The duration of analgesia (min) was 107.00 25.82 and 143.40 39.57 minutes in group I and II respectively. Common adverse events were nausea/ vomiting seen 2 in group I and 4 in group II and urinary retention seen 0 in group I and 2 in group II. The difference was non- significant (P> 0.05). Conclusion: Authors found that the addition of magnesium sulfate to epidural fentanyl for elective lower limb orthopedic surgeries has prolonged the duration of fentanyl analgesia without any significant side effects.