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Indian Journal of Anesthesia and Analgesia

Volume  5, Issue 1, January 2018, Pages 119-131


Original Article

Clinical Study to Evaluate the Effectiveness of Epidural Dexmedetomidine for Postoperative Analgesia in Lower Limb Vascular Surgeries
Sargam Goel1, Mohammed Omar Kamal Ansari2, Sudhakar Koppad3
1Senior Resident, Department of Anaesthesiology, University College of Medical Sciences, Delhi 110095, India. 2Senior Resident, Department of Anaesthesiology, ESI Post Graduate Institute of Medical Science and Research, Rajajinagar, Bengaluru, Karnataka 560010, India. 3Consultant, Department Of Anaesthesiology and Critical Care, Bhagwan Mahaveer Jain Hospital, Vasanthnagar, Bengaluru, Karnataka 5600052, India.
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Background: The synergism between epidural local anaesthetics and opioids is well established but studies regarding combination of local anaesthetic with Dexmedetomidine as a continuous infusion for epidural analgesia are very few. This study compares the effectiveness of epidural infusion of Ropivacaine with Dexmedetomidine and Ropivacaine with Fentanyl for postoperative analgesia in lower limb vascular surgerieswith respect to the Quality of analgesia, Motor block, Sedation, Patient satisfaction, Hemodynamic effects and Adverse effects if any. Methods: Sixty patients scheduled for lower limb vascular surgeries between 18-70yrs of ASA 1, 2, 3 were prospectively randomized by computer generated method into 2 groups of 30 each. Group 1: Ropivacaine + Fentanyl . Group 2: Ropivacaine + Dexmedetomidine. Ethics committee approval was granted and patients consent was taken. Data was analyzed with the help of Chi-square test and SPSS software version 21.0. Epidural catheter was inserted at the start of surgery and used for both anaesthesia and postoperative analgesia. 0.75% Ropivacaine 3- 4mg/kg was administered as a bolus dose at the start of surgery for anaesthesia. After the surgery, patient was shifted to the recovery room. 3 hours after the elapse of the bolus Ropivacaine dose, a continuous infusion of 0.1% Ropivacaine + 0.04micrograms (mcg)/kilograms (kg)/hour (hr) of Dexmedetomidine or 0.1% Ropivacaine + 0.2mcg/kg/hour Fentanyl for 48 hours at the rate of 4millilitres (ml)/hour was started through the epidural catheter. The patient was assessed at regular intervals for 48 hours. Results: There was no statistically significant difference between the two groups in terms of VAS at rest and on movements, Motor blockade, sedation, hemodynamics , Patient satisfaction (p > 0.05). There was no adverse adverse effect in any patient. Conclusion: Dexmedetomidine as an adjuvant to Ropivacaineprovides good postoperative analgesia, stable hemodynamics, no unwarranted motor blockade and minimal sedation without any adverse effects. This is comparable to Fentanyl.

Keywords: Epidural Analgesia; Ropivacaine; Fentanyl; Dexmedetomidine; Vascular Surgeries. 

Corresponding Author : Mohammed Omar Kamal Ansari, Senior Resident, Department of Anaesthesiology, ESI Post Graduate Institute of Medical Science and Research, Rajajinagar, Bengaluru, Karnataka 560010, India.