Comparative study of intrathecal isobaric levobupivacaine (0.5%) 3ml with dexmedetomidine 0.5ml (5 mcg) and isobaric levobupivacaine (0.5%) 3ml with fentanyl 0.5ml (25 mcg) in patients undergoing surgeries under subarachnoid block: a prospective randomized double blind study

Abstract

Spinal Anesthesia is the preferred choice for lower limb surgeries due to the benefits of an awake patient, low drug costs, effective intraoperative and excellent postoperative analgesia, and quick patient recovery. Adjuvant must be added intrathecally with low-dose local anesthetics to improve the duration of blockade.   

Methodology: A prospective randomized, double-masked study with 60 patients (30 in each group, assigned by computer-generated randomization code). Group A ~ (n = 30 ) Patients will receive 3 ml of Isobaric Levobupivacaine 0.5% + Dexmedetomidine 5 mcg (0.5ml) – diluted with NS. Group B ~ (n = 30 ) Patients will receive 3 ml of Isobaric Levobupivacaine 0.5% +Fentanyl 25 mcg (0.5ml)

Results: The mean time for the highest sensory block among Group A (7.17 ± 5.26) mins and among Group B (5.90 ± 3.52) mins, which did not show statistical significance between both the groups (p-value> 0.05). The mean time for regression of sensory block level up to T 10 among Group A cases was (183.60 ± 56.71) mins and among Group B cases (171.17 ± 53.01) mins, which was found to be statistically insignificant (p-value> 0.05).

The mean time of onset of a motor block of Group A (2.35 ± 1.40) & Group B (2.53 ± 1.69) mins was found to be statistically significant between both the groups (p-value < 0.05). It was found that Group A had the fastest time of onset of motor block (Modified Bromage 2) than Group B. The duration of motor blockade in Group A (296.30 ± 75.5) mins and Group B (267.35 ± 23.78) mins was found to be statistically significant between the two groups. (p-value < 0.05), It was found that Group A had the fastest time of onset of motor block (Modified Bromage 2) than Group B. The mean time for first rescue analgesia was significant between the two groups. The time for first rescue analgesia was significantly longer in 

 Group A (6.93 ± 1.47 hours) and Group B (4.78 ± 2.71 hours).

Conclusion:

The addition of Dexmedetomidine to Isobaric levobupivacaine significantly prolongs the duration of analgesia and anesthesia when compared with fentanyl as an adjuvant to Isobaric levobupivacaine. Levobupivacaine, when administered along with Fentanyl, is a suitable drug for daycare surgeries, while levobupivacaine with dexmedetomidine is an excellent agent for longer-duration surgeries. Dexmedetomidine appears to be an appealing adjuvant to intrathecal local anesthetics compared to opioids.