Comparison of dexmedetomidine and fentanyl as adjuvants to intrathecal levobupivacaine in lower segment cesarean section: A prospective, randomized double blind study

Abstract

Background: Intrathecal bupivacaine is the most commonly used local anesthetic for lower segment cesarean section (LSCS) but there is constant endeavor for search of a local anesthetic (LA) which has improved safety profile for mother as well as the fetus. So far, many adjuvants like fentanyl, morphine or tramadol etc. have been used to prolong intraoperative anesthesia and postoperative analgesia. But the literature lacks information on the use of dexmedetomidine as adjuvants with isobaric levobupivacaine. So, we planned this study to compare dexmedetomidine and fentanyl added to 0.5% isobaric intrathecal levobupivacaine in spinal anesthesia for LSCS.

Methodology: After institutional ethical committee approval and informed written consent, the patients were divided into three equal groups: Group L; to receive 2.5 ml of isobaric levobupivacaine 0.5%, Group LD to receive 2.5 ml of isobaric levobupivacaine and 5 µg dexmedetomidine and Group LF to receive 2.5 ml of isobaric levobupivacaine and 25 µg fentanyl intrathecally. Primary outcome was measured as duration of sensory and motor blockade from the time of intrathecal administered drugs. Statistical analysis was performed by using chi-square test or Fischer's exact test and One-way ANOVA or Kruskal Wallis test as applicable. A p-value of < 0.05 was considered as statistically significant.

Results: Duration of sensory and motor blockade was significantly prolonged (p < 0.001) in Group LD as compared to Group LF or L. Onset of sensory and motor blockade was earlier in Group LF as compared to Group LD and L (p < 0.001). Time to first rescue analgesia was prolonged in Group LD than Group LF and L (p < 0.001).

Conclusion: Intrathecal dexmedetomidine produces prolonged motor blockade as well as postoperative analgesia than fentanyl when used as an adjuvant to 0.5% isobaric levobupivacaine in elective cesarean section.

Key words: Cesarean section; Dexmedetomidine; Fentanyl; Intrathecal analgesia; Levobupivacaine; Spinal anesthesia

Citation: Rastogi K, BhartiAK, Singh Y, Ranjan P. Comparison of dexmedetomidine and fentanyl as adjuvants to intrathecal levobupivacaine in lower segment cesarean section: A prospective, randomized double blind study. Anaesth. pain intensive care 2020;24(3):383-388.

Received: 18 April 2020, Reviewed: 14 May 2020, Revised: 15 May 2020, Accepted: 23 June 2020