Dexmedetomidine versus fentanyl as an adjuvant to bupivacaine in saddle anesthesia for anoplasty: a correlative randomized double-blinded trial
Abstract
Background: A saddle block is a preferred choice for peri-anal surgical procedures including anoplasty. Anesthesiologists have experimented by adding different adjuvants like dexmedetomidine and fentanyl to local anesthetics for spinal anesthesia, in an attempt to maintain balanced hemodynamics, fast recovery and prolonged post-operative pain relief. We compared the effect of dexmedetomidine with fentanyl on these parameters when added to hyperbaric bupivacaine for saddle block for anoplasty.
Methodology: Fifty-eight adult patients were categorized into two groups. Group-Fen, consisting of 29 patients, underwent a saddle block with 2.5 ml hyperbaric bupivacaine combined with fentanyl 0.5 ml (25 μg). Second group, the Group-Dex, consisted of 29 patients, received 2.5 ml hyperbaric bupivacaine mixed with dexmedetomidine 10 μg (0.5 ml). Monitoring of HR and SpO2 was conducted every min for 10 min, then every 10 min. Evaluation of sensory blockage was done by using the pinprick technique, and the motor block was done utilizing the Bromage scale. Following surgery, assessments were conducted. Postoperative pain was determined utilizing the visual analog scale (VAS) in the ward and PACU.
Results: The Group-Dex exhibited significantly longer duration of two-segment retrogression and sensory retrogression to S1 compared to Group-Fen. Group-Dex exhibited a significantly prolonged duration until reaching Bromage 0 compared to the Group-Fen. A notable difference between groups was noted in terms of the time to request analgesia. The total consumption of tramadol and analgesic requirement frequency in Group-Dex was more alleviated than in Group-Fen, with highly substantial differences between groups.
Conclusion: Dexmedetomidine is recommended over fentanyl as adjunctive medication to bupivacaine for spinal anesthesia in anoplasty surgeries and procedures, in terms of duration of two-segment retrogression and sensory retrogression to S1.
Abbreviations: Anoplasty; BMI - Basal Metabolic Rate; IV - Intravenous; LA - Local anesthetics; PACU - Post-anesthesia care unit; VAS - Visual Analog Scale
Keywords: Dexmedetomidine; Regional Anesthesia; Spinal block; Bromage scale
Citation: Seyam SHA, Abdelgawad IM, Abdelhalim MA. Dexmedetomidine versus fentanyl as an adjuvant to bupivacaine in saddle anesthesia for anoplasty: a correlative randomized double-blinded trial. Anaesth. pain intensive care 2024;28(2):302−309. DOI: 10.35975/apic.v28i2.2438
Received: January 23, 2024; Revised: March 03, 2024; Accepted: March 04, 2024
