Anaesthetic and Analgesic Efficacy of Dexmedetomidine versus Fentanyl as an Adjuvant to Epidural Levobupivacaine for Total Abdominal Hysterectomy: A Prospective, Randomized, Controlled Study

Author(s): Nidhi Pathak1 , Bhavya Krishna2

BACKGROUND After Total abdominal hysterectomy (TAH) is a major surgery and is associated with significant morbidity, if pain is not adequately controlled intra- and postoperatively. Epidural analgesia with a variety of local anaesthetics and adjuvants is widely used for TAH as it provides both intra- and post-operative analgesia. Primary objective of our study is to compare the effect of epidural levobupivacaine with fentanyl versus levobupivacaine with dexmedetomidine for analgesia and motor blockade in patients undergoing Total Abdominal Hysterectomy. METHODS This is a prospective, double-blinded trial conducted among 100 women aged between 35 and 65 years of age who were allocated randomly into one of the two groups for elective total abdominal hysterectomies. Group D received epidural levobupivacaine 0.5% with dexmedetomidine as adjuvant, and the other group F received epidural levobupivacaine 0.5% with fentanyl as adjuvant. RESULTS Time to achieve sensory level at T6 was found to be significantly lower (p<0.001) in Group D (9.22 + 0.86 min) as compared to Group F (11.30 + 0.99 min). The time to achieve complete motor block in Group D was 20.0 + 1.53 minutes and in Group F it was found to be 24.02 + 1.12 minutes. Complete motor block was achieved in significantly lower (p<0.001) time by Group D subjects as compared to Group F. Also, it was found that the duration of analgesia was significantly higher (p<0.001) in Group D (384.02 + 20.84 minutes) as compared to Group F (270.30 + 19.34 minutes). CONCLUSIONS Dexmedetomidine is a better adjuvant to levobupivacaine than fentanyl for epidural analgesia with better quality of analgesia, prolonged duration of analgesia, higher sedation scores, and no significant side effects.