Spinal Anesthesia using Isobaric Ropivacaine with Fentanyl Versus Spinal Anesthesia using Isobaric Ropivacaine with Dexmedetomidine for Lower Abdominal Surgeries: A Prospective Observational Study
DOI:
https://doi.org/10.69980/ajpr.v28i5.714Keywords:
Anesthesia, Spinal, Ropivacaine, Dexmedetomidine, Fentanyl, Adrenergic alpha-2 Receptor AgonistsAbstract
Background: Spinal anesthesia is widely used for lower abdominal surgeries due to its reliability, cost-effectiveness, and rapid onset. However, the limited duration of local anesthetics such as ropivacaine necessitates the use of adjuvants to prolong block and improve postoperative analgesia. Fentanyl, an opioid, enhances block quality but is associated with opioid-related side effects. Dexmedetomidine, a selective α2-adrenergic agonist, has shown promise as an intrathecal adjuvant with superior block characteristics and fewer complications.
Objective: This prospective observational study compared the efficacy of intrathecal fentanyl versus dexmedetomidine as adjuvants to isobaric ropivacaine in patients undergoing lower abdominal surgeries.
Methods: Eighty ASA I–II patients were randomized into two groups: Group RD (ropivacaine + dexmedetomidine, n=40) and Group RF (ropivacaine + fentanyl, n=40). Demographic variables, block onset, duration, hemodynamic changes, analgesic requirements, and side effects were recorded and analyzed.
Results: Both groups were comparable in baseline characteristics. The onset of sensory (159.2±7.39 vs. 189.7±9.34 sec) and motor block (453.2±10.61 vs. 489.4±9.68 sec) was significantly faster in Group RD. The duration of sensory (191.8±4.81 vs. 135.8±3.22 min) and motor block (152.9±4.99 vs. 126.5±3.05 min) was significantly longer with dexmedetomidine. Time to first analgesic request was also prolonged in Group RD (265±71.4 vs. 203±35.6 min). Hemodynamic parameters were stable in both groups, with mild bradycardia more frequent in Group RD but easily managed. Adverse effects were minimal and comparable.
Conclusion: Intrathecal dexmedetomidine as an adjuvant to isobaric ropivacaine provides faster onset, prolonged sensory and motor block, extended postoperative analgesia, and stable hemodynamics compared to fentanyl. Dexmedetomidine appears to be a superior alternative for lower abdominal surgeries.
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