Effects of Dexmedetomidine & Fentanyl as Adjuncts to Bupivacaine for Postoperative Analgesia in Subarachnoid Block of Urological Surgeries

Md Samir  Asif; Sadia Islam  Mohua; Shanjida  Kibria; Md. Ashfak  Ahmad; Ponam Saha; Priyanka  Das; Moshiur  Rahman; Mohammad Shafiqul  Islam

doi:10.62848/bjpain.v5i2.7604

Authors

Md Samir Asif Resident, Department of Anaesthesia, Analgesia and Intensive Care Medicine, Bangladesh Medical University, Dhaka.
Sadia Islam Mohua Lecturer, Department of Physiology, Shaheed Monsur Ali Medical College, Dhaka
Shanjida Kibria Resident, Department of Anaesthesia, Analgesia and Intensive Care Medicine, Bangladesh Medical University, Dhaka. https://orcid.org/0009-0009-4617-8991
Md. Ashfak Ahmad Resident, Department of Anaesthesia, Analgesia and Intensive Care Medicine, Bangladesh Medical University, Dhaka.
Ponam Saha Resident, Department of Anaesthesia, Analgesia and Intensive Care Medicine, Bangladesh Medical University, Dhaka.
Priyanka Das Medical Officer, Dhanmondi Cosmetic Hospital, Dhaka
Moshiur Rahman Epidemiologist, CDC, DGHS
Mohammad Shafiqul Islam Professor, Department of Anaesthesia, Analgesia and Intensive Care Medicine, Bangladesh Medical University, Dhaka. https://orcid.org/0000-0003-3443-7828

DOI:

https://doi.org/10.62848/bjpain.v5i2.7604

Keywords:

Dexmedetomidine, Fentanyl, Bupivacaine, Postoperative Analgesia, Subarachnoid block, Urological surgery

Abstract

Background: Spinal anesthesia is preferred for its quick action, reliability, and fewer complications, aiding in faster recovery and enhanced postoperative outcomes in elective urologic surgeries. Adjuvants like fentanyl and dexmedetomidine enhance spinal anesthesia, improving analgesia duration and hemodynamic stability. This study aims to compare the analgesic efficacy, hemodynamic profile, and adverse effects of dexmedetomidine and fentanyl.
Methods: Adult patients aged 18-50 years, ASA physical statuses I and II, undergoing elective urological surgery were selected for the study. Sixty patients were enrolled following inclusion and exclusion criteria and divided into two groups. One group received 0.2 ml (10 mcg) fentanyl with 1.8ml hyperbaric bupivacaine while the other group received 0.2ml (5mcg) dexmedetomidine with 1.8 ml hyperbaric bupivacaine. The patients in post-operative period received analgesics when VAS score was equal or more than 4. By maintaining the standard operative procedure heart rate and blood pressure were measured at 5 min,10 min,15 min, 30 min, 45 min, 60 min, 75 min, 90 min, 105 min, 120 min, 6-hour, 12 hour and 24 hours. After completing the surgery VAS at first analgesic request, duration of analgesia was also recorded. VAS at 0-hour, 1 hour, 3-hour, 6-hour, 12-hour and 24-hour was also recorded respectively. Patients were monitored for side effects e.g. nausea, bradycardia, hypotension, pruritus, shivering.
Results: Combining dexmedetomidine with bupivacaine yielded superior analgesic effects in urological surgery patients compared to bupivacaine and fentanyl. Dexmedetomidine reduced postoperative pain scores (p=0.002) and analgesic like paracetamol (p<0.001) or pethidine (p<0.001) requirement. It prolonged analgesia (p<0.001) and caused less side effects like nausea (p=0.011). Up to 120 minutes, SBP, DBP, MAP, HR were stable in experimental group while it was elevated in control group.
Conclusion: Addition of dexmedetomidine with bupivacaine for urological surgeries under subarachnoid block resulted in superior analgesia for a longer duration without demand for additional analgesia & fewer side effects (nausea, hypotension, bradycardia, pruritus, shivering) compared to fentanyl with bupivacaine.