Dexmedetomidine as an adjuvant to epidural 0.75% ropivacaine in patients undergoing infraumbilical surgery: a clinical study

Background: Epidural block provides surgical anesthesia as well as post-operative analgesia in patients undergoing lower abdominal surgeries. Ropivacaine, is safe and effective for regional anesthetic techniques. Dexmedetomidine, alpha-2 agonist, as adjuvant to local anesthetic is reported to have synergistic effect for epidural anesthesia. The present study was designed with the aim to evaluate the efficacy and safety of dexmedetomidine as an adjuvant to epidural 0.75% ropivacaine in patients undergoing infraumbilical surgery. Method: Eighty adult consented patients 18-58 yr of age, of either sex, of ASA grade I/II undergoing infraumbilical surgeries were enrolled for the present study. Patients were randomised in two groups of 40 patients each: Group A received epidural ropivacaine only whereas Group B received epidural ropivacaine and dexmedetomidine. Patients of group A received 15 ml 0.75% ropivacaine + 1 ml Normal Saline and group B received 15 ml 0.75% ropivacaine + 0.6 μ kg-1 dexmedetomidine in 1 ml NS (group B) epidurally. Various block characterstics sensory onset time, time to complete motor block, time to two dermatome regression, duration of sensory analgesia and motor block, sedation scores, hemodynamic changes and any side effect were all recorded and statistically analysed by one way ANOVA and chi-square test. The p value<0.05 is considered significant and p<0.001 as highly significant. Results: The demographic profile of patients was comparable in both the groups. Onset of sensory block (2.50 ± 0.877 vs 7.00 ± 1.198 min) and establishment of complete motor blockade (17.20 ± 4.10 vs 23.90 ± 3.57 min) was significantly earlier in the ropivacaine with dexmedetomidine group. Postoperative analgesia was prolonged significantly in the ropivacaine with group (429.25 ± 58.34 min). Sedation scores were also higher in the dexmedetomidine group with statistically highly significant difference (p<0.001). Incidence of nausea, vomiting and shivering were were more in patients of ropivacaine alone group with statistically significant difference (p=0.003) Conclusion: Dexmedetomidine is effective adjuvant with ropivacaine for epidural block as it prolongs duration of motor block and analgesia with adequate sedation and minimal side effects. Correspondence to: Dr. Bhawana Rastogi, Department of Anaesthesiology & Critical Care in NSCB Subharti Medical College, Meerut (UP), India, Tel: +918449114984; Fax: +91-0121-2439056; E-mail: [email protected]