Title: Use of Intrathecal dexmedetomidine and fentanyl as adjuvants to low dose spinal anesthesia with levobupivacaine in patients undergoing transurethral resection of prostrate -A Comparative study
Authors: Dr Praveen Kumar Moturi, Dr Yogitha Devi Allu, Dr Gunaseelan.C, Dr Avinash .R
DOI: https://dx.doi.org/10.18535/jmscr/v7i5.109
Abstract
Purpose of the study: Patients undergoing transurethral resection of prostate are usually elderly patients with unstable hemodynamics. As far as transurethral resection of prostate cases are concerned, anesthesia level up to T10 dermatome is sufficient. This will minimize the hemodynamic alterations in geriatric age group. So the aim is to use low dose spinal anesthesia but this low dose spinal anesthesia alone using single drug levobupivacaine does not provide sufficient surgical anesthesia. So addition of adjuvants was considered. The aim of the study was to compare the adjuvant effects of intrathecal dexmedetomidine and intrathecal fentanyl with low dose levobupivacine spinal anesthesia.
Methods: Comparative study was double blinded randomized trial which included 60 patients of ASA grade I,II,III posted for transurethral resection of prostate. They were divided into two groups. Group D receiving Dexmedetomidine and Group F receiving Fentanyl with low dose levobupivacaine intrathecally Outcomes which were compared between two groups were characteristics of block; hemodynamical changes intra-operatively and post-operative analgesic requirements.
Results: Baseline demographic attributes were comparable. peak sensory levels were similar in both groups D and F around T8. Group D has quicker onset of sensory block than group F.
[Group D 10.7 ± 2.24 min][Group F 11.8 ± 1.75 min]
Duration of block was more in group D (197.033 ± 12.71min) compared to Group F with (187.8 ± 8.23min) The requirement of first analgesic dose was based on VAS score. It was delayed in Group D where the mean time of analgesic requirement was (212.033 ± 15.07 min) where as in fentanyl it was (200.27 ± 7.45 min).
Conclusion: Intrathecal dexmedetomidine with low dose levobupivacaine provided faster onset of anesthesia with increased duration of sensory and motor block. The duration for rescue analgesic requirement was more in group D with lower post-operative VAS scores. However, the haemodynamics in both groups were similar.
Keywords: Adjuvants, levobupivacaine, dexmedetomidine, fentanyl, spinal anesthesia, TURP.
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