Aug 2026· Journal of Clinical and Diagnostic Research· 0 citations
Abstract
Introduction: Spinal Anaesthesia (SA) is a suitable Regional Anaesthesia (RA) for lower limb surgery, but is limited by its comparatively short analgesic duration. Adjuvants like fentanyl and dexmedetomidine can be administered intrathecally with local anaesthetics like ropivacaine to assist in modulating block parameters, extend the duration of analgesia and decrease systemic administration of opioids.
Aim: To compare and evaluate the safety and efficacy of intrathecal fentanyl and dexmedetomidine as adjuvants to ropivacaine in lower limb orthopaedic surgery.
Materials and Methods: This double-blinded, randomised controlled study was carried out at the Department of Anaesthesiology, Jawaharlal Nehru Medical College, Acharya Vinoba Bhave Rural Hospital, Datta Meghe Institute of Higher Education and Research (DMIHER), Sawangi (Meghe), Wardha, Maharashtra, India. It was performed in 60 American Society of Anaesthesiologists (ASA) I-II patients aged 18-50 years undergoing elective lower limb operations. The patients were divided into two groups: Group-RD was administered 15 mg 0.5% hyperbaric ropivacaine with 10 μg dexmedetomidine and Group-RF was administered 15 mg 0.5% hyperbaric ropivacaine with 20 μg fentanyl. Haemodynamic parameters, sensory and motor block characteristics, sedation {as measured by the Ramsay Sedation Score (RSS)}. Duration of analgesia and sideeffects were recorded. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) v22.0 and GraphPad Prism v6.0 and p<0.05 was considered statistically significant.
Results: The mean age was 38.43±8.31 years in GroupRF and 37.27±8.75 years in Group-RD. Group-RD showed a significantly earlier onset of sensory block (4.33±0.64 min vs 5.58±0.59 min). Motor block onset was also earlier in Group-RD (5.04±0.75 min) than in Group-RF (7.57±0.60 min), with a longer motor block duration (207.26±6.58 min vs 148.9±8.22 min). Postoperative analgesia lasted significantly longer in Group-RD (391.86±9.89 min) compared with Group-RF (213.3±3.79 min). Haemodynamic parameters remained clinically stable in both groups, with only slight transient decreases in PR and blood pressure and no significant bradycardia or hypotension.
Conclusion: Dexmedetomidine is a better adjuvant to ropivacaine compared to fentanyl in SA. It provides better onset, longer sensory and motor block duration and increased analgesia without inducing further haemodynamic instability or respiratory depression.
Background:Epidural anaesthesia is widely used for lower limb orthopaedic surgeries because of its ability to provide effective intraoperative anaesthesia and prolonged postoperative analgesia. Addition of adjuvants such as dexmedetomidine, clonidine, and fentanyl toepidural local anaesthetics improves block characteristics and haemodynamic stability. This study was conducted to compare the effects of dexmedetomidine, clonidine, and fentanyl on intraoperative haemodynamics when used as adjuvants to epidural ropivacaine.Methodology:This randomized prospective comparative study was conducted in the Department of Anaesthesiology, Sree Mookambika Institute of Medical Sciences, Kulasekharam, from February 2025 to November 2025. A total of 45 ASA grade I and II patients aged 20–60 years undergoing lower limb orthopaedic surgeries under epidural anaesthesia were randomly divided into three groups of 15 each. Group A received ropivacaine with dexmedetomidine, Group B received ropivacaine with clonidine, and Group C received ropivacaine with fentanyl. Intraoperative haemodynamic parameters, onset and duration of sensory and motor blockade, analgesia, and adverse effects were assessed.Results:A statistically significant fall in systolic, diastolic, and mean arterial pressure was observed in Groups B and C from 15 to 120 minutes after epidural block (p<0.05). Dexmedetomidine demonstrated better haemodynamic stability compared to clonidine and fentanyl groups. All three groups provided effective anaesthesia and satisfactory analgesia with manageable adverse effects.Conclusion:Dexmedetomidine, clonidine, and fentanyl are effective epidural adjuvants in lower limb orthopaedic surgeries. Dexmedetomidine showed superior haemodynamic stability and prolonged analgesic effect with minimal adverse effects.
Dr. Sreekala, Dr. Subhasan JV· Asian Journal of Medical Res...· 0 citations
Background: Spinal anaesthesia is a well-established anaesthetic technique due to its quick onset and reliable sensory-motor inhibition. However, limited postoperative analgesia remains a major drawback of bupivacaine-based subarachnoid block. The addition of intrathecal adjuvants has been explored to improve block quality and extend analgesic duration. Among these, α₂-adrenergic agonists such as dexmedetomidine and clonidine have demonstrated favourable effects on anaesthetic performance. Owing to its greater α₂-receptor selectivity, dexmedetomidine may offer advantages over clonidine in enhancing spinal anaesthesia outcomes. Objective: To compare the efficacy and safety of dexmedetomidine and clonidine as intrathecal adjuvants to hyperbaric bupivacaine in spinal anaesthesia. Methods: This study was designed as a prospective randomized comparative trial at Combined Military Hospital, Dhaka, between December 2019 and December 2020. Study population consisted of adult patients (n = 120) undergoing elective infraumbilical surgery with spinal anaesthesia. were registered and randomly split into two groups equally. Group A received 10 mg of 0.5% hyperbaric bupivacaine combined with dexmedetomidine 5 µg, whereas Group B received the same dose of bupivacaine with clonidine 30 µg. Outcomes assessed included onset and duration of sensory and motor blockade, duration of postoperative analgesia, haemodynamic variables, and treatment-related adverse events. Results: Patients receiving dexmedetomidine exhibited a significantly shorter time to peak sensory blockade compared with those receiving clonidine (2.13±0.54 vs 3.52±0.34 minutes; p<0.001). Similarly, complete motor blockade was achieved earlier in the dexmedetomidine group (2.93±0.43 vs 4.42±0.34 minutes; p<0.001). Dexmedetomidine was also associated with significantly prolonged sensory regression time, delayed motor recovery, and extended postoperative analgesia (all p<0.001). The mean duration before rescue analgesia was required was 544.5±17.6 minutes in Group A and 423.5±16.6 minutes in Group B. Haemodynamic measurements remained stable in both groups, and the incidence of adverse effects was comparable, with no episodes of clinically significant respiratory depression or excessive sedation. Conclusion: Low-dose intrathecal dexmedetomidine provided superior block characteristics and longer postoperative analgesia than clonidine while maintaining stable hemodynamic and safety profiles. It appears to be an effective adjuvant to hyperbaric bupivacaine with a comparable safety profile in subarachnoid anesthesia.
Mohammad Abedur Reza, Tahmina Bhuiyan, Meryem Kamal et al.· Islami Bank Medical College...· 0 citations
Dexmedetomidine was found to be a superior adjuvant to epidural bupivacaine compared to clonidine due to better sedation, prolonged postoperative analgesia, and effectivehaemodynamic stability with manageable adverse effects.
Dr. Mahilamani, Dr. Vijay Balan.P· Asian Journal of Medical Res...· 0 citations
Background: Spinal anaesthesiais widely used for lower abdominal surgeries due to its rapid onset and effective analgesia. However, limited duration of action remains a concern. Intrathecal midazolam, acting via GABA receptors, has been shown to enhance analgesic effects when used as an adjuvant to bupivacaine. This study aims to compare the efficacy and safety of two doses (1 mg and 2 mg) of intrathecal midazolam combined with 0.5% hyperbaric bupivacaine.Methods: 80patients (ASA I–II, aged.18–60) undergoing elective lower abdomen operations participated in a prospective, randomised, single-centretrial. Two groups of patients were created: bupivacaine and 1 mg of midazolam were given to Group M1, while bupivacaine and 2 mg of midazolam were given to Group M2. The onset and duration of sensory and motor block, sedation scores, time to rescue analgesia, haemodynamic alterations, and side effects were among the parameters evaluated. The t-test and chi-square test were used for statistical analysis, with significance set at p<0.05.Results: Group M2 showed significantly faster onset of sensory (1.23 vs 1.78 min) and motor block (1.78 vs 2.25 min). The duration of sensory and motor block was significantly prolonged in Group M2 (191.25 vs 154.13 min and 238.35 vs 196.50 min, respectively). Time to rescue analgesia was longer in Group M2 (272.73 vs 235.88 min). Sedation scores were higher in Group M2 but remained clinically acceptable. Hemodynamic parameters were stable and comparable in both groups, with minimal and statistically insignificant adverse effects.Conclusion: Intrathecal midazolam 2 mg as an adjuvant to 0.5% hyperbaric bupivacaine provides superior analgesia, prolonged block duration, faster onset, and acceptable sedation without significant adverse effects compared toa1 mg dose.
Ashmi Samad, Harini Priyadarshini M.S, Srija P et al.· Asian Journal of Medical Res...· 0 citations
Background: Spinal anesthesia is a very commonly used procedure in modern-day anesthesia practice. Today most of the lower limb surgeries are performed under spinal anesthesia. Midazolam, dexmedetomidine, and fentanyl are common intravenous adjuvants used during anesthesia to allay anxiety and sedation. The aim of this study was to compare the effects of intravenous dexmedetomidine-midazolam versus fentanyl-midazolam in terms of analgesic characteristics, sedation, and adverse effects.
Methods: This is a randomized prospective study that included 35 patients in each group, posted for lower limb orthopedic surgery. Intravenous dexmedetomidine, fentanyl, and midazolam were administered after subarachnoid block. Data for sedation, analgesia, hemodynamic parameters, and adverse effects were recorded.
Results: RR for FM group showed significant intra-group variability in RR across perioperative stages (p<0.05), whereas the DM group maintained greater respiratory stability (p=0.243). HR for DM group exhibited significantly lower intraoperative and postoperative HR compared to FM group (p<0.001), with notable within-group changes, unlike the FM group. MAP for both groups remained stable over time (DM: p= 0.283, FM: p= 0.260), although the FM group had slightly higher values in the postoperative recovery phase. Sedation (RSS): DM produced deeper and more sustained sedation intraoperatively and postoperatively (p<0.001), while FM showed quicker sedation decline. Patient satisfaction was significantly higher in the DM group (VAS: 3.0 vs. 4.0, p= 0.001), although surgeon satisfaction did not differ notably. Adverse events were rare and comparable, though hypotension was more frequent in the DM group (22.9% vs. 8.6%).
Conclusion: Dexmedetomidine plus midazolam provided superior sedation quality and patient satisfaction, with more stable cardiopulmonary parameters during orthopedic surgery under spinal anesthesia. Despite a slightly higher rate of hypotension, DM appears to offer a more favorable sedative profile compared to fentanyl plus midazolam.
M. Rahimi, Mohamad Sorani, Afzal Shamsi et al.· Archives of Anesthesia and C...· 0 citations
Background:The supraclavicular approach to blockage of nerves around the brachial plexus is a commonly used technique for upper extremity surgical procedures. The performance of the procedure can be graded as either ‘reliable’ or ‘unreliable’ depending on whether thenerve block worked out. Long-acting local anaesthetic agents such as bupivacaine give satisfactory analgesia and some degree of prolongation of pain relief. Adjuvant agents added to the local anaesthetic may improve the quality and duration of the supraclavicular nerve block and possibly improve postoperative analgesia, fentanyl and dexmedetomidine being studied as adjuvants for the use of local anaesthetics. The object of the study reported here was to investigate the relative efficacy and safety of theseagents as adjuvants compared to each other and in combination with local anaesthetics.Objectives:The aim of this study was to compare the use of dexmedetomidine and fentanyl with bupivacaine for pain relief among persons with a supraclavicular brachial plexus block. The comparison of dexmedetomidine and fentanyl assesses the effect on onset of sensory (pain) block and motor (muscle) block and duration, the effectiveness of postoperative pain medications, stability during surgery, greater comfort from sedation, and adverse effects.Methods:This was a prospective, randomized trial conducted over a one year period involving one hundred patients going for elective surgery of their upper extremities. The patients were randomized into groups of fifty patients each receiving a brachial plexus block using supraclavicular brachial plexus block placement by ultrasound based approach. The patients in group D received a combination of bupivacaine and dexmedetomidine while patients in group F received bupivacaine and fentanyl. The primary outcomes studied were time to the onset of sensory and motor block, and duration of post-operative analgesia. Secondary outcomes included the length of sensory and motor blocks; intra-operative/post-operative hemodynamic parameters, sedation scores and side effects.Results:At baseline, demographic and clinical characteristics were similar between groups. In dexmedetomidine group the sensory and motor block developed was faster and individual's sensory block, motor block, and durationof post-operative pain relief Latency was longer than that in control group. Although hemodynamic variable were stable for both group during preoperative and postoperative periods, there was a trend to greater frequency of milder sedation in the dexmedetomidine group than in the control group. The overall incidence of adverse events was low and the incidence of adverse events was similar for both groups.Conclusion:Patients who underwent surgery on the upper limbs with a supraclavicular brachial plexus block will benefit from added dexmedetomidine rather than fentanyl to their bupivacaine. The addition of dexmedetomidine significantly extends duration of analgesia from the brachial plexus block and provides added reduction of pain after surgery with safetyand hemodynamic stability.
Macha Niranjan Reddy, Mukesh Kumar Prasad, Payal Jain et al.· Asian Journal of Medical Res...· 0 citations
