الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Femur fractures are one of the most common fractures in elderly aged above 50 years of age. Geriatric patients suffer from comorbidities and low physiological reserve.
Spinal anaesthesia is the preferred method of anaesthesia in hip fractures as it is associated with a lower risk of early mortality, postoperative confusion, myocardial infarctions, pneumonia, deep vein thrombosis, fatal pulmonary embolism, and postoperative hypoxia.
Pain associated with femur fracture makes positioning patients to receive spinal anaesthesia a difficult process. Moreover, pain may increase the risk of perioperative arrhythmia, increase in blood pressure level, and postoperative delirium
The present study aimed at comparing between sedative and analgesic effects of dexmedetomidine versus fentanyl to optimize the sitting position of the patients to receive spinal anaesthesia
This study was carried out at EL HADARA main University Hospital, on 61 patients with ASA physical status I and II randomized into two groups
group D (Dexmedetomidine group): received intravenous dexmedetomidine (1μg /kg) as an infusion for 10 minutes that ended 5 minutes before positioning.
group F (Fentanyl group): received intravenous fentanyl (1.5μg /kg) as an infusion for 10 minutes that ended 5 minutes before positioning.
The random allocation sequence was concealed in opaque, sealed envelopes until a group had been assigned.
Proper medical history and clinical examination were done followed by obtaining written informed consent from each patient. An 18 G cannula was inserted in a peripheral vein and a crystalloid 10 ml/kg was administered. All patients were supplied with oxygen 3L/min via face mask. Either dexmedetomidine or fentanyl infusion started. After 5 minutes from the end of drug infusion patients were placed in the sitting position. Under strict aseptic precautions, a spinal tap in L3–4, L4–5 or L5-S1 was performed. NRS was recorded by an anaesthesiologist who was blind to the type of drug being infused. Hyperbaric bupivacaine (12-15mg) was injected intrathecally after confirmation of the free flow of cerebrospinal fluid.
Measurements:
1. Demographic data Patients’ age, Patients ‘sex, Patients’ weight
2. Pain assessment:
a. The numerical rating scale for pain (NRS): (NRS 0 = no pain, 10 = worst pain imaginable) values were recorded at the following: a. The day before surgery. b. On admission at the operating room and before starting the infusion of the drugs. c. At the end of infusion of the drug. d. Five minutes after the end of the infusion of the drug and just before positioning of the patient. e. During positioning the patient in a sitting position. f. After positioning the patient in the supine position for the procedure.
b. Pain score was also assessed by another anaesthesiologist not involved in the study protocol during positioning the patient as follows: (0= calm, 1= facial grimacing, 2= moaning, 3=screaming, 4= unable to proceed because of restlessness or agitation)
c. The total of additional fentanyl requirements during positioning were recorded.
3. Time to perform the spinal block
4. The number of attempts for successful spinal needle placement.
5. Anaesthesiologist’s satisfaction with the quality of patient position maintained for spinal block
− 0 = not satisfactory
− 1 = satisfactory
− 2 = good
− 3 = optimal
6. Patient satisfaction: Yes: satisfied. No: not satisfied.
7. Sedation scale: 6 point Ramsay Sedation Scale.
8. Vital parameters: a. Mean Arterial Pressure (MAP). b. Heart rate. c. Oxygen saturation. d. Respiratory rate