الفهرس 
SPINAL ANESTHESIAOnly 14 pages are availabe for public view
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Abstract
Background: lower abdominal and lower limb surgeries may be performed under local, regional (spinal or epidural), or general anesthesia, but neuraxial blockade is the preferred mode of anesthesia. Spinal block is still the first choice because of its rapid onset, superior blockade, low risk of infection as from catheter in situ, less failure rates, and cost effectiveness, but has the drawbacks of shorter duration of block and lack of postoperative analgesia. Dexmedetomidine is a highly selective α2-adrenoreceptor agonist that binds to a transmembrane G protein-binding receptor. Pre-clinic evidence showed that dexmedetomidine, used as a local anesthetic adjuvant for intrathecal anesthesia can shorten the onset time of the block, decrease postoperative pain intensity, prolong the duration of the block and reduce the requirement of analgesics. Most importantly it doesn’t have significant side effect comparing to fentanyl or bupivacaine. Fentanyl is an μ receptor agonist and it has been used intrathecally for many years and recently also given in combination with bupivacaine to improve the quality and the quantity of spinal anesthesia and prolong the duration of postoperative analgesia.
Aim: The aim of this study is to compare the addition of intrathecal dexmedetomidine or fentanyl as adjuvants to hyperbaric bupivacaine in the onset and duration of sensory and motor block, and postoperative analgesia.
Method: This prospective randomized clinical trial study was performed on a total 60 patients underwent elective pott’s fracture surgery under spinal anaesthesia in Ain Shams University hospitals. They were divided into three equal groups; control group, fentanyl group and dexmedetomidine group (20 patients in each group).
Result: The comparison included assessment of onset and duration of sensory and motor block, and postoperative analgesia. Regarding the time of sensory and motor block, it was of faster onset and prolonged duration in both fentanyl and dexmedetomidine groups compared to the control group but dexmedetomidine group was of faster and longer duration compared to other groups. Therefore, time to first analgesic rescue was longest in dexmedetomidine group. Regarding side effect dexmedetomidine did not cause marked sedation or severe side effects.
Conclusion: Using dexmedetomidine as an adjuvant to intrathecal bupivacaine compared with fentanyl was associated with more rapid onset, as well as prolonged durations of both sensory and motor blockade. In addition, postoperatively it was associated with prolonged analgesia, as well as less analgesic consumption. Moreover, it did not cause marked sedation or severe side effects.