European Journal of Cardiovascular Medicine

Introduction: The effective management of pain during and after lower limb orthopaedic surgeries is crucial for optimizing patient comfort and postoperative outcomes. Epidural analgesia, often employed in this context, relies on the adjunctive use of medications to enhance pain control. Among the numerous options available, two commonly used adjuvants are dexmedetomidine and fentanyl. This study aims to provide a comparative analysis of the efficacy and safety of these two medications when incorporated into epidural analgesia protocols for lower limb orthopaedic surgeries. By exploring their respective benefits and potential drawbacks, this research seeks to contribute valuable insights to the field of perioperative pain management, ultimately aiding clinicians in making informed decisions regarding the choice of adjuvants in orthopaedic surgical settings. Materials and Methods:  The present study included 120 patients who underwent lower limb orthopaedic surgery and were of both sexes, aged 20 years to 56 years, and of physical status I and II according to the American Society of Anaesthesiologists (ASA). Sixty patients each were randomly assigned to the two groups Group 1 [ropivacaine + dexmedetomidine (RD)] and Group 2 [ropivacaine + fentanyl (RF)]. Epidurally, 15 ml of 0.75% ropivacaine injection was given to both groups, along with 1 g/kg of dexmedetomidine for Group 1 and 1 g/kg of fentanyl for Group 2. Various block characteristics, such as the time to the first onset of analgesia at T10, the maximum sensory analgesic level, the duration of the motor blockade, the duration of the two segmental dermatomal regressions, and the duration of the first rescue analgesic, were also noted along with cardio-respiratory parameters and sedation scores. Data was rigorously gathered at the conclusion of the study and analyzed using Fisher's exact test, Chi-square test, and ANOVA with post-hoc significance. Statistical significance was set at 0.05 (if the P-value ≤ 0.05, it is significant). Results: The demographic profile of patients was comparable in both groups. The onset of sensory analgesia at T10 (7.65±1.93 minutes vs 9.76±2.19 minutes) and establishment of complete motor blockade (19.42±4.11 minutes vs 21.65±5.37 minutes) was significantly earlier in Group 1 [ropivacaine + dexmedetomidine (RD)].  Postoperative analgesia was prolonged significantly in Group 1 [ropivacaine + dexmedetomidine (RD)] (362.13±20.87 minutes) and consequently low dose consumption of local anaesthetic (74.56±9.82 mg vs 108.65±14.69 mg) during epidural top‑ups postoperatively. Sedation scores were much better in Group 1 [ropivacaine + dexmedetomidine (RD)] and highly significant in statistical comparison. The incidence of nausea and vomiting was significantly higher in Group 2 [ropivacaine + fentanyl (RF)] , while the incidence of dry mouth was significantly higher in Group 1 [ropivacaine + dexmedetomidine (RD)].  Conclusion: As an epidural adjuvant, dexmedetomidine appears to be preferable to fentanyl because it offers comparable stable hemodynamics, early onset and establishment of sensory anaesthesia, prolonged postoperative analgesia, lower post-operative local anaesthetics consumption for epidural analgesia, and significantly higher sedation levels.