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POST OPERATIVE ANALGESIC EFFECT OF INTRATHECAL DEXMEDETOMIDINE ON BUPIVACAINE SUBARACHNOID BLOCK FOR OPEN REDUCTION AND INTERNAL FIXATION OF FEMORAL FRACTURES
ABSTRACT
[Background
Regional anaesthesia especially spinal anaesthesia is mostly used in lower limb orthopaedic
surgeries for intra and post operative analgesia. It has a drawback of short duration of
analgesia with local anaesthetics alone. Various adjuvants have been used to prolong the
duration of analgesia with varying side effects. Dexmedetomidine, an α2 adrenergic agent has
been found to posses analgesic effect. This study was conducted to determine the
postoperative analgesic effect of intrathecal dexmedetomidine on open reduction and internal
fixation of femoral fractures.
Aim
To determine the analgesic efficacy of intrathecal 7.5 µg of dexmedetomidine and its
complication in open reduction and internal fixation of femoral fractures.
Method
Seventy ASA I or II patients scheduled for open reduction and internal fixation of femoral
fracture were randomised into two groups of 35 each to receive 3 ml of 0.5% hyperbaric
bupivacaine combined with either 7.5µg of dexmedetomidine in 0.3 ml of normal saline
(group D) or 0.3 ml of normal saline alone (group S) in a double blinded study. Patients were
assessed for time to first analgesic request for which 30mg of intravenous pentazocine was
given when NRS is > 3, proportion of patient with pain score < 4 in the postoperative period
using NRS, total analgesic consumed in 24 hours, incidence of side effects and patient
satisfaction.
Results
The groups were comparable demographically. The time to first request of analgesia in group
D (407.83±36.04 minutes) was significantly longer than group S (233.09±23.79 minutes),
P<0.0001. The proportion of patients with pain score < 4 in the postoperative period in both
groups using NRS were 100% in group D versus 86% in group S (P=0.34) in 1st hour, 100%
in group D versus 17% in group S (P=0.001) in the 2nd hour. No patient in group S was pain
free beyond the 2nd hour while 9% of the patients in group D reached the 5th hour. Total
analgesic consumed in 24hrs was significantly lower in group D (90.00 ± 7.27 mg)
compared to group S (125.14 ± 11.47 mg) with a P value of 0.0001. Incidences of side
effects such as hypotension, bradycardia, shivering and nausea were not statistically
significant between the groups (P>0.05). Patient satisfaction was better in group D compared
to group S (P < 0.001).
Conclusion
This study demonstrated that the addition of 7.5µg of dexmedetomidine to bupivacaine
subarachnoid block for patient undergoing open reduction and internal fixation of femoral
fractures significantly prolonged the duration of postoperative analgesia without significant
side effects.
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