A Comparative Analysis of Complications of Intrathecal Dexmedetomidine versus Fentanyl as Adjuvants to Bupivacaine in Knee Joint Surgeries

Abstract

ABSTRACT

Background: The world is observing a rapid rise in orthopedic surgeries, and spinal anesthesia is usually the technique of choice for lower limb surgeries. Bupivacaine is generally the local anesthetic administered during these surgeries; however, adjuvants such as fentanyl and dexmedetomidine are also widely used to extend analgesia. The side effects and efficacy of such adjuvants, however, remain a topic of clinical interest. Objectives: To study the intraoperative and postoperative complications of two adjuvants, intrathecal fentanyl (25 µg), and dexmedetomidine (10 µg) for bupivacaine in patients undergoing knee joint surgeries and compare them. Materials and methods: A quantitative cross-sectional study was carried out on 80 patients, 40 in each group, recruited from PIMS Hospital and Allama Iqbal Teaching Hospital, Pakistan. All the patients were given spinal anesthesia, which included either intrathecal fentanyl or dexmedetomidine plus bupivacaine as an adjuvant. SPSS v22 was used for statistical analysis; one-way ANOVA was used to compare the complications, and statistical inference was drawn. Results: Dexmedetomidine caused prolonged sensory and motor blockade but, at the same time provided enhanced postoperative analgesia. It was also associated with a higher incidence of bradycardia and hypotension. Fentanyl increased the incidence of nausea and/or vomiting. Overall, once again, dexmedetomidine came out to be better of the two in terms of complications which were less in number and less severe, besides providing its usual strong analgesic effects. Conclusion: Intrathecal dexmedetomidine (10 µg) leads to better and longer analgesia with less complications, compared to fentanyl (25 µg), as an adjuvant to bupivacaine, hence providing a viable alternative for knee joint surgeries in terms of safety.