Prospective Double Blinded Randomized Control Study, Comparing the Intrathecal Efficacy of Adjuvants Like Fentanyl 25mcg, Dexmeditomedine 10mcg with Low Dose 0.42% Hyperbaric Levobupivacaine (4.2mg) in Patients Coming for Elective Anorectal Surgeries

Abstract

Anorectal surgeries, typically performed in ambulatory settings, often result in postoperative challenges such as prolonged pain, leg immobility, urinary retention, and hemodynamic disturbances. Regional anesthesia, specifically saddle block anesthesia, using low doses of local anesthetics with adjuvants like opioids and alpha-2 agonists, can extend analgesia while minimizing these complications. This study aimed to compared the effects of intrathecal administration of Dexmedetomidine and Fentanyl with 0.42% hyperbaric Levobupivacaine on sensory and motor block onset and duration, hemodynamic stability, postoperative analgesia, and adverse effects. Conducted between November 2016 and June 2018 at K.R. Hospital, 240 patients undergoing elective anorectal surgeries were randomly divided into three groups: one receiving Levobupivacaine with Dexmedetomidine (Group D), another with Fentanyl (Group F), and a control group (Group C) receiving Levobupivacaine without additives. Results indicated that Group D had a slower onset of sensory block compared to Group F but a significantly prolonged duration of analgesia (314.54 minutes for Group D vs. 200.98 minutes for Group F and 185.71 minutes for Group C). Sensory regression times were longest in Group D, the time for first voiding of urine was delayed, particularly in Group D (242.56 minutes) compared to Group F (135.90 minutes) and Group C (100.25 minutes). Hemodynamic parameters, including heart rate, blood pressure, and mean arterial pressure, remained stable across all groups. Overall, the study concluded that using low-dose hyperbaric Levobupivacaine with adjuvants such as Dexmedetomidine or Fentanyl provides prolonged postoperative analgesia, minimal motor block, and stable hemodynamic parameters, allowing for early ambulation in patients undergoing anorectal surgery. Dexmedetomidine, in particular, proved more effective in extending the duration of analgesia compared to Fentanyl, making it a promising adjuvant for enhancing patient outcomes in anorectal surgeries.