Comparative Addition of Dexmedetomidine and Fentanyl to Intrathecal Bupivacaine in Orthopedic Procedure in Lower Limbs

Poupak Rahimzadeh; Seyed Hamid Reza Faiz; Farnad Imani; Pooya Derakhshan; Saeed Amniati


BMC Anesthesiol. 2018;18(62) 

In This Article


Lower limb surgeries could be performed under local, neuroaxial and general anesthesia, but neuroaxial block is the preferred method. Spinal block has rapid onset, deep block, lower risk of infection and is cost effective. However, post-operative pain is an important problem as the used drugs have limited duration of effect; so the post-operative analgesic administration is necessary.[1,2]

Administrating the combinations of other classes of analgesics with local anesthetics has used to increase the duration and reduce side effects of analgesia.[3] Some drugs have been used as adjuvants in spinal anesthesia to prolong intraoperative and postoperative analgesia[1,2] including opioids, α2 agonists, neostigmine, vasoconstrictors, etc. Clonidine and dexmedetomidine are two α2 agonists affecting via pre- and post-synaptic α2 receptors.[4] Dexmedetomidine has been widely used for anesthesia and analgesic purposes. This drug has sedative, anti-anxiety, analgesic, neuroprotective, and anesthetic-sparing effects.[5] Dexmedetomidine along with other drugs have been used to increase the duration of analgesia in subarachnoid, epidural and caudal blocks.[6,7]

Fentanyl is a synthetic opioid with central action, which is used widely for pain control. Intrathecal fentanyl is usually added to other local anesthetics to increase anesthesia and analgesia. It has improved spinal anesthesia and reduced the anesthetic drug related side effects including pruritus, nausea and vomiting.[8]

Dexmedetomidine and fentanyl have been used as adjuvant to local anesthetics in different surgeries to provide superior analgesia and to improve the duration of the block.[9–11] One study on lower limbs surgery showed a better efficacy with dexmedetomidine.[12]

In this study, we aim to compare the efficacy of dexmedetomidine and fentanyl added to intrathecal bupivacaine in orthopedic procedures in lower limbs in terms of block strength and time.