الفهرس | Only 14 pages are availabe for public view |
Abstract Aiming to compare the effects of dexmedetomidine versus fentanyl as adjuvant to intrathecal bupivacaine in diabetic patients submitted for lower limb surgeries in improving the spinal anesthetic efficacy, with taking in consideration that the spinal analgesic effect of μ opioids in diabetic neuropathic pain is reduced due to the functional μ opioid receptors in the dorsal horn of spinal cord in diabetics are either reduced or impaired in their function and the high selectivity of dexmedetomidine to alpha 2-adrenoceptor as agonist with sedative, anxiolytic, sympatholytic, and analgesic sparing effects, and minimal depression of respiratory function, Sixty diabetic patients were divided randomly in three equal groups (20 patients for each group): Bupivacaine saline control group group I (BS), Bupivacaine fentanyl group group II (BF) and Bupivacaine dexmedetomidine group group III (BD) were prospectively studied in this work. By analyzing the results of this study, the conclusion in dealing with adding dexmedetomidine versus fentanyl as adjuvant to intrathecal bupivacaine in diabetic patients submitted for lower limb surgeries can be summarized in the following points: ◙ The use of dexmedetomidine and fentanyl as adjuvant to intrathecal bupivacaine provided adequate anesthesia for lower limb surgeries with hemodynamic stability in diabetic patients. ◙ The duration and the degree of motor blockade was prolonged and more dense respectively in dexmedetomidine group compared to the other two groups according to the Bromage scale. ◙ The duration of spinal anesthesia which was defined as the time of two dermatomal regression of anesthesia from the maximum sensory level was significantly more prolonged in dexmedetomidine group compared to the other two groups. ◙ The postoperative pain in the first two hours postoperatively has been markedly decreased in dexmedetomidine group compared to the other two groups a according to the Visual Analogue pain Scale (VAS). ◙ There was a difference between the three groups according to the need for the rescue analgesia in the first two hours postoperatively. The least need for analgesia requirements was in dexmedetomidine group compared to the other two groups. ◙ There was no statistically significant difference between the fentanyl and dexmedetomidine groups according to the maximal sensory block level, although the highest sensitivity level of T4, T6 and T8 was achieved by higher proportion of subjects from dexmedetomidine group compared to fentanyl groups. ◙ As regard the postoperative complications (nausea, vomiting, shivering, purities and urinary retention), there was no statistically significant difference between the three groups. Finally, this conclusion needs furthermore documentation by studying a large randomized sample size of patients for a longer duration. |