الفهرس 
Pathophysiology of Diabetes Mellitus
Diabetes-related chronic complicationsOnly 14 pages are availabe for public view
 |  | from | 121 |  |  |
| | | from | 121 | | |
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.