الفهرس 
Anatomy Relevant to Epidural and Subarachnoid BlockadeOnly 14 pages are availabe for public view
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Abstract
The use of epidural analgesia for the management of postoperative pain has evolved as a critical component of multimodal approach to achieve the goal of adequate analgesia with improved outcome. Epidural analgesia offers superior postoperative pain relief compared with systemic opioids. In addition to improved patient outcome.
This double blinded prospective randomized study was done to evaluate and compare the efficacy, analgesic effects, postoperative analgesia of epidural fentanyl and dexmetedomidine as adjuvants to epidural levobupivacaine for patients undergoing knee replacement surgeries. The onset of sensory block at T 10 level, time taken for complete motor block, duration of analgesia and time to rescue analgesia and side effects were observed.
60 patients undergoing knee replacement surgeries were allocated into two equal groups 30 patients each:
group BD: received a loading dose of 15 ml from a mixture (38 ml of 0.25% levobupivacaine + 1 ml of 100 µg dexmedetomidine + 1 ml of normal saline), then Epidural infusion of this mixure started 30 min after loading dose at rate of 15ml/h till the end of the surgery.
group BF: received aloading dose of 15ml from amixture (38 ml of 0.25%levobupivacaine hydrochloride + 2 ml of 100 µg fentanyl) then epidural infusion of this mixure started 30 min after loading dose at rate of 15ml/h till the end of the surgery.
The onset of sensory block assessed by loss of cold sensation and motor block by bromage score. Duration of analgesia and time to rescue analgesia were assessed in our study. Hemodynamic parameters such as pulse rate, blood pressure and oxygen saturation were monitored.postoperative pain is assessed using visual analogue scale. If VAS 4and above rescue analgesics is administered. The following observations were made:
1. Addition of dexmedetomidine as adjuvant to epidural levobupivacaine, produced early onset of sensory and motor block when compared to epidural fentanyl.
2. Addition of dexmedetomidine significantly prolonged the duration of analgesia and the time for first rescue analgesia when compared to epidural fentanyl.
3. Better and easy arousable sedation score was observed when dexmedetomidine used as adjuvant than epidural fentanyl.
4. None of the patients had respiratory depression in both groups.
Thus it is founded that epidural levobupivacaine with dexmedetomidine provided better sedation, adequate surgical anesthesia with prolonged postoperative analgesia for knee replacement surgeries than epidural levobupivacaine with Fentanyl.