LEVOBUPIVACAINE WITH DEXMEDETOMIDINE VERSUS LEVOBUPIVACAINE WITH NALBUPHINE VIA PATIENT CONTROLLED EPIDURAL ANALGESIA IN LOWER LIMB ORTHOPAEDIC SURGERIES

Abstract

Background: Epidural analgesia provides effective pain relief. Patient controlled epidural analgesia (PCEA) allows individualized dosing. This study compares Dexmedetomidine and Nalbuphine as adjuncts to Levobupivacaine for postoperative pain relief via PCEA.

Method:  This prospective, double-blind study was conducted on 94 patients (ASA I – II, 18–65 years). All patients received 3 ml (0.5%) levobupivacaine for spinal anaesthesia. At regression of sensory block to T10, patients received 0.25% levobupivacaine either with 1 mcg/kg dexmedetomidine (Group D) or 0.1 mg/kg nalbuphine (Group N). For postoperative analgesia epidural infusion of 0.125% levobupivacaine either with 1 mcg/ml dexmedetomidine (Group D) or 0.2 mg/ml Nalbuphine (Group N) was started at 3 ml/hr and demand dose of 4ml was given.

Results: Heart rate decreased after epidural bolus in Group D and remained lower due to which 6 patients in Group D reported bradycardia. Other haemodynamic parameters were comparable. VAS was comparable initially, higher in Group N at 4–10 hours, and comparable thereafter. Group D required fewer PCEA boluses (0.98 ± 0.82) than Group N (2.66 ± 0.48) and lower drug consumption (87.91 ± 3.28ml) than Group N (94.64 ± 1.92 ml). No group required rescue analgesia. Group D demonstrated higher sedation scores relative to Group N. Itching incidents were higher in Group N (8.51%).The patient satisfaction was higher in Group D.

Conclusion: Dexmedetomidine offered better analgesia with lower VAS scores, fewer PCEA demands, reduced drug consumption.