A COMPARATIVE STUDY OF LEVOBUPIVACAINE AND LEVOBUPIVACAINE PLUS DEXMEDETOMIDINE IN CONTINUOUS EPIDURAL INFUSION FOR INTRA OPERATIVE ANALGESIA IN PATIENTS UNDERGOING OPEN RENAL TRANSPLANT SURGERIES

Abstract

Background and aims: General anaesthesia with epidural anaesthesia is preffered technique for renal transplant surgery as it provides superior muscle relaxation and controlled diaphragmatic movement during surgery with added advantage of stable hemodynamics and better perioperative field. Dexmedetomidine, a selective alpha-2 agonist has been found to be a better epidural adjuvant with more stable cardio-respiratory parameters, higher sedation score and prolongs postoperative analgesia.

Method: Prospective, randomised, double blind study. It was conducted on 80 adult ASA III or IV patients of either sex, scheduled for elective renal transplant surgery requiring general and epidural anaesthesia (during 2018-2020). Group-L received epidural bolus dose of 0.25% L-bupivacaine(10ml) followed by infusion of 0.125% L-bupivacaine @0.1ml/kg/hr, Group-LD received epidural bolus dose of 0.25% L- bupivacaine plus dexmedetomidine 10mcg(10 ml) followed by infusion of 0.125% L-bupivacaine plus dexmedetomidine 40mcg(20ml) @0.1ml/kg/hr. In both the groups intraoperative hemodynamics, depth of anaesthesia, requirement of inhalational agents and muscle relaxants, duration of postoperative analgesia and requirement of rescue analgesia were compared.

Result: There is statistically significant difference was observed in hemodynamics intraoperative as well as postoperatively (p<0.01). Requirement of inhalational agent and muscle relaxants was significantly less in group-LD(p<0.01). Duration of postoperative analgesia was prolonged and requirement of total no. of rescue analgesia were significantly less in group-LD(p<0.01). Postoperative sedation (Ramsay sedation scale) was higher initially in group-LD.

Conclusion: Dexmedetomidine better adjuvant to L-bupivacaine as it has longer duration of analgesia, hemodynamic stability, muscle relaxant and inhalational agent sparing effect and better sedation.