Regional anesthesia in ambulatory surgery

Prospective Randomized Control Trial Comparing Effect of Dexamethasone Versus Fentanyl as Adjuvants to Intrathecal Bupivacaine for Orthopedic Surgery

Introduction Spinal anesthesia is the most consistent block for lower limb orthopedic surgeries. We conducted this randomized prospective study to evaluate comparative efficacy of intrathecal dexamethasone with fentanyl and normal saline as adjuvants to hyperbaric bupivacaine in spinal anesthesia administered to patients scheduled for lower limb orthopedic surgery. Materials and methods 105 patients scheduled for lower limb orthopedic surgeries under spinal anesthesia were included in this clinical trial. After randomization, patients received an intrathecal injection of hyperbaric bupivacaine (12.5 mg) with 4 mg of dexamethasone in group I, hyperbaric bupivacaine (12.5 mg) with 25 ug fentanyl with 0.5 ml of normal saline in group II and hyperbaric bupivacaine (12.5 mg) with normal saline (1 ml) in group III, so as to make volume of drug equal in all three groups. The observer evaluated the sensory and motor blocks and other parameters like time to self-void, stay in post-anesthesia care unit (PACU) and complications.  Results The total duration of sensory blockade was found to be 311.43, 197.86 and 115.29 minutes and motor blockade of 223.43, 163.86 and 83.0 minutes in groups I, II and III respectively. The PACU stay was 233.14, 173.86 and 93.00 minutes in groups I, II and III, respectively. The average time to self-void was 400.00, 315.29 and 203.00 in three groups, respectively. Conclusion Intrathecal dexamethasone seemed to be an effective adjuvant to spinal bupivacaine as it prolongs the duration of analgesia, stable hemodynamic profile with minimal side effects. Further studies are required to evaluate the optimum dose and long-term safety of intrathecal dexamethasone.