Comparison of Dexmedetomidine Versus Dexamethasone as Adjuvants to Intrathecal Bupivacaine in Emergency Orthopedic Lower Limb Operations

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Background:Various adjuvants were added to intrathecal anesthetics to improve quality of the block and postoperative analgesia. Objective: The aim of the current work was to compare the efficacy of adding dexmedetomidine versus dexamethasone as adjuvants to intrathecal bupivacaine in emergency orthopedic lower limb surgery. Patients and Methods:This prospective comparative double blinded study included a total of 90 patients with lower limb trauma requiring surgery, attending at Mansoura University emergency Hospital. Cases were randomly divided into three groups; each consisted of 30 cases. Group A received dexmedetomidine as an adjuvant to bupivacaine, Group B received dexamethasone as an adjuvant, and Group C received spinal bupivacaine plus 1 cm of normal saline. Sensory and motor blocks as well as post-operative VAS score in addition to need for analgesics were assessed. Results:Demographic data did not differ between the three study groups (p > 0.05). Group A showed a significantly earlier onset of sensory block (p =0.005), motor block (p = 0.009), as well as late regression to L1 sensory level (p <0.001). Additionally, longer analgesia (p < 0.05) and longer time before the first call for analgesics (p = 0.005) was associated with group A. However, complications encountered did not differ between the three study groups (p > 0.05). Conclusion: It could be concluded that intrathecal dexmedetomidine is superior to both dexamethasone and bupivacaine alone regarding duration of analgesia and pain severity. Moreover, it has more rapid onset and longer duration of sensory blockade. No significant side effects were noted when compared to the remaining groups.

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