COMPARISON OF 0.75% HYPERBARIC ROPIVACAINE WITH FENTANYL AND 0.75% HYPERBARIC ROPIVACAINE WITH DEXMEDETOMIDINE FOR SPINAL ANAESTHESIA IN ELECTIVE LOWER LIMB SURGERIES
DOI:
https://doi.org/10.22159/ijcpr.2026v18i2.8064Keywords:
Dexmedetomidine, Fentanyl, Hyperbaric ropivacaine, SpinalanaesthesiaAbstract
Objective: Spinal anaesthesia is a preferred technique for lower limb surgeries due to its reliability and safety. Adjuvants like fentanyl and dexmedetomidine are commonly added to local anaesthetics to enhance block characteristics. To compare the sensory and motor block characteristics, haemodynamic profile, sedation, duration of analgesia, and complications of intrathecal 0.75% hyperbaric ropivacaine with fentanyl versus dexmedetomidine in elective lower limb surgeries.
Methods: After institutional ethics committee approval, 60 ASA I–II patients aged 18–60 y scheduled for elective lower limb surgeries were randomised into two groups (n=30 each). Group I received 2 ml of 0.75% hyperbaric ropivacaine+25 µg fentanyl, and Group ii received 2 ml of 0.75% hyperbaric ropivacaine+10 µg dexmedetomidine intrathecally. Onset and duration of sensory and motor block, haemodynamics, sedation (Ramsay score), postoperative pain (VAS), and side effects were recorded. Data were analysed using Student’s t-test and chi-square test; p<0.05 was considered significant.
Results: Onset of sensory (Group I: 2.76±0.08 min vs Group ii: 2.72±0.08 min; p=0.134) and motor block (Group i: 1.58±0.40 min vs Group ii: 1.38±0.37 min; p=0.053) was comparable. Duration of sensory block (Group I: 275.10±16.46 min vs Group ii: 310.13±14.94 min; p<0.001), motor block (Group I: 113.77±13.01 min vs Group ii: 124.30±6.91 min; p<0.001), and analgesia (Group I: 226.40±18.09 min vs Group ii: 280.60±13.90 min; p<0.001) was significantly longer in Group ii. Haemodynamic parameters and sedation scores remained stable and comparable. Incidence of side effects was similar.
Conclusion: Intrathecal dexmedetomidine as an adjuvant to 0.75% hyperbaric ropivacaine provides significantly longer sensory and motor blockade and postoperative analgesia compared to fentanyl, with similar haemodynamic stability and side-effect profile.
Downloads
References
1. Gupta R, Bogra J, Verma R, Kohli M, Kushwaha JK, Kumar S. Dexmedetomidine as an intrathecal adjuvant for postoperative analgesia. Indian J Anaesth. 2011 Jul;55(4):347-51. doi: 10.4103/0019-5049.84841, PMID 22013249.
2. Kanazi GE, Aouad MT, Jabbour Khoury SI, Al Jazzar MD, Alameddine MM, Al-Yaman R. Effect of low-dose dexmedetomidine or clonidine on the characteristics of bupivacaine spinal block. Acta Anaesthesiol Scand. 2006;50(2):222-7. doi: 10.1111/j.1399-6576.2006.00919.x, PMID 16430546.
3. Shashikala TK, Sagar SS, Ramaliswamy P, Hudgi VV. Comparing effects of intrathecal adjuvants fentanyl and dexmedetomidine with hyperbaric ropivacaine in patients undergoing elective infraumbilical surgeries: a prospective double-blind clinical study. Anesth Essays Res. 2019 Oct 1;13(4):654-62. doi: 10.4103/aer.AER_183_18, PMID 32009711.
4. Al-Ghanem SM, Massad IM, Al-Mustafa MM, Al-Zaben KR, Qudaisat IY, Qatawneh AM. Effect of adding dexmedetomidine versus fentanyl to intrathecal bupivacaine on spinal block characteristics in gynecological procedures: a double-blind controlled study. Am J Appl Sci. 2009;6(5):882-7. doi: 10.3844/ajassp.2009.882.887.
5. Sun Y, Lu Y, Huang Y, Jiang H. Perioperative dexmedetomidine foranalgesia. Drug Des Dev Ther. 2014;8:1927-37.
6. Ravipati P, Isaac GA, Reddy PN, Krishna L, Supritha T. A comparative study between intrathecal isobaric ropivacaine 0.75% plus dexmedetomidine and isobaric ropivacaine 0.75% plus fentanyl for lower limb surgeries. Anesth Essays Res. 2017 Jul-Sep;11(3):621-6. doi: 10.4103/0259-1162.206857, PMID 28928559.
7. Farokhmehr L, Modir H, Yazdi B, Kamali A, Almasi Hashiani A. Effect of different doses of intrathecal dexmedetomidine on hemodynamic parameters and block characteristics after ropivacaine spinal anesthesia in lower-limb orthopedic surgery: a randomized clinical trial. Med Gas Res. 2019 Apr 1;9(2):55-61. doi: 10.4103/2045-9912.260645, PMID 31249252.
8. Sharma A, Varghese N, Venkateswaran R. Effect of intrathecal dexmedetomidine versus intravenous dexmedetomidine on subarachnoid anesthesia with hyperbaric bupivacaine. J Anaesthesiol Clin Pharmacol. 2020 Jul-Sep;36(3):381-5. doi: 10.4103/joacp.JOACP_323_17, PMID 33487907.
9. Pang RY, Shen YH, Jin XQ, Xu HF, Wang Y, Zhu BX. Comparison of epidural dexmedetomidine to fentanyl in reducing ropivacaine dose in programmed intermittent epidural bolus plus patient-controlled epidural analgesia during labor: a randomized double-blind controlled study. Front Med (Lausanne). 2022 Oct 17;9:935643. doi: 10.3389/fmed.2022.935643, PMID 36325391.
10. Qi X, Li Y, Rahe Meyer N, Huang X, Gu Y, Wang X. Intrathecal dexmedetomidine as adjuvant to ropivacaine in hysteroscopic surgery: a prospective randomized control study. Int J Clin Pharmacol Ther. 2016 Mar 1;54(3):185-92. doi: 10.5414/CP202427, PMID 26857782.
11. Hosseini R, Pazoki S, Hadi HA, Alimohammadi A, Kamali A. Effect of dexmedetomidine and fentanyl on hemodynamic changes and block profile following spinal anesthesia with ropivacaine among patients with femoral fractures undergoing lower limb surgery. Eur J Transl Myol. 2023 Feb 3;33(1):10610. doi: 10.4081/ejtm.2023.10610, PMID 36786149.
12. Zhang J, Liu Y, Gu X, Chai J. A bibliometrics and visualization analysis of ropivacaine research from 2000 to 2023. Front Med (Lausanne). 2024 Oct 2;11:1465308. doi: 10.3389/fmed.2024.1465308, PMID 39421864.
13. Kiran K, Sirisha C, Aasim SA. Comparison of readymade 0.75% hyperbaric ropivacaine vs conventional 0.5% hyperbaric bupivacaine for elective C-sections. Eur J Cardiovasc Med. 2023 Apr 1;13(2):742-53. doi: 10.5083/ejcm.
14. Patel SK, Patel US. A comparison of dexmedetomidine and fentanyl as an adjuvant to intrathecal hyperbaric bupivacaine in elective lower limb surgeries. Natl J Med Res. 2021 Oct 1;11(4):125-30.
15. Sun Y, Xu Y, Wang GN, Wen Y, Yang H, Liu J. Comparison of intrathecal dexmedetomidine and fentanyl as adjuvant to bupivacaine in spinal anesthesia for lower limb orthopedic surgeries. J Anesth Clin Res. 2015;6(6):531.
16. El-Attar A, Aleem MA, Beltagy R, Ahmed W. A comparative study of intrathecal dexmedetomidine and fentanyl as additives to bupivacaine. Res Opin Anesth Intensive Care. 2015 Apr 1;2(2):43-9. doi: 10.4103/2356-9115.161328.
17. Nallam SR, Kandala S, Kanipakam S, Bathini V, Chiruvella S, Sesham S. Cesarean sections under spinal anaesthesia: comparison of varying doses of dexmedetomidine combined with 0.75% hyperbaric ropivacaine: a double-blind randomized trial. Turk J Anaesthesiol Reanim. 2024 Sep 17;52(4):134-41. doi: 10.4274/TJAR.2024.241619, PMID 39287192.
18. Agrawal P, Singhania A, Kulkarni M. Combined spinal-epidural anesthesia with ropivacaine plus fentanyl versus dexmedetomidine in hip replacement surgery: a comparative study. Br J Anaesth. 2022;128(2):e145-51. doi: 10.1016/j.bja.2021.12.022.
19. Bajwa SJ, Arora V, Kaur J, Singh A, Parmar SS. Comparative evaluation of dexmedetomidine and fentanyl for epidural analgesia in lower limb orthopedic surgeries. Saudi J Anaesth. 2011 Oct;5(4):365-70. doi: 10.4103/1658-354X.87264, PMID 22144922, PMCID PMC3227304.
20. Choudhary G, Chaudhary K, Swami R, Karnawat R. Comparison of clonidine with fentanyl as an adjuvant to isobaric ropivacaine in patients undergoing vaginal hysterectomy under subarachnoid block. Sri Lankan J Anaesthesiol. 2021 Apr 28;29(1):18-23. doi: 10.4038/slja.v29i1.8694.
Published
How to Cite
Issue
Section
Copyright (c) 2026 Soumith Kethavath, Tanveer, Simrit Kaur, Tejinderpal Kaur Grewal, Shamnad, Tripat kaur bindra
This work is licensed under a Creative Commons Attribution 4.0 International License.