Comparison of epidural ropivacaine vs bupivacaine with addition of fentanyl or dexmedetomidine in major lower limb orthopaedic surgery

Adequate analgesia following major lower limb orthopaedic surgeries is necessary for both intra and postoperative pain relief, to promote early ambulation and improved patient outcome.

To study and compare the analgesia and patient satisfaction when using the local anesthetic drugs ropivacaine and bupivacaine with the adjuvants, fentanyl or dexmedetomidine in major lower limb orthopaedic surgeries.

80 patients undergoing major lower limborthopaedic surgeries under combined spinal epidural anaesthesia were randomly divided into 4 groups. Group RF received Ropivacaine 0.2% with Fentanyl 2μg/ml, Group RD received Ropivacaine 0.2% with Dexmedetomidine 2μg/ml, Group BF received Bupivacaine 0.125% with Fentanyl 2μg/ml and Group BD received Bupivacaine 0.125% with Dexmedetomidine 2μg/ml as epidural infusion. Effective analgesia, sensory level, motor block, patient satisfaction were measured. The statistical analysis was done using ANOVA, student ‘t’ test, Mann-whitney test and chi square test. P value < 0.05 was taken as statistically significant.

Group Bupivacaine with dexmedetomidine had a very high patient satisfaction and analgesia when compared to the other groups.

Addition of epidural Bupivacaine with dexmedetomidine as an adjuvant provides slightly better analgesia and patient satisfaction when compared to ropivacaine with dexmedetomidine or fentanyl in patients undergoing major lower limb orthopaedic surgeries.