A Comparative Study of Dexmedetomidine-Fentanyl Versus Dexmedetomidine-Pentazocine for Monitored Anesthesia Care in Tympanoplasty

Background: Monitored anesthesia care (MAC) is increasingly being used in various surgical procedures due to its safety and effectiveness. Tympanoplasty, a common otological procedure, requires careful anesthesia management to provide adequate analgesia while maintaining stable hemodynamics. The combination of dexmedetomidine with either fentanyl or pentazocine has been explored in this context, but there is limited data directly comparing the efficacy of these combinations. This study aims to compare the effects of dexmedetomidine-fentanyl and dexmedetomidine-pentazocine for monitored anesthesia care during tympanoplasty surgery. Objectives: 1. To compare the efficacy of dexmedetomidine-fentanyl versus dexmedetomidine-pentazocine in providing adequate sedation and analgesia during tympanoplasty surgery. 2. To assess the hemodynamic stability, including blood pressure and heart rate, in both groups. 3. To evaluate the incidence of perioperative complications, including respiratory depression, nausea, and vomiting. 4. To compare the postoperative pain scores and the requirement for additional analgesics in the two groups. Methods: This randomized controlled trial was conducted at Department of Anesthesiology, Netaji Subhas Medical College, and Hospital, Bihta, Patna, Bihar, India, over a period of 18 months. A total of 100 patients undergoing tympanoplasty surgery were randomly assigned to two groups: the dexmedetomidine-fentanyl group (Group DF) and the dexmedetomidine-pentazocine group (Group DP). The primary outcome measures included sedation level, intraoperative analgesia, hemodynamic stability, and the incidence of complications. Secondary outcomes included postoperative pain scores, time to recovery, and patient satisfaction. Results: Group DF demonstrated significantly better sedation scores and more stable intraoperative hemodynamics compared to Group DP. The incidence of postoperative nausea and vomiting was lower in Group DF, while postoperative pain scores were significantly lower in Group DP, although both groups had comparable analgesic efficacy. Both groups had similar safety profiles, with no significant differences in respiratory depression or other complications. Conclusion: Both dexmedetomidine-fentanyl and dexmedetomidine-pentazocine are effective combinations for providing monitored anesthesia care during tympanoplasty. However, dexmedetomidine-fentanyl provides superior sedation and hemodynamic stability, making it a more preferable option for this procedure.