Key result
Dexmedetomidine as an adjuvant to ropivacaine significantly prolonged the duration of analgesia compared to nalbuphine (353.86 vs 295.28 min; P<0.001).
Why the study?
Epidural anaesthesia with or without adjuvants provides effective anaesthesia and postoperative analgesia, but the comparative clinical efficacy of dexmedetomidine versus nalbuphine as an adjuvant to ropivacaine was unestablished.
Does dexmedetomidine compared to nalbuphine as an adjuvant to ropivacaine improve the duration of analgesia in patients undergoing infraumbilical surgeries under epidural anaesthesia?
RCT (n=100)
Double-blind
randomized
Does dexmedetomidine compared to nalbuphine as an adjuvant to ropivacaine improve the duration of analgesia in patients undergoing infraumbilical surgeries under epidural anaesthesia?
Absolute Event Rate: 353.86% vs 295.28%
p-value: p=< 0.001
Dexmedetomidine is a superior adjuvant to ropivacaine compared to nalbuphine for epidural anaesthesia, providing faster onset and prolonged duration of postoperative analgesia.
Dexmedetomidine may be preferred over nalbuphine as ropivacaine adjuvant for infraumbilical procedures; extends comparative RCT data on epidural adjuvants.
Background and Aims: Epidural anaesthesia using local anaesthetic agent with or without adjuvant is an effective technique for providing both anaesthesia and postoperative analgesia. This study aimed to compare the clinical efficacy of dexmedetomidine and nalbuphine as an adjuvant with 0.5% ropivacaine under epidural anaesthesia in terms of duration of analgesia as a primary objective and onset and duration of sensory and motor blockade, VAS score, sedation score, haemodynamic changes and adverse effects as secondary objectives. Methods: This prospective, randomized, double blind study conducted on total of 100 patients belonging to ASA physical status I and II undergoing infraumbilical surgeries was randomly allocated into 2 groups—Group D ( n = 50) received ropivacaine 0.5%, 18 ml and 0.75 μg/kg dexmedetomidine and Group N ( n = 50) received ropivacaine 0.5%, 18 ml and 200 μg/kg nalbuphine in epidural anaesthesia. Results: The mean time for onset of sensory block was statistically faster in Group D (11.94 ± 1.66 min.) as compared to Group N (14.24 ± 2.14 min) ( P < 0.0001). The duration of analgesia was statistically longer in Group D (353.86 ± 28.36 min.) as compared to Group N (295.28 ± 22.43 min) ( P < 0.001). The mean time to achieve maximum level, two-segment regression of sensory block, onset of motor block and time to achieve maximum bromage score were comparable in both groups. Complete reversal of sensory and motor blockade was faster in Group N as compared to Group D. Hemodynamic parameters, VAS score and ramsay sedation score were comparable in both groups. Conclusion: Dexmedetomidine is a better adjuvant to ropivacaine for epidural anaesthesia when compared with nalbuphine as it provides earlier onset and prolonged duration of sensory block and postoperative analgesia with stable vitals and minimal side effects.
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Khare et al. (2023) conducted an RCT in Infraumbilical surgeries (n=100). Dexmedetomidine vs. Nalbuphine (200 μg/kg with 18 ml of 0.5% ropivacaine) was evaluated on Duration of analgesia (p=< 0.001). Dexmedetomidine as an adjuvant to ropivacaine significantly prolonged the duration of analgesia compared to nalbuphine (353.86 vs 295.28 min; P<0.001).
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