To determine the effect of Epidural ropivacaine vs fentanyl on Intravenous fluid requirement in patients undergoing renal transplant surgery. A randomized controlled study.

Epidural anesthesia is commonly given during renal transplant surgeries and is proven to be safe and effective in mitigating perioperative pain of the patient. Most commonly used drug for the same is local anesthetics like Bupivacaine and Ropivacaine. But many studies have shown lower thoracic epidurals that are normally placed for abdominal surgeries will cause hypotension when local anesthetic drug is given due to its effect on sympathetic blockade resulting in vasodilation, pooling of blood and drop in blood pressure. This mechanism of action is specific to local anesthetic drugs. However, this can be easily treated by giving bolus of Intravenous crystalloids. This study focuses on comparing this fluid requirement seen in Ropivacaine (less cardiotoxic) as compared to Fentanyl which is an opioid that acts via blocking u receptors (not causing vasodilation). As renal transplant recipients have a narrow margin for euvolemic status, studies that further optimise fluid management strategies will benefit the patients directly and indirectly by contributing to the literature. As there is a gap in literature for whether this fluid requirement is significant in the two drugs, we propose studying this in a controlled environment to evaluate the same. The study participants will be recruited after ethics committee approval and clinical trial registration and blinded and randomized into one of the two groups. Intraoperative IV fluids will be given based on dynamic targets like pulse pressure variation and systolic pressure variation and also central venous pressure, heart rate and mean arterial pressure. Any need for vasopressor requirement will be noted and the total Intravenous fluids given to the patient at end of surgery will be noted. The results from two groups will be statistically analysed to determine if the effect of drug is significantly more.