COMPARISON BETWEEN INTRATHECAL FENTANYL AND DEXMEDETOMIDINE AS AN ADJUVANT TO HYPERBARIC 0.5% LEVOBUPIVACAINE IN SUBARACHNOID BLOCK FOR CEASAREAN SECTION: A PROSPECTIVE STUDY

PROPOSEDTOPIC OF RESEARCH:Comparison between intrathecal fentanyl and dexmedetomidine as an adjuvant tohyperbaric 0.5% levobupivacaine in subarachnoid block for caesarean section: Aprospective study.

OBJECTIVEOF PROPOSED RESEARCH:To compare the duration of sensory and motor block between fentanyl anddexmedetomidine when administered intrathecally as adjuvant to 0.5% hyperbaric levobupivacainein spinal anaesthesia for elective lower segment caesarean section.

Background of present study: In recent years levobupivacaine, the pure S(−)-enantiomer of bupivacaine, emerged as a safer alternative for regionalanesthesia than its racemic parent. Recently 0.5% hyperbaric levobupivacaine hasbeen introduced in clinical practice and widely used as a substitution of 0.5%hyperbaric bupivacaine in spinal anaesthesia.

Toprolong the duration of sensory and motor block many adjuvants have beenpreviously added to 0.5% hyperbaric bupivacaine in spinal anaesthesia. Fentanyland dexmedetomidine both have been profoundly used as adjuvant with 0.5%hyperbaric bupivacaine in cesarean section. As there is no published data onthe effect of adjuvants with hyperbaric levobupivacaine we propose to comparethe effects of fentanyl and dexmedetomidine with 0.5% hyperbariclevobupivacaine in caesarean section.

Methodology: After ethicalclearance and written informed consent, 105 mothers undergoing electivecaesarean section will be randomly allocated into three groups. Group F will receivedintrathecal fentanyl 25 mcg (0.5 ml) along with 1.8 ml of 0.5% hyperbaric levobupivacaine,group D will received intrathecal dexmedetomidine 5 mcg (prepared in 0.5 ml ofnormal saline) along with 1.8 ml of 0.5% levobupivacaine and group C will begiven 0.5 ml of normal saline along with same dose of 0.5% of hyperbaric levobupivacaine.Maximum level of sensory block, time for two segment regression of sensoryblock and duration of motor block will be recorded. Post operative analgesiawill be assessed by using visual analogue score (VAS) and patients complainingof VAS>4 will be given rescue analgesia. Time of first dose ofpost-spinal rescue analgesic will be noted.

 Expected outcome: As there is no previous published data comparing fentanyl anddexmedetomidine as adjuvant with 0.5% hyperbaric levobupivacaine, we acceptthat there will be no difference regarding the duration of sensory and motorblock in these two groups.