To study the effects of dexmedetomidine in two different doses as an adjunct to Ropivacaine in epidural for hip surgeries: A randomized controlled study

Post oprative pain management is of growing concern in current practice of anesthesia as inadequately controlled postoperative paincan  led  to  higher incidence of chronic post surgical pain, increased stress response, decreased ambulation and increased incidnces of thrombo embolism,  postoperative morbidities and worsened patient releted outcomes such as increased hospital stay, poor quality of life.

Among the commonly used postop-analgesia methods, patient controlled analgesia (PCA) with opioids, non-steroidal anti-inflammatory drugs (NSAIDS) and epidural LA, epidural LA with adjuncts are the most effective as they provide  dynamic pain relief after hip surgeries. Intrathecal and epidural route of administration has an advantage that an analgesic can be administered at the time of giving block with a single injection, which is being utilised for providing anaesthesia for surgery as well as for postoperative pain relief, thereby serving a dual purpose of anaesthesia and postoperative analgesia.

Many adjuncts to local anaesthetics have been Used to  supplement epidural local anaesthetics for improving and enhancing the quality and duration of anaesthesia, reducing the  total dose of local anaesthetics and their side effects, increasing the duration of postoperative analgesia and reduced postoperative analgesic requirements.  Adjunct used  commonly in central neuraxial blocks are opioids which offer the above mentioned   advantagesbut with side effects like delayed respiratory depression, nausea, vomiting, pruritus, constipation & urinary retention

Torben et al examined the dose-response relationship of epidural clonidine at small doses (75 mcg) with respect to prolonging bupivacaine epidural anaesthesia and pain relief. They concluded that small doses of epidural clonidine (75 mcg followed by 18.75 mcg/hr infusion) significantly prolong the anaesthetic and analgesic effects of bupivacaine in a dose-dependent manner without unwarranted side effects like excessive sedation, hypotension and bradycardia

Antônio et al concluded that 150 mcg clonidine and 2 mcg/kg dexmedetomidine when added to 0.75%ropivacaine epidurally in cholecystectomy procedures hastened the onset of sensory and motor block and prolonged the duration of the block produced in comparison to the use of ropivacaine alone.

Bajwa SS et alfound that 1.5 mcg/kg dexmedetomidine and 2 mcg /kg clonidine  epidurally when added to 0.75% ropivacaine in patients undergoing vaginal hysterectomies, dexmedetomidine produced significant short onset of sensory and motor block as well as significantly longer duration of sensory and motor block than ropivacaine with clonidine without serious side effects.

In another study Bajwa SS et al added 1 mcg/kg dexmedetomidine to 0.75% ropivacaine epidurally which produced prolonged motor and sensory block as compared with addition of 1 mcg/kg fentanyl with ropivacaine in lower limb orthopaedic surgeries.

These reviews, aim to give background information to explore the properties and applications of the alpha2-adrenoceptor agonist, and optimal dose of dexmedetomidine epidurally with less worrysome side effects in patients of hip surgeries