INTRANASAL DEXMEDETOMIDINE FOR POSTOPERATIVE ANALGESIA IN GERIATRIC PATIENTS UNDER GOING LOWER LIMB ORTHOPEDIC SURGERIES

All patients will undergo a pre anaesthetic evaluation to ensure safe anaesthetic planning and perioperative care. This will include a detailed history of chronic illnesses such as hypertension, diabetes, asthma, and cardiac conditions, along with prior surgeries, previous anaesthetic exposure, hospital admissions, and any known drug allergies. A complete physical examination will be conducted to assess the patient’s general condition. Baseline vital parameters including heart rate, blood pressure, respiratory rate, mean arterial pressure, and body mass index will be recorded. Systemic examinations of the respiratory, cardiovascular, central nervous, and vertebral systems will be performed. Airway assessment will include Mallampati grading, mouth opening, neck mobility, dentition, and thyromental distance.

Subarachnoid block will be administered using three millilitres of zero point five percent hyperbaric bupivacaine under strict aseptic precautions. Intraoperatively, heart rate, non invasive blood pressure, mean arterial pressure, oxygen saturation, and respiratory rate will be continuously monitored. Postoperatively, patients will be observed in the post anaesthesia care unit until recovery, and vitals will be recorded. Pain will be assessed using the Visual Analogue Scale ranging from zero to ten. If the Visual Analogue Scale score exceeds four, intravenous paracetamol fifteen milligrams per kilogram will be administered. Patients will be randomized into two groups, D and C. Both groups will receive intranasal medication using a mucosal atomizer. The D group will receive dexmedetomidine zero point six micrograms per kilogram which is one millilitre, while the C group will receive one millilitre of normal saline. The study will be conducted in a double blinded manner. Parameters such as heart rate, respiratory rate, non invasive blood pressure, mean arterial pressure, oxygen saturation, and Visual Analogue Scale will be recorded at baseline, fifteen minutes, thirty minutes, forty five minutes, one hour, two hours, four hours, six hours, twelve hours, and twenty four hours. Sedation will be assessed every two hours using the modified Richmond Agitation Sedation Scale which ranges from plus four, which is combative, to minus five, which is unarousable, with zero indicating alert and calm. This study design allows a safe evaluation of intranasal dexmedetomidine for postoperative sedation and analgesia.