COMPARATIVE STUDY OF IV DEXMEDETOMIDINE AND FENTANYL ON HEMODYNAMIC RESPONSE, SEDATION, ANALGESIA AND ANXIOLYSIS IN SURGERIES REQUIRING LOCAL ANAESTHESIA WITH INTRAVENOUS SEDATION

BACKGROUND LA with IV sedation is referred to as twilight anaesthesia. The choice and route of anaesthesia administration is paramount to the patient's overall surgical experience. The qualities of a good sedative or anaesthetic agent include sedation, anxiolysis, analgesia and amnesia. This study was planned to compare effects of IV Dexmedetomidine and IV Fentanyl that lead to changes in hemodynamic response. Aims and Objectives 1. To compare Dexmedetomidine and Fentanyl in surgery requiring Local Anaesthetic with respect to IV sedation, analgesia, anxiolysis and hemodynamic changes. 2. To compare post-operative recovery time. 3. To compare side effects of the drugs. 4. To compare patient satisfaction. MATERIALS AND METHODS A total of 60 patients in the age group of 18-60 yrs. of either sex undergoing elective surgery requiring local anaesthetic agent with IV sedation, categorized under ASA 1, 2 were included. These patients were divided into 2 groups of 30 patients each. Sample size was taken for convenience. Group A patients received Dexmedetomidine 1 mcg/kg IV loading dose over 10 mins followed by 0.2 mcg/Kg/hr IV infusion. Group B patients received fentanyl 1 mcg/Kg IV over 10 mins followed by 0.5 mcg/Kg/hr IV infusion. Heart rate mean arterial blood pressure, respiratory rate, SpO(2) were recorded every 10 mins. Tramadol 2 mg/Kg slow IV was given as rescue analgesic and the surgeon used an additional dose of local anaesthetic. Ramsay sedation score was assessed. Visual Analogue Scale of more than 3, analgesia was provided with 75 mg slow IV diclofenac. Aldrete score was assessed in recovery room. RESULTS From statistical data derived, it was observed that dexmedetomidine provided more sedation (RSS: 2+0.6 with fentanyl, RSS: 3 +/- 1.3 with dexmed), anxiolysis and hemodynamic stability as compared to fentanyl. For analgesia, results were comparable for both groups (5.9-6.9 with dexmed, 7.4-8.3 with fentanyl). Bradycardia (13.3% in dexmed and 3.3% in fentanyl) and hypotension (6.6% in dexmed and 3.3 % in fentanyl) were more common with dexmedetomidine than with fentanyl. Itching was 30 % more common with fentanyl while only 3.3% in dexmed. CONCLUSION Dexmedetomidine provides better sedation and anxiolysis by decreased heart rate, systolic BP, diastolic BP, mean BP. Analgesic effect is comparable in both groups. Dexmedetomidine causes less nausea and vomiting, shorter recovery period and a higher level of patient and surgeon's satisfaction than fentanyl.