EFFECT OF DEXMEDETOMIDINE AND FENTANYL AS ADJUVANT TO ROPIVACAINE IN POPLITEAL FOSSA NERVE BLOCK FOR POST OPERATIVE ANALGESIA IN FOOT AND ANKLE SURGERIES
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Keywords
Foot and ankle surgeries, Postoperative analgesia, Ultrasonography, peripheral nerve block, ropivacaine
Abstract
Background: Inadequately controlled pain negatively affects quality of life, function and functional recovery. It also increases the risk of post-surgical complications and persistent postsurgical pain. Aim: To observe the effect of Dexmedetomidine and Fentanyl as adjuvants to USG guided Popliteal nerve block with 0.2% Ropivacaine for post-operative analgesia in Foot and ankle surgeries. Methods: This prospective observational study was conducted at Bone and Joint Hospital which is one of the associated hospitals of Government Medical College, Srinagar over a period of 18 months, after obtaining approval from Institutional Ethical Committee and informed consent of the patients scheduled to undergo foot and ankle surgeries. A total sample size of 77 patients was available for the study, with 27 patients receiving Popliteal fossa nerve block (PFNB) with Inj.Ropivacaine 0.2% (24ml)+Normal saline (1 ml) designated as GROUP SR, 24 patients receiving Popliteal fossa nerve block (PFNB) with Inj. Ropivacaine 0.2% (24 ml)+ Inj. Dexmedetomidine (1ml-100μg) designated as GROUP DR and 26 patients receiving Popliteal fossa nerve block (PFNB) with Inj. Ropivacaine 0.2% (24ml) + Inj. Fentanyl (1ml-50μ) designated as GROUP FR. After receiving USG guided PFNB, the patients were observed for duration of analgesia, quality of analgesia, total dose of rescue analgesia consumed in 24 hours postoperatively and side effects of drugs. Pain was assessed using Visual Analogue Scale (VAS) of 0 to 10 with (0= no pain) and (10= worst imaginable pain). Results: Duration of analgesia was statistically significant among the three groups with longest duration in Group FR (7.8± 1.18 hours) followed by Group DR (5.6±1.67 hours) and was least in Group SR (4.1± 1.66 hours) (p value< 0.05).Postoperative pain scores were found to be lowest in group FR, as compared to those in group DR and group SR, with the patients in group SR having the highest pain scores. Total quantity of rescue analgesia consumed within 24 hours postoperatively were maximum in group SR followed by group DR and was least in group FR (p value<0.005). There were no major side effects observed in patients among all three groups. 3.7% of patients in Group SR and 3.8% of patients in Group FR had nausea (single episode). 3.8% patients in Group FR had vomiting (single episode). Bradycardia (mild) was noted in 8.3% in Group DR. 4.2% patients had mild hypotension in Group DR while as 3.8% patients had mild hypotension in Group FR. The side effects were mild in all three groups and were statistically insignificant (p value >0.05). Conclusion: We concluded that the addition of fentanyl and dexmedetomidine to ropivacaine for Popliteal fossa nerve block in foot and ankle surgeries prolongs duration of block, increases postoperative analgesia time and reduces total amount of rescue analgesic consumed postoperatively. Both the adjuvants were safe to use.
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Dr Fauzia Shifaat
Associate Professor, Department of Anesthesiology and Critical Care, GMC Srinagar, India.
Dr Manpreet
Senior Resident, AIIMS Jammu, India.
Dr Nidhi Breya
Postgraduate Scholar, Department of Anesthesiology and Critical Care, GMC Srinagar.
Prof. (Dr) Hina Bashir
Professor& HOD, Department of Anesthesiology and Critical Care, GMC Srinagar, India.