Comparative Study of Intrathecal 0.5% Hyperbaric Bupivacaine with Dexmedetomidine and Fentanyl for Lower Abdominal Surgeries: A Randomized Double-blind Clinical Trial

  • Pandellapalli Vasudeva Sreekanth Viswabharathi Medical College and Hospital, Kurnool, Andhra Pradesh, India
  • Diapule Sandeep Kumar Viswabharathi Medical College and Hospital, Kurnool, Andhra Pradesh, India
  • S V Lakshmi Kumar Viswabharathi Medical College and Hospital, Kurnool, Andhra Pradesh, India
Keywords: Dexmedetomidine, Fentanyl, Intrathecal, Pain management, Post-operative analgesia, Spinal anesthesia, Spinal block


Background: In this modern year, the intrathecal adjuvants use has gained good acceptance in the field of anesthesiology. The
spinal anesthesia quality is very much improved with addition of opioids and other drugs and as we know, no drug is without
side effects. Spinal block has rapid onset, lower risk of infection rate and is very cost effective. However, post-operative pain
is a very significant problem as the drugs used have limited duration of action. Hence, the administration of analgesics plays
a key role postoperatively. To increase the duration and to reduce side effects, various local anesthetics and analgesics are
used in combination. Some of the drugs have been used as adjuvants in spinal anesthesia to prolong intra- and post-operative
analgesia which includes opioids, α2 agonists, vasoconstrictors, and other drugs.
Aim of the Study: The aim of the current study is to compare the efficacy of dexmedetomidine and fentanyl added to intrathecal
bupivacaine to evaluate the onset and duration of sensory and motor block, post-operative analgesia, hemodynamic effects,
and adverse effects of either drug in lower abdominal surgeries.
Materials and Methods: Sixty patients with the American Society of Anesthesiologists Grade I and II posted for lower abdominal
surgeries were allocated to two groups randomly (30 patients each): Group D received 2.5 ml 0.5% hyperbaric bupivacaine and
5 μg of dexmedetomidine intrathecally and Group F received 2.5 ml 0.5% hyperbaric bupivacaine and 25 μg of fentanyl intrathecally.
Results: Patients in Group F had faster onset of sensory block and motor block than Group D (P = 0.000). Patients in Group D
had significantly longer duration of motor and sensory blockade as compared to those in Group F (P = 0.000). Post-operative
analgesia was significantly longer in Group D than Group F (P = 0.000). Incidence of side effects among the two groups was
not statistically significant.
Conclusions: Fentanyl has its own benefits like faster onset compared with dexmedetomidine, but prolonged duration of motor
and sensory blockade with post-operative analgesia was seen with dexmedetomidine without significant side effects.

Author Biographies

Pandellapalli Vasudeva Sreekanth, Viswabharathi Medical College and Hospital, Kurnool, Andhra Pradesh, India

Assistant Professor, Department of Anaesthesiology

Diapule Sandeep Kumar, Viswabharathi Medical College and Hospital, Kurnool, Andhra Pradesh, India

Assistant Professor, Department of Anaesthesiology

S V Lakshmi Kumar, Viswabharathi Medical College and Hospital, Kurnool, Andhra Pradesh, India

Head of the Department, Department of Anaesthesiology


1. Elia N, Culebras X, Mazza C, Schiffer E, Tramèr MR. Clonidine as an
adjuvant to intrathecal local anesthetics for surgery: Systematic review of
randomized trials. Reg Anesth Pain Med 2008;33:159-67.
2. Boussofara M, Carlès M, Raucoules-Aimé M, Sellam MR, Horn JL. Effects
of intrathecal midazolam on postoperative analgesia when added to a
bupivacaine-clonidine mixture. Reg Anesth Pain Med 2006;31:501-5.
3. Faiz SH, Rahimzadeh P, Sakhaei M, Imani F, Derakhshan P. Anesthetic
effects of adding intrathecal neostigmine or magnesium sulphate to
bupivacaine in patients under lower extremities surgeries. J Res Med Sci
4. Shah A, Patel I, Gandhi R. Haemodynamic effects of intrathecal
dexmedetomidine added to ropivacaine intraoperatively and for
postoperative analgesia. Int J Basic Clin Pharmacol 2013;2:26-9.
5. Panzer O, Moitra V, Sladen RN. Pharmacology of sedative-analgesic
agents: Dexmedetomidine, remifentanil, ketamine, volatile anesthetics, and
the role of peripheral mu antagonists. Crit Care Clin 2009;25:451-69.
6. Bekker A, Sturaitis M, Bloom M, Moric M, Golfinos J, Parker E, et al.
The effect of dexmedetomidine on preoperative hemodynamics in patients
undergoing craniotomy. Anesth Analg 2008;107:1340-7.
7. Sudheesh K, Harsoor S. Dexmedetomidine in anaesthesia practice:
A wonder drug? Indian J Anaesth 2011;55:323-4.
8. Jain N, Mathur PR, Soni P, Patodi V, Sethi SK, Mathur V. A comparative
clinical study of intrathecal bupivacaine 2.5 mg with dexmedetomidine
5 μg versus intrathecal bupivacaine 2.5 mg with fentanyl 25 μg on the
duration of labor analgesia using combined spinal epidural technique.
J Obstet Anaesth Crit Care 2019;9:24-9.
9. Dahl JB, Jeppesen IS, Jorgensen H, Wetterslev J, Moiniche S. Intraoperative
and postoperative analgesic efficacy and adverse effects of intrathecal
opioids in patients undergoing cesarean section with spinal anesthesia:
A qualitative and quantitative systematic review of randomized controlled
trials. Anesthesiol J Am Soc Anesthesiol 1999;91:1919-27.
10. Biswas BN, Rudra A, Bose BK, Nath S, Chakrabarty S. Intrathecal
fentanyl with hyperbaric bupivacaine improves analgesia during caesarean
delivery and in early postoperative period. Indian J Anaesth 2002;46:
11. Bhure A, Jagtap N. A comparison of intrathecal dexmedetomidine and
fentanyl as an adjuvant to isobaric levobupivacaine for lower limb
orthopaedic surgery. Indian J Clin Anaesth 2019;6:89-96.
12. Nayagam HA, Singh NR, Singh HS. A prospective randomised double
blind study of intrathecal fentanyl and dexmedetomidine added to low dose
bupivacaine for spinal anesthesia for lower abdominal surgeries. Indian J
Anaesth 2014;58:430.
13. Kim JE, Kim NY, Lee HS, Kil HK. Effects of intrathecal dexmedetomidine
on low-dose bupivacaine spinal anaesthesia in elderly patients undergoing
transurethral prostatectomy. Biol Pharm Bull 2013;36:959-65.
14. Khosravi F, Sadeghi N, Jarineshin H. The effect of dexmedetomidine on
spinal anesthesia quality and hemodynamic changes in patients undergoing
inguinal hernia repair surgery: Intravenous versus intrathecal. Eur J Clin
Pharmacol 2020;76:923-8.
15. Gupta R, Bogra J, Verma R, Kohli M, Kushwaha JK, Kumar S.
Dexmedetomidine as an intrathecal adjuvant for postoperative analgesia.
Indian J Anaesth 2011;55:347.
16. Shahi V, Verma AK, Agarwal A, Singh CS. A comparative study of
magnesium sulfate vs dexmedetomidine as an adjunct to epidural
bupivacaine. J Anaesthesiol Clin Pharmacol 2014;30:538.
17. Jarineshin H, Baghaei AA, Fekrat F, Kargar A, Abdi N, Navabipour S,
et al. Comparison of two different doses of dexmedetomidine in attenuating
cardiovascular responses during laryngoscopy and endotracheal intubation:
A double blind, randomized, clinical trial study. J Med Life 2015;8:45-1.
18. Shukla D, Verma A, Agarwal A, Pandey HD, Tyagi C. Comparative study
of intrathecal dexmedetomidine with intrathecal magnesium sulfate used as
adjuvants to bupivacaine. J Anaesthesiol Clin Pharmacol 2011;27:495.
19. Contractor HU, Gajjar VA, Shah VA. Evaluating effect of intravenous
dexmedetomidine on hyperbaric bupivacaine spinal anesthesia. Anaesth
Pain Intensive Care 2016;20:398-403.
20. Arain SR, Ruehlow RM, Uhrich TD, Ebert TJ. The efficacy of
dexmedetomidine versus morphine for postoperative analgesia after majorinpatient surgery. Anesth Analg 2004;98:153-8.
21. Suthar O, Sethi P, Sharma UD. Comparison of dexmedetomidine and
clonidine as an adjuvant to intrathecal bupivacaine in lower limb surgery:
A randomised, double-blind, placebo controlled trial. Anaesth Pain
Intensive Care 2019;19:147-52.
22. Sun Y, Xu Y, Wang GN. Comparative evaluation of intrathecal bupivacaine
alone, bupivacaine-fentanyl, and bupivacaine-dexmedetomidine in
caesarean section. Drug Res 2015;65:468-72.
23. Mahendru V, Tewari A, Katyal S, Grewal A, Singh MR, Katyal R.
A comparison of intrathecal dexmedetomidine, clonidine, and fentanyl as
adjuvants to hyperbaric bupivacaine for lower limb surgery: A double blind
controlled study. J Anaesthesiol Clin Pharmacol 2013;29:496.
Original Articles